Louisiana Administrative Code

A. Notification shall be given to the DPS, via electronic submittal, to the 24-hour Louisiana Emergency Hazardous Materials Hotline email address at emergency@la.gov within 12 hours of a mandatory evacuation order issued by the proper parish authorities. B. Definitions Hazardous …

A. The targeted population for ventilator care coordination shall consist of Medicaid beneficiaries, birth through age 25, who require the use of mechanical ventilation and are participants of the Children’s Choice Waiver (CC), New Opportunities Waiver (NOW), Residential Options …

A. Each Medicaid-enrolled provider must employ the following staff: 1. licensed registered nurse; and 2. registered respiratory therapist. B. The staff listed in Paragraphs A.1 and A.2 of this Section must possess at least two years of experience working with individuals who requ…

A. This Early and Periodic Screening, Diagnosis and Treatment (EPSDT) targeted population shall consist of recipients who are between the ages of 0 and 21 years old, on the Request for Services Registry, and meet the specified eligibility criteria. The point of entry for targeted…

A. In order to be eligible to receive case management services, the EPSDT recipient shall be between the age of 0 and 21 and meet one of the following criteria: 1. placement on the Request for Services Registry and determined to be eligible for OCDD services through the statement…

A. No certified copy of an original birth record that has been submitted for "registration" in the Vital Records Registry as defined in R.S 40:32 (1) shall be issued unless and until the said original birth record contains the information required by R.S. 40:34 A(1)(a) through (q…

A. The purpose of this regulation is: 1. to implement the statutory requirements in establishing pilot health insurance programs to increase access to affordable health insurance for small employers and for individuals pursuant to R.S. 22:244 et seq., of the Louisiana Revised Sta…

A. Except as otherwise specifically provided, the requirements of this regulation shall apply to health insurance issuers that choose to offer health insurance under the provisions of LaChoice as required pursuant to R.S. 22:244 et seq., of the Louisiana Revised Statutes of 1950.

A. In order to participate in LaChoice, employers must not have provided group health insurance coverage to their employees for at least six months from the date the last policy of insurance was terminated or nonrenewed. B. The commissioner of insurance shall have the authority v…

A. The health insurance issuer shall provide to the Department of Health and Hospitals through electronic means via a current ANSI X12N 834 transaction format pursuant to the HIPAA transactions and code sets requirements, an initial enrollment roster for each employer group listi…

A. Underwriting criteria shall comply with the provisions in Title 22 and shall be subject to actuarial review and approval by the Department of Insurance, pursuant to R.S. 22:246(6).

A. To be eligible for the LaChoice premium subsidy, an employee of a qualified employer that opts to provide LaChoice must make application and have household income levels at or below 200 percent of the federal poverty level as established by the Department of Health and Hospita…

A. The commissioner of insurance shall have the authority to disapprove a policy submitted pursuant to LaChoice in accordance with R.S. 22:621 that fails to comply with the provisions of any statute or regulation.

A. The following requirement is applicable only to health insurance issuers that offer LaChoice policies. Such health insurance issuers shall be required to report LaChoice business in a supplemental worksheet to the annual statement in a format to be provided by the Louisiana De…

A. When a health insurer issuer decides to discontinue offering policies pursuant to the LaChoice program, R.S. 22:250.7(C)(1)(a),(b),(c) and (d) shall be applicable in the discontinuation of such product.

A. If any Section or provision of this regulation or the application to any person or circumstance is held invalid, such invalidity or determination shall not affect other Sections or provisions or the application of this regulation to any persons or circumstances that can be giv…

A. Effective May 20, 2007, children’s choice services are capped at $17,000 per individual per plan of care year. B. Participants are eligible to receive all medically necessary Medicaid State Plan services, including early periodic screening, diagnosis, and treatment (EPSDT) ser…

A. The services in this §11303 are included in the service package for the Children’s Choice Waiver. All services must be included on the approved plan of care which prior authorizes all services. 1. Children’s choice services may be utilized to supplement EPSDT State Plan servic…

A. A policy is a guiding principle or course of action adopted and pur­sued by a society through its government as well as by various societal groups such as voluntary associations and professional organizations. Social policy, as a type of policy, addresses three areas which are…

A. Health planning should emerge from the analysis and interpretation of health policy if policy, as a guiding principle, is considered to be a standing plan. However, analysis and interpretation are dependent upon some conclusion as to how to conceptualize that policy. Therefore…

A. Louisiana has a large body of Law devoted to providing health care, promoting health within its general population, and protecting the health of its citizens. This phase of analysis has attempted only to determine the broad objectives of each health related statute or group of…

A. Introduction 1. All documents submitted to accomplish changes on a birth certificate as a result of acknowledgement of paternity of judgments of filiation shall be either the original or certified true copies of the original instruments bearing an official seal. All documents …

A. Except as herein provided in these rules and regulations, a legitimation of an illegitimate child pursuant to Article 198 of the Louisiana Civil Code may result in the sealing of the registrant's original certificate of birth and the issuance of a new certificate of birth in t…

A. The State Health Planning and Development Agency is required to develop standards, criteria, and plans against which proposed capital expenditures are to be reviewed. Goals are established for institutional health care resources requiring 1122 review and for other important ar…

A. In reviewing projects under Section 1122, DPPE shall use the following criteria: 1. the relationship of the proposal to the State Health Plan; 2. the relationship of the proposal to the long range development plan (if any) of the facility; 3. the need of the service area popul…

A. General Information, Criteria and Standards 1. Description a. General acute care hospital beds are those short-term acute care beds available for the overnight care of patients hospitalized for any of a variety of medical reasons. b. In Louisiana, general acute care hospital b…

A. Description 1. Psychiatric beds are located in general hospitals, psychiatric specialty hospitals, or other medical centers which are set up to provide inpatient medical care to persons with mental illness or disorders. 2. Chemical dependency services may be provided in psychi…

A. Description 1. Chemical dependency services are provided in general acute care hospitals, in psychiatric hospitals, or in licensed free-standing substance abuse facilities. The only free standing facilities subject to section 1122 review are those licensed as hospitals or for …

A. Definition/Description 1. Open heart surgery is the generic term for various surgical operations performed on the heart or major arteries of the heart. Open heart surgery procedures are defined as those which use a heart-lung bypass machine to perform the function of circulati…

A. Definition/Description of Service 1. Cardiac catheterization is a hospital-based diagnostic medical procedure, for examination of the heart and surrounding blood vessels. The "invasive" procedure involves the insertion of a catheter into the patient's arm or leg and into the c…

A. Definition/Description 1. Radiation therapy is a clinical medical specialty in which ionizing radiation is used to treat patients with cancer (and other tumors or neoplasms). The objective is to deliver a lethal dose of radiation to cancer cells, with minimal damage to surroun…

A. Description of Service 1. Computed tomography (CT) is a diagnostic service utilizing an X-Ray source, detector and computer to reconstruct from multiple projections a pictorial representation of the internal structure of an object. CT scanning is based upon the principle of co…

A. Definition 1. End Stage Renal Disease services are diagnostic, therapeutic, maintenance, and rehabilitative services required for the care of patients with End State Renal Disease. End Stage Renal Disease (ESRD) is defined as renal impairment which is permanent and irreversibl…

1. Title 40 of the Louisiana Revised Statutes established the Emergency Medical Services program within the Louisiana Department of Health & Human Resources. The department was granted the authority to adopt rules and regulations pertaining to Emergency medical Services in Louisi…

A. Skilled Nursing and Intermediate Care Facilities 1. Definition/Description a. In the broadest sense, long term care includes the complete spectrum of institutional and non-institutional services which provide health care to persons with chronic disease or disability requiring …

A. Description 1. Ambulatory surgery is elective minor surgery for pre-examined and diagnosed low-risk patients. Ambulatory surgery is limited to excisional, incisional, or repair procedures which require local, regional, or general anesthesia followed by at least an hour of prof…

A. Definition/Description 1. Traditional definitions of health prevention are divided into three levels of activity: those which prevent the occurrence of disease or illness, those which intervene after disease is detected but before it is symptomatic, and those which prevent the…

A. Definition. In general, rehabilitation is the process of restoring disabled persons to the fullest degree of physical, mental, social, vocational, and economic usefulness of which they are capable. Within this context, Comprehensive Physical Rehabilitation Facilities, (CPRF's)…

A. Definition/Description 1. Home health care is that component of comprehensive health care in which health services are provided to individuals and families in their places of residence for purpose of restoring health or maximizing the level of independence, while minimizing th…

A. Definition/Description 1. Magnetic resonance imaging (MRI), also referred to as Nuclear magnetic resonance, is a diagnostic technique that employs magnetic and radio frequency fields to image body tissue and monitor body chemistry noninvasively. The basic principle of this mod…

A. Health Care for Persons with Acquired Immunodeficiency Syndrome 1. It is recognized that certain factors may limit accessibility of health care facility beds to persons who have been diagnosed as having Acquired Immunodeficiency Syndrome (AIDS) or even persons who have tested …

A. Support Coordination Providers. Families of waiver participants shall choose one support coordination agency from those available in their region to provide developmental disabilities support coordination services. B. Service Providers. Agencies licensed to provide personal ca…

A. In order to participate in the Medicaid Program, a provider must meet all of the following requirements. 1. The provider must meet all the requirements for licensure as established by state laws and rules promulgated by the Department of Health (LDH) or have a current, valid l…

A. Both support coordination and direct services providers must comply with the requirements of this §11523 in order to participate as Children Choice providers. Agencies will not be added to the Freedom of Choice (FOC) list of available providers maintained by OCDD until they ha…

A. Case management providers must also comply with Paragraphs 1 and 2 of this Subsection A in order to participate as children choice providers. 1. Providers of case management services for the Children’s Choice program must have a contract with LDH to provide services to waiver …

A. Direct service providers, except those listed in §11529, must also comply with §11527 in order to participate as children’s choice providers. 1. The provider must be licensed by LDH as a home and community-based services provider and meet the module specific requirements for t…

A. Professional services are direct services to participants, based on need, that may be utilized to increase the participant’s independence, participation and productivity in the home and community. Service intensity, frequency and duration will be determined by individual need.…

A. Effective for dates of service on or after August 1, 2015, Children’s Choice Waiver providers shall use the electronic visit verification (EVV) system designated by the department for automated scheduling, time and attendance tracking, and billing for certain home and communit…

A. The purpose of Regulation 90 is to implement R.S. 22:1851-1862 relative to the making of the prompt and correct payment for prescription drugs, other products and supplies, and pharmacist services covered under insurance or other contracts that provide for pharmacy benefits, a…

A. Except as otherwise specifically provided, the requirements of Regulation 90 apply to all health insurance issuers including health maintenance organizations that offer coverage in their insurance contracts for pharmacy services in accordance with the statutory requirements Su…