Louisiana Administrative Code

A. Any provider who fails to comply with any obligation this Chapter requires or engages in any conduct this Chapter prohibits is subject to one or more of the following sanctions: 1. require the provider receive prior authorization for any or all services provided under the Medi…

A. Exclusion precludes a person from providing any services paid through a publicly funded health program. This prohibition includes: 1. services provided directly to a Medicaid recipient; 2. any service for which the Medicaid program pays any part of the reimbursement; and 3. ad…

A. The imposition of non-mandatory sanction(s) shall be at the discretion of the PIU section chief with the concurrence of the BHSF director. The imposition of one sanction does not preclude the imposition of another sanction for the same or different violations. B. At the discre…

A. The BHSF director and the PIU section chief shall exclude any provider from the Medicaid program if the provider has: 1. been charged or convicted in court of a criminal offense related to the individual’s participation in any publicly funded healthcare program; 2. been exclud…

A. In addition to the authorities provided in this Chapter, the department may permissively exclude a provider for any reason listed in 42 U.S.C 1320a-7(b).

A. A provider who knowingly fails to comply with an information request from the department or any other health oversight agency shall be suspended from the program until the provider supplies the information requested.

A. Except as provided in this Section, all sanctions subject to an appeal are effective upon the mailing of the results of the informal hearing. 1. The timely filing of an administrative appeal does not suspend the imposition of a sanction(s). 2. A sanction becomes a final admini…

A. A provider’s remittance may be withheld or the department may instruct an MCO to withhold payments to a provider if: 1. an overpayment to the provider may have occurred; 2. the department has reason to believe an overpayment to the provider may occur; 3. a provider has failed …

A. Unless excluded or suspended, a provider may continue to provide and submit claims for services during a withholding period. B. Withheld amounts, bonds, or other security posted may be used to satisfy any monetary sanction imposed.

A. The BHSF director and PIU section chief shall suspend all Medicaid payments to a provider under investigation upon a determination there is a credible allegation of fraud. The department may waive the requirement to suspend payments if it determines there is good cause not to …

A. A provider who has received a notice of sanction may request an informal hearing. 1. The informal hearing is not intended to be a contradictory or adversarial hearing, and the rules of evidence do not apply. 2. The request for an informal hearing shall be submitted in writing …

A. The provider may seek an appeal from the imposition of any sanction. The appeal shall be filed with the DAL. For an appeal to be timely, it must be filed: 1. if an informal hearing was requested, 30 calendar days from the mailing of the results of the informal hearing, or 2. i…

A. The BHSF director and the PIU section chief may issue a notice of corrective action to a provider. This notice will outline specific issues that may constitute violations of law, regulations or sub-regulatory guidance. B. A corrective action plan must be in writing and contain…

A. At the department’s discretion, it may issue a warning or education notice to a provider whose conduct potentially violates any of the Medicaid program’s laws, rules, or sub-regulatory guidance. B. Education or warning notices are not sanctions and are not subject to an inform…

A. In any investigation or claims review, the department may issue an IFR to the provider. This report is intended to: 1. notify the provider of the department’s preliminary findings; and 2. provide an opportunity for the provider to address the findings prior to the issuance of …

A. The following actions are not sanctions nor subject to an informal hearing or appeal: 1. referral to a state, federal, or professional licensing authority; 2. referral to the MFCU or any other law enforcement or prosecutorial authority; 3. referral to governing boards, peer re…

A. Final overpayments and other monetary sanctions must be made within 60 calendar days of the date the sanction becomes final unless an extended payment term is agreed to. B. The PIU section chief may agree to a longer repayment term, not to exceed six months. C. The BHSF direct…

A. Any extended payment term allowed by LAC 50.I.4155.B and C of this Chapter shall be in writing and contain at the minimum: 1. the amount to be repaid; 2. the person(s) responsible for making the repayments; 3. a specific time table for making the repayment; and 4. if installme…

A. The secretary may approve a reward of up to $2,000 to a person who submits information to the secretary resulting in a recovery under this Chapter or the Medical Assistance Programs Integrity Law. B. Any award shall be granted from monies appropriated for this purpose from the…

A. No reward shall be made to any person if: 1. the information was previously known to the department or criminal investigators; 2. the person planned or participated in the action resulting in the investigation; 3. the person is, or was at the time of the tip, excluded from the…

A. Mailing refers to the sending of correspondence or other documents via any means. This includes but is not limited to “mailing” through: 1. the U.S. Post Office; 2. commercial carrier; 3. facsimile; 4. hand delivery; or 5. to the provider’s email address.

A. All contents of investigations and reviews conducted pursuant to this Chapter shall remain confidential until entry of the final sanction. The only persons that may review the contents of an investigatory file are: 1. the parties to a matter or their authorized agents and repr…

A. If any provision of this Chapter is declared invalid or unenforceable for any reason by any court of proper venue and jurisdiction, the provision shall not affect the validity of the entire regulation or other provisions thereof.

A. This Chapter, when promulgated, shall supersede all other departmental regulations which conflict with the provisions of this Chapter.

State—the state of Louisiana. State Agency—the state of Louisiana, Louisiana Department of Health, Office of Public Health, Center for Community and Preventive Health, Bureau of Nutrition Services. State Plan—a plan of program operation and administration that describes the manne…

Supplemental Foods—those foods containing nutrients determined by nutritional research to be lacking in the diets of pregnant, breastfeeding and postpartum women, infants, and children, and foods that promote the health of the population served by LA WIC as indicated by relevant …

Maximum Allowable Reimbursement Level (MARL)— the highest reimbursement amount for WIC approved food items for each peer group. Migrant Farmworker—an individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, a…

A. The purpose of LAC 48:V.Subpart 15 is to adopt applicable and corresponding state regulations enacted under the authority of the federal Secretary of Agriculture in order to implement the federal Special Supplemental Nutrition Program for Women, Infants and Children (WIC progr…

A. The Medicaid Program hereby adopts provisions to provide coverage under the Medicaid state plan for school-based behavioral health services rendered to children and youth with behavioral health disorders. These services shall be administered under the authority of the Departme…

A. As a result of the devastation caused by Hurricanes Katrina and Rita, many Louisiana health care providers have incurred costs in furnishing medical services and supplies to hurricane evacuees and other affected individuals who do not have health care coverage through insuranc…

A. Individuals at least 3 years of age and under the age of 21, who meet Medicaid eligibility and clinical criteria, shall qualify to receive behavioral health services in a setting determined by the IEP. B. Qualifying children and adolescents must have been determined eligible f…

A. The following words and terms are defined for the purposes of this Subpart and for all contracts, guidelines, instructions, forms and other documents related hereto. Abbreviated Administrative Review—a procedure by which a vendor may appeal specified adverse actions by LA WIC …

A. These rules are promulgated by the state librarian who serves as the assistant secretary of Culture, Recreation and Tourism, Office of the State Library, as authorized by R.S. 25:122(B) and as required by the Administrative Procedure Act (R.S. 49:953).

A. The Louisiana State Public Documents Depository Program is created as a unit of the state library under the direction of the state librarian.

A. The state librarian has the duty to establish a depository system to facilitate the preservation and accessibility of state documents for public use.

A. In pursuing the mission to provide citizens of the state access to state government publications, the recorder of documents will seek the advice of an advisory council. Members will be appointed by the state librarian, and will include representatives of state agencies, state …

A. Overview of Program Purpose 1. The Subsidized Guardianship Program enables the Department of Children and Family Services (DCFS) to make payments to certified relative and fictive kin caregivers as well as certified caregivers with a significant familial bond with the child on…

A. The Department of Children and Family Services (DCFS) sets forth criteria for reimbursement of nonrecurring expenses associated with establishing guardianship arrangements for children in foster care. 1. The amount of the payment made for nonrecurring expenses associated with …

A. The purpose of this Chapter is to establish procedures for prioritizing sites for funding from the Hazardous Waste Site Cleanup Fund.

A. This Chapter applies to hazardous and nonhazardous sites to be funded by the Hazardous Waste Site Cleanup Fund and will become effective on May 20, 2003.

A. Each site shall be prioritized by a numerical ranking system based on: 1. health risks; 2. groundwater and surface water contamination; 3. owner/operator recalcitrance or refusal to comply with department-required actions; 4. site owner/operator financial abilities; 5. eligibi…

A. Except as specified in Subsection B of this Section, live animals may not be allowed on the premises of food establishments or retail food stores/markets. B. Live animals may be allowed in the following situations if the contamination of food; clean equipment, utensils, and li…

A. Except as specified in Subsection B of this Section, live animals may not be allowed on the premises of food establishments or retail food stores/markets. B. Live animals may be allowed in the following situations if the contamination of food; clean equipment, utensils, and li…

A. Products that are held by the food establishment or retail food store/market for credit, redemption, or return to the distributor, such as damaged, spoiled, or recalled products, shall be segregated and held in designated areas that are separated from food, equipment, utensils…

A. Products that are held by the food establishment or retail food store/market for credit, redemption, or return to the distributor, such as damaged, spoiled, or recalled products, shall be segregated and held in designated areas that are separated from food, equipment, utensils…

A. Dressing rooms or dressing areas shall be designated if employees routinely change their clothes in the establishment. B. Lockers or other suitable facilities shall be provided and used for the orderly storage of employees' clothing and other possessions. C. Areas designated f…

A. Dressing rooms or dressing areas shall be designated if employees routinely change their clothes in the establishment. B. Lockers or other suitable facilities shall be provided and used for the orderly storage of employees' clothing and other possessions. C. Areas designated f…