Louisiana Administrative Code

A. The purpose of this regulation is: 1. to provide for the uniform and practicable administration of the form filing, review and approval requirements of the Louisiana Insurance Code; 2. to clarify the provisions of R.S. 22:861(B); 3. to protect the interests of insurance consum…

A. This regulation is adopted pursuant to R.S. 22:11.

A. This regulation applies to all insurers doing business in the state of Louisiana subject to the form filing, review and approval provisions of the Louisiana Insurance Code.

A. Definitions. As used in this Section, the following terms shall have the meaning or definition as indicated herein. Affirmative Approval⎯department approval, as a result of the department taking action, following compliance review of a complete filing, or a filing pursuant to …

A. Definitions. As used in this Section, the following terms shall have the meaning or definition as indicated herein. Affirmative Approval⎯department approval, as a result of the department taking action, following compliance review of a complete filing, or a filing pursuant to …

A. Definitions. As used in this Section, the following terms shall have the meaning or definition as indicated herein. Affirmative Approval―department approval, as a result of the department taking action, following compliance review of a complete filing, or a filing pursuant to …

A. Pursuant to R.S. 22:44, "False or Fraudulent Material Information," in accordance with all provisions thereof, and specifically applicable to all documents required by this regulation. 1. It shall be unlawful for any person to intentionally and knowingly supply false or fraudu…

A. If any provision of this regulation, or its application to any person or circumstance, is held invalid, such determination shall not affect other provisions or applications of this regulation which can be given effect without the invalid provision or application, and to that e…

A. This regulation became effective January 1, 2003; however, the amendments to this regulation will become effective January 1, 2019.

A. This glossary contains a comprehensive list of abbreviations and definitions used in the requirements for payment for nursing facilities. Abuse—the infliction of physical or mental injury or causing deterioration to such an extent that the resident's health, moral, and/or emot…

A. Certification of title XVIII (Medicare)/ skilled nursing facilities (SNF). DHH shall obtain a certification notice from the Secretary of the Department of Health and Human Services (DHHS) that verifies a skilled nursing facility is qualified to participate in the Title XVIII P…

A. In order to participate as a provider of nursing services under Medicaid, a facility must meet certification requirements and enter into a provider agreement with the Department of Health and Hospitals. A provider agreement is the basis for payments by the Bureau of Health Ser…

A. Assignment of Agreement 1. As a temporary measure during a change of ownership, the Bureau of Health Services Financing-Health Standards Section shall automatically assign the provider agreement and certification to the new owner. The new owner shall comply with all participat…

A. A facility may involuntarily or voluntarily lose its participating status in the Medicaid Program. When a facility loses its participating status in the Medicaid Program, a minimum of ten percent of the final vendor payment to the facility is withheld pending the fulfillment o…

A. A facility shall be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. It shall be responsible for ensuring that all services pr…

A. The facility must establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment in which residents reside and to help prevent the development and transmission of disease and infection using Centers for Disease Control gui…

A. The facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel, and the public as set forth below. B. Favorable Environment for Residents. Resident living areas are designed and equipped for the comfort and privacy…

A. Facility Administrator. All facilities are required to have full-time administrators. "Full-time" administrators are persons who are licensed, currently registered and engaged in the day to day management of the facility. A full-time employee functioning in an administrative c…

A. Medical Director. The nursing facility shall have a written agreement with a physician who shall serve as the medical director on a full-time or part-time basis. Whether the physician is employed full-time or part-time shall be based on the residents' needs. 1. The medical dir…

A. The facility shall provide an organized nursing service with a sufficient number of licensed and unlicensed qualified nursing personnel to meet the total nursing needs of all residents in accordance with the resident care policies of the facility on a 24 hour basis. 1. The fac…

A. The facility must conduct initially and periodically a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity and needs, in relation to a number of specified areas. Comprehensive assessments must: 1. be based on a uniform data set…

A. Basis for the Comprehensive Care Plan. All services in a facility shall be provided in accordance with a physician's written order which shall be developed either before admission or before authorization for payment. The facility must develop a comprehensive care plan for each…

A. The facility must arrange for the provision of pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident. Prescription drugs not covered by Medicaid …

A. A designated full-time staff member suited by training and experience in food management and nutrition shall be responsible for supervision of dietary services. If the designated staff member is not a qualified dietitian, he/she shall serve as the dietary manager and shall fun…

A. A NF with more than 120 beds must employ a full-time qualified social service director with the following qualifications: 1. a bachelor's degree in social work or a bachelor's degree in a human services field including but not limited to sociology, special education, rehabilit…

A. The facility shall provide an ongoing activities program designed to stimulate and promote the physical, social, emotional, and intellectual well-being of each resident and encourage normal activity and return to self-care. B. Resident Activity Director. The facility's activit…

A. The facility shall maintain medical records which include clinical, medical, and psychosocial information on each resident. 1. These records must be: a. complete; b. accurately documented; c. readily accessible; and d. systematically organized. 2. Facilities shall have written…

A. Dental Services 1. The facility shall assist residents in obtaining routine and 24 hour emergency dental care to meet needs of each resident. 2. Routine dental services are defined as including dentures, relines and repairs to dentures, and some oral surgeries. Medicaid reside…

A. Effective July 1, 1993, a Louisiana nursing facility (NF) resident who is eligible for both Medicare and Medicaid can elect the Medicare hospice benefit if the nursing facility is being or will be reimbursed for the resident's care by Medicaid. B. Hospice care focuses on assur…

A. Mental health rehabilitation services are defined as medically necessary services which can reasonably be expected to reduce the resident's disability resulting from mental illness and to restore the individual to his/her best possible functional level in the community. The se…

A. Residents Receiving Care Under Title XIX (Medicaid) Only 1. The BHSF Medicaid Program shall determine the resident's applicable income (liability when computing facility vendor payments. Vendor payments are subject to the following conditions. a. Vendor payments shall begin wi…

A. Regulations pertaining to this subsection are incorporated under the state plan for the Medicaid program and included in the Medicaid Eligibility Manual (MEM). B. Services and Supplies Included. The nursing facility shall be responsible for providing the following services, su…

A. Initial Cost Report. The initial cost report submitted by all providers of Long Term Care services under the Medicaid Program shall be based on the most recent fiscal year end. 1. An exception to the initial cost report requirement may be recognized on an individual basis upon…

A. General. Facilities shall be subject to audits, inspections of the quality of care provided, and review of each applicant/recipient's need for SN-NRTP, SN-TDC, SN-ID, SN, IC I, or IC II services. B. Audits. All nursing facility providers participating in the Medicaid Program s…

A. The purpose of the level of care (LOC) determination is to assure that individuals meet the functional and medical necessity requirements for admission to and continued stay in a nursing facility. In addition, the LOC determination process assists persons with long-term or chr…

A. Classifications of care are established to ensure placement of residents in Long Term Care Facilities with available and appropriate resources to meet their social psychological, psychological, and biophysical needs. B. Classifications of care are established with consideratio…

A. Several potential avenues of functional and medical eligibility shall be investigated by OAAS. These avenues are called pathways. The pathways are utilized to ensure consistency, uniformity, and reliability in making nursing facility level of care determinations. In order to m…

m. Retaliation by Nursing Facility. Facilities are prohibited from taking retaliatory action against complainants. Persons aware of retaliatory action or threats in this regard should contact the Department of Health and Hospitals. n. Notification of the Complaint Procedure. The …

A. Health facilities must permit each resident to remain in the facility and not transfer or discharge the resident from the facility unless: 1. the transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; 2. the transf…

A. Under the provisions of Louisiana R.S. 40:2009.2 through 2009.20 and State Operations Manual as published by the Department of Health and Hospitals and Health Care Financing Administration, the following procedures are established for receiving, evaluating, investigating, and …

A. Authority and Scope. Any person or entity found to be in violation of any provision of R.S. 40:2009.1 through 40:2009.11 or any other state or federal statute, regulation, or any Department of Health and Hospitals' rule adopted pursuant to the Administrative Procedure Act gove…

A. All Medicaid-enrolled case management agencies are required to perform the following core elements of case management services. 1. Case Management Intake. The purpose of intake is to serve as an entry point for case management services and to gather baseline information to det…

A. For recipients in the Family Opportunity Act Medicaid Program, an income disregard of $85 will be applied to total gross (earned and unearned) family income and then half of the remaining income will be disregarded. B. During the eligibility determination process for home and …

A. MAGI-based 1. Income shall be calculated in accordance with 42 CFR §435.603 and

B. Financial eligibility for the MAGI groups shall be made using income received in the calendar month prior to the month of application or renewal as an indicator of anticipated income. The taxable gross income of each member of the MAGI household shall be used. Income eligibili…

A. Through contract between the Department of Public Safety and Corrections and the United States Department of Transportation, the state has agreed to adopt and assume responsibility for enforcing certain federal regulations as required by 49 CFR 350.207 and additional regulatio…

A. The following federal motor carrier safety regulations and hazardous materials regulations promulgated by the United States Department of Transportation, revised as of January 1, 2021, and contained in the following parts of 49 CFR as now in effect or as hereafter amended, are…

A. For the purpose of this Chapter, the federal regulations, as adopted or amended herein, shall govern all carriers, drivers, persons or vehicles: 1. to which the federal regulations apply; 2. engaged in the transportation of hazardous materials within this state; 3. designed or…

A. Any person who is determined by the Secretary of the Department of Public Safety and Corrections, after reasonable notice and opportunity for a fair and impartial hearing held in accordance with the Administrative Procedure Act, to have committed an act that is a violation of …

A. To enforce the collection of a civil penalty levied after due process upon a person determined by the secretary of the Department of Public Safety and Corrections to have committed an act that is a violation of R.S. 32:1501 et seq., or adopted or promulgated regulations as pro…