Louisiana Administrative Code

A. The MCO must have a system in place for members that includes a grievance process, an appeal process, and access to the state fair hearing process once the MCO’s appeal process has been exhausted. B. Filing Requirements 1. Authority to File. A member, or a representative of hi…

A. In handling grievances and appeals, the MCO must meet the following requirements: 1. give members any reasonable assistance in completing forms and taking other procedural steps. This includes, but is not limited to, providing interpreter services and toll-free telephone numbe…

A. Language and Format Requirements. The notice must be in writing and must meet the language and format requirements of federal regulations in order to ensure ease of understanding. Notices must also comply with the standards set by the department relative to language, content, …

A. The MCO must resolve each grievance and appeal, and provide notice as expeditiously as the member’s health condition requires, within the timeframes established in this Section. The MCO must provide written notice to all members who filed a grievance whether the grievance was …

A. The MCO must establish and maintain an expedited review process for appeals when the MCO determines (either from a member’s request or indication from the provider making the request on the member's behalf or in support of the member's request) that taking the time for a stand…

A. Timely Filing⎯filing on or before the later of the following: 1. within 10 calendar days of the MCO’s mailing of the notice of adverse benefit determination; or 2. the intended effective date of the MCO’s proposed adverse benefit determination. B. Continuation of Benefits. The…

A. Provision of Services during the Appeal Process 1. If the MCO or the state fair hearing entity reverses a decision to deny, limit, or delay services that were not furnished while the appeal was pending, the MCO must authorize or provide the disputed services promptly and as ex…

A. If the provider is filing a grievance or appeal on behalf of the member, the provider shall adhere to the provisions outlined in Subchapter A of this Chapter. B. The MCO must have a grievance and appeals process for claims, medical necessity, and contract disputes for provider…

A. Requests for home or vehicle modifications will most often originate from the claimant or a vocational rehabilitation consultant. B. A request for modification or repair of a dwelling must be substantiated by detailed estimates listing the following: 1. exact nature of work to…

A. The main objective of the carrier/self-insured employer is to maintain the claimant in a home environment, thus avoiding prolonged or repeated hospitalization. B. Written authorization detailing the approved modifications and their exact cost must be issued prior to the initia…

A. The carrier/self-insured employer will authorize modifications to vehicles only on the basis of medical necessity. Modifications will be limited to the following: 1. installation of hand controls; and 2. van modifications when transfers into and out of a sedan type vehicle are…

A. The reimbursement allowances for home and vehicle modifications are determined by obtaining bids for the specific modifications. Maximum allowable reimbursement schedules cannot be preset or predetermined. A minimum of three bids should be obtained by the carrier/self-insured …

A. All annual and sick leave certified by the employee's employing agency to be accrued in accordance with the leave accrual rates established by the Department of State Civil Service and for which payment cannot be made in accordance with law at the time of retirement shall be c…

A. An employee, in lieu of conversion of leave to retirement credit, may request in writing that he be paid the actuarial value of such leave, as determined by the retirement system's actuary, in a lump sum cash payment. The employee shall be paid the actuarial value of the conve…

A. The employee requesting the lump sum cash conversion of leave shall be solely responsible for any tax consequences of this decision, and the employee must acquire any tax advice from a private source (CPA or tax attorney) as LASERS shall not be responsible for any tax liabilit…

A. The purpose of this Chapter is to administer the Louisiana Community Economic Development Act as established by R.S. 33:130.751 et seq. and R.S. 47:6031. B. The purpose of this program is to provide for community development corporations and community development financial ins…

A. Terms not otherwise defined in this Chapter shall have the same meaning given to them in R.S. 33:130.751 et seq., unless the context clearly requires otherwise. B. In this Chapter, the following terms shall have the meanings provided herein, unless the context clearly indicate…

A. Community Development Corporation (CDC). An applicant must meet all of the following requirements: 1. is chartered pursuant to Chapter 2 of Title 12 of the Louisiana Revised Statues of 1950; 2. is tax exempt pursuant to Section 501(C)(3) of the Internal revenue Code of 1986, a…

A. An applicant for certification shall submit the following documents to the department: 1. complete, notarized certification application; 2. organizational management; a. certificate of incorporation; b. either 501(c)(3) tax exempt letter or CDFI fund certification letter; c. b…

A. The department shall review the application and supporting documentation, and if necessary conduct a site visit to determine qualification. B. The department shall issue the applicant a final written determination, indicating either approval or denial of certification.

A. If approved, certification shall be valid for two years from the date of certification. B. A certified CDC or CDFI shall submit to the Department, on or before the anniversary date of their certification; a notarized annual financial report complying with the requirements of R…

A. Certification may be renewed for subsequent two-year periods. B. Applicants must re-apply to the department, submit all required documentation and an application fee of $175. C. The department shall review the application, supporting documentation, and verify that all reportin…

A. The department shall serve notice of intent to deny certification or renewal of certification, or to revoke an existing certification. B. Such notice shall be a written determination by the department, including a brief statement of the reasons alleged for denial. C. Such noti…

A. Floors shall be constructed of smooth, durable, nonabsorbent and easily cleanable material. B. Closely woven and easily cleanable carpet may be used in certain areas of the food establishment or retail food store/market except where food is prepared and processed. C. Properly …

A. Floors shall be constructed of smooth, durable, nonabsorbent and easily cleanable material. B. Closely woven and easily cleanable carpet may be used in certain areas of the food establishment or retail food store/market except where food is prepared and processed. C. Properly …

A. Walls and ceilings in the food preparation areas and equipment-utensil washing areas shall be constructed of light colored, smooth, durable and easily cleanable materials. B. Utility service lines, pipes, exposed studs, joists, rafters and decorative items shall not be unneces…

A. Walls and ceilings in the food preparation areas and equipment-utensil washing areas shall be constructed of light colored, smooth, durable and easily cleanable materials. B. Utility service lines, pipes, exposed studs, joists, rafters and decorative items shall not be unneces…

A. The lighting intensity: 1. in walk-in refrigeration units and dry food storage areas, and in other areas or rooms during periods of cleaning, shall be at least 110 lux (10 foot-candles) at a distance of 30 inches (75 cm) above the floor; 2. in areas where there is consumer sel…

A. The lighting intensity: 1. in walk-in refrigeration units and dry food storage areas, and in other areas or rooms during periods of cleaning, shall be at least 110 lux (10 foot-candles) at a distance of 30 inches (75 cm) above the floor; 2. in areas where there is consumer sel…

A. Light bulbs shall be shielded, coated, or otherwise shatter-resistant in areas where there is exposed food, clean equipment, utensils and linens or unwrapped single-service and single-use articles. B. Infrared or other heat lamps shall be protected against breakage by a shield…

A. Light bulbs shall be shielded, coated, or otherwise shatter-resistant in areas where there is exposed food, clean equipment, utensils and linens or unwrapped single-service and single-use articles. B. Infrared or other heat lamps shall be protected against breakage by a shield…

A. If necessary to keep rooms free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke and fumes, mechanical ventilation of sufficient capacity shall be provided exhausting to the outside atmosphere.

A. If necessary to keep rooms free of excessive heat, steam, condensation, vapors, obnoxious odors, smoke and fumes, mechanical ventilation of sufficient capacity shall be provided exhausting to the outside atmosphere.

A. Ventilation hood systems and devices shall be sufficient in number and capacity to prevent grease or condensation from collecting on walls and ceilings and should be equipped with filters to prevent grease from escaping into the outside atmosphere.

A. Ventilation hood systems and devices shall be sufficient in number and capacity to prevent grease or condensation from collecting on walls and ceilings and should be equipped with filters to prevent grease from escaping into the outside atmosphere.

A. These systems shall be designed and installed so that make-up air intake and exhaust vents do not cause contamination of food, food preparation surfaces, equipment and utensils.

A. These systems shall be designed and installed so that make-up air intake and exhaust vents do not cause contamination of food, food preparation surfaces, equipment and utensils.

A. To be covered, a certification of terminal illness must be completed as set forth in §3703, the election of hospice care form must be completed in accordance with §3501, and a plan of care must be established in accordance with

A. The hospice must obtain written certification of terminal illness for each of the periods listed in §3501.C, even if a single election continues in effect for two, three, or more periods. 1. For the first 90-day period of hospice coverage, the hospice must obtain a verbal cert…

A. A written plan of care must be established and maintained for each individual admitted to a hospice program in accordance with the provisions set forth in the Licensing Standards for Hospices (LAC 48:I.Chapter 82), and the care provided to an individual must be consistent with…

A. The hospice must maintain and retain the business and professional records sufficient to document fully and accurately the nature, scope, and details of the health care provided. B. In accordance with the provisions set forth in the Licensing Standards for Hospices (LAC 48:I.C…

A. In accordance with the provisions set forth in the Licensing Standards for Hospices (LAC 48:I.Chapter 82) the hospice must conduct an ongoing, comprehensive, integrated, self-assessment of the quality and appropriateness of care provided, including inpatient care, home care an…

A. Whenever lands or other property are overflowed by the waters of the Mississippi River, or by the waters of any other river, lake, bayou, or backwater, the assessors within whose parishes such lands or other property may be situated, shall reassess such lands or property for t…

A. If lands or property, including buildings, structures, or personal property, are damaged or destroyed, non-operational, or uninhabitable due to an emergency declared by the governor or to a disaster or fire, the assessor or assessors within such parish shall assess such lands …

A. The Department of Insurance recognizes that insurers possessing a certificate of authority routinely enter into reinsurance agreements that yield legitimate relief to the ceding insurer from strain to surplus. B. However, it is improper for an insurer possessing a certificate …

A. This regulation shall apply to all domestic life and accident and health insurers and to all other life and accident and health insurers which possess a certificate of authority and which are not subject to a substantially similar regulation in their domiciliary state. This re…

A. No insurer subject to this regulation shall, for reinsurance ceded, reduce any liability or establish any asset in any financial statement filed with the department if, by the terms of the reinsurance agreement, in substance or effect, any of the following conditions exist: 1.…