Louisiana Administrative Code

A. The amount of the flexible family fund shall be $258 monthly to families of eligible children with severe disabilities to assist them in keeping their child at home; families may be asked to complete a survey periodically indicating how the flexible family funds are used to as…

A. Reasons for termination may include the following: 1. the responsible caregiver establishes residency or domicile outside Louisiana; 2. family requests termination of the flexible family fund stipend; 3. child is placed into a subsidized living setting or resides in a school a…

A. The responsible caregiver is responsible for maintaining contact with the LGE administering the flexible family fund at least every 90 days to verify that the child is in the home and the conditions of the individual agreement and flexible family fund are being met. B. Such qu…

A. All persons receiving an adverse eligibility determination shall have the right to request a fair hearing from the Division of Administrative Law. Upon being terminated from Flexible Family Fund, the family will receive written notification of closure. The closure letter will …

A. Effective for dates of service on or after January 20, 2013, providers of behavioral health services may qualify for supplemental payments for services rendered to Medicaid recipients. To qualify for the supplemental payment, the behavioral health provider must be: 1. licensed…

A. The Residential Options Waiver (ROW), a 1915(c) home and community-based services (HCBS) waiver, is designed to assist beneficiaries in leading healthy, independent and productive lives to the fullest extent possible and promote the full exercise of their rights as citizens of…

Advisory Board—the nine-member advisory board of the program. Birth Defect—an abnormality of structure, function or metabolism that develops during prenatal, perinatal or early postnatal life that is diagnosed before a child reaches 3 years of age. Case Finding—the process used t…

A. Spousal impoverishment provisions assure that the needs of an institutionalized individual’s legal spouse and/or dependents that reside in the community continue to be met. B. Spousal impoverishment resource provisions allow certain long term care applicants/recipients residin…

A. The Rural Health Clinic (RHC) Act of 1977 authorized the development of rural health clinics to encourage and stabilize the provision of outpatient primary care in rural areas through cost-based reimbursement. B. Rural health clinic regulations distinguish between two types of…

A. The supplemental payment shall be calculated in a manner that will bring payments for these services up to the community rate level. 1. For purposes of these provisions, the community rate shall be defined as the rates paid by commercial payers for the same service. B. The beh…

A. The department uses a statewide average, monthly private-pay nursing facility cost amount to calculate the periods of ineligibility for long-term care services when uncompensated transfers of assets occur. The average, monthly private-pay nursing facility cost amount shall be …

A. The ROW is designed to utilize the principles of self-determination and to supplement the family and/or community supports that are available to maintain the individual in the community and are designed to allow an individual experience that mirrors the experiences of individu…

A. ROW beneficiaries are expected to be integrated in and have full access to the greater community while receiving services, to the same extent as individuals without disabilities. Providers shall meet the requirements of the U.S. Department of Health and Human Services, Centers…

A. In order to qualify for Residential Options Waiver (ROW), individuals of all ages must meet all of the following criteria: 1. have an intellectual and/or developmental disability as specified in R.S. 28:451.2; 2. be determined eligible through the developmental disabilities en…

A. The Money Follows the Person (MFP) Rebalancing Demonstration is a federal demonstration grant awarded by the Centers for Medicare and Medicaid Services to the Department of Health. The MFP demonstration is a transition program that targets individuals using qualified instituti…

A. The intellectual/developmental disabilities request for services registry, hereafter referred to as “the registry,” shall be used to identify individuals with intellectual and/or developmental disabilities who are waiting for an OCDD waiver opportunity. Individuals who are fou…

A. Admission to the ROW shall be denied if one of the following criteria is met: 1. the individual does not meet the requirements for an ICF/IID level of care; 2. the individual does not meet developmental disability system eligibility; 3. the individual is incarcerated or under …

A. The purpose of this regulation is to identify and to incorporate by reference the current edition of handbooks, guidelines, forms, and instructions adopted by the National Association of Insurance Commissioners (NAIC) and referenced in the Louisiana Insurance Code. B. The foll…

A. Regulation 112 shall become effective upon final promulgation in the Louisiana Register.

A. If any Section or provision of Regulation 112 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 Regulation 112 to any persons or circumstances that can be given…

A. Assistive technology and specialized medical equipment and supplies (AT/SMES) service includes providing specialized devices, controls, or appliances which enable a beneficiary to increase his/her ability to perform activities of daily living, ensure safety, and/or to perceive…

A. Community living supports (CLS) are provided to a beneficiary in his/her own home and in the community to achieve and/or to maintain the outcomes of increased independence, productivity, and enhanced family functioning, to provide relief of the caregiver, and to provide for in…

A. The program will include the following. 1. Reporting sources required to report pursuant to the rule shall allow personnel from the department or its contractors to abstract information from the mother's and infant's files on their demographic characteristics, family history o…

A. The office shall determine the health care facilities and providers which shall be required to report all birth defects, the types of conditions or defects that shall be reported, the type of information that shall be contained in the confidential report and the method for mak…

A. Except as specifically authorized by this Chapter, information furnished to a LBDMN employee or to an authorized agent of the office that relates to cases or suspected cases of a birth defect is confidential and may be used only for the purposes outlined in this Chapter. B. In…

A. The LBDMN or other authorized persons may conduct investigations of cases or suspected cases in the LBDMN registry. B. Access to the central registry information is limited to LBDMN personnel. Other persons with a valid scientific research interest may be granted access to the…

A. The office shall monitor reporting sources for compliance with all sections of this statute.

A. The purpose of this regulation is: 1. To establish the procedure to register claims adjusters in the event of a catastrophe or an emergency pursuant to R.S. 22:1667 and 22:1678. 2. To set forth the time periods for expiration or extension of catastrophe or emergency adjuster r…

A. Regulation 113 shall apply to all adjusters employed or retained by an insurer and brought into the state for the purpose of investigating or making adjustment of losses resulting from a catastrophe or an emergency.

A. Regulation 113 is promulgated by the commissioner pursuant to the authority granted under the Louisiana Insurance Code, R.S. 22:11, 22:821, 22:1667, 22:1672 and 22:1678 and the Administrative Procedure Act, R.S. 49:950 et seq.

A. For the purposes of Regulation 113 the following terms are defined as follows: Adjuster—an individual who investigates or adjusts losses on behalf of an insurer as an independent contractor or as an employee of: a. an adjustment bureau; b. an association; c. a property and cas…

A. Insurers shall be authorized to utilize catastrophe adjusters in the event of emergencies declared by the governor of this state pursuant to R.S. 29:724 and for any other event which the commissioner has determined to have caused widespread property damage or loss. B. If not o…

A. No license shall be required for an individual who is employed or retained for a particular event by an insurer and brought into this state specifically for the purpose of investigating or making adjustments of losses resulting from a catastrophe or an emergency. B. Prior to u…

A. A catastrophe adjuster registration is effective upon submission provided fees are received within ten days. A registration shall be valid for a period not to exceed 180 days. B. The commissioner may extend the registration’s effective period for an additional ninety days upon…

A. The commissioner may, without notice and hearing, revoke the privileges of an individual registered as a catastrophe adjuster for the grounds specified in R.S. 22:1672. B. Any notice of revocation shall be sent to the employing or retaining insurer. The notice shall be sent to…

A. Regulation 113 shall become effective upon final publication in the Louisiana Register and shall apply to any act or practice committed on or after the effective date.

A. If any section or provision of Regulation 113 or the application to any individual or circumstance is held invalid, such invalidity or determination shall not affect other sections or provisions or the application of Regulation 113 to any individuals or circumstances that can …

A. Medicaid reimbursement is limited to medically necessary services that are covered by the Medicaid State Plan and would be covered if furnished by a physician. The following services shall be covered: 1. services furnished by a physician, within the scope of practice of his pr…

A. There shall be no limits placed on rural health clinic visits (encounters) payable by the Medicaid program for eligible beneficiaries.

A. The department shall provide coverage of medically necessary substance use screening and intervention services rendered to Medicaid-eligible pregnant women at the discretion of the medical professional providing care to the pregnant woman.

A. Screening services shall include the screening of pregnant women for: 1. alcohol use; 2. tobacco use; 3. drug use; and/or 4. domestic violence. B. Intervention services shall include a counseling session, which shall be a minimum of 15-30 minutes in duration, with a health car…

A. Reimbursement for substance use screening and intervention services provided to pregnant women shall be a flat fee based on the appropriate current procedural terminology (CPT) code.

A. In order to enroll and participate in the Medicaid Program, a RHC must submit a completed provider enrollment packet. B. The effective date of enrollment to participate in the Medicaid Program shall not be prior to the date of receipt of the completed enrollment packet.

A. Rural health clinics must comply with the applicable licensure, accreditation and program participation standards for all services rendered. If a RHC wishes to initiate participation, it shall be responsible for meeting all of the enrollment criteria of the program. The RHC pr…

A. Self-direction is a service delivery option which allows beneficiaries (or their authorized representative) to exercise employer authority in the delivery of their authorized self-directed services (community living supports). 1. Beneficiaries are informed of all available ser…

A. In order to participate in the Medicaid Program as a provider of services in the Residential Options Waiver, a provider must: 1. meet all of the requirements for licensure and the standards for participation in the Medicaid Program as a home and community-based services provid…

A. Legally responsible individuals may only be paid for services when the care is extraordinary in comparison to that of a beneficiary of the same age without a disability and the care is in the best interest of the beneficiary. B. In order to receive payment, relatives must meet…

A. Effective for dates of service on or after July 1, 2015, Residential Options 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. Regulation 115 implements the provisions of R.S. 22:533 which provides that the department may prescribe the specific record entries and documents to be kept by licensed title insurers and licensed title insurance producers and the retention period of said records. B. The purp…

A. Regulation 115 shall apply to all licensed title insurers and licensed title insurance producers in the State of Louisiana.