Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 5 - Health Planning
Chapter 111 - Area Level Planning
Section I-11105 - Ambulatory Care
Universal Citation: LA Admin Code I-11105
Current through Register Vol. 50, No. 9, September 20, 2024
A. New Orleans/Bayou-River Health System Area
1. The
New Orleans/Bayou-River area is predominantly urban, with a higher per capita
income, more physicians and more hospital beds than elsewhere in the state. Yet
the area has the highest mortality rate in the state. Mortality rates in the
area which have particular significance for ambulatory care planning are those
for heart disease, cancer and infants.
2. There is a shortage of primary care
physicians in some of the rural sections of the area and in the poverty pockets
of New Orleans. Dental services are also relatively inaccessible to some of the
poorer residents of New Orleans.
3.
Planning Objectives for Ambulatory Care in HSA I
a. ambulatory or mobile health care settings
which provide low cost screening diagnosis and treatment or referral should be
available and accessible to all residents of the area within 30 minutes travel
time. Programs directed especially toward screening for heart disease,
hypertension, cancer, tuberculosis, anemia, gonorrhea and syphilis are
needed.
b. Primary care physician
services should be available in Assumption Parish and in Northeastern St.
Tammany Parish, Dulac, Desire/ Florida (N.O.), Teche and Lafitte by
1985.
c. Low-cost pre-natal care
programs for the low-income population should be available within 30 minutes
travel time for all residents of the area, with appropriate referral services
for high risk patients.
d.
Ambulatory or mobile dental services which provide low-cost screening and
treatment should be available to all residents of the area within 30 minutes
travel time, but especially in the poverty areas of New Orleans.
e. By 1987, 30 percent of all surgical
procedures performed in the area should be performed on an ambulatory
basis.
f. By 1987, there should be
conformity to goals and standards established in the 1982-87 State Health Plan
for radiation therapy services.
g.
By 1987, there should be conformity to goals and standards established in the
1982-87 State Health Plan for computed tomography services.
h. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for end-stage
renal disease services.
i. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for ambulatory surgical services.
j. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for preventive
health services.
4.
Recommended Actions
a. Primary care
physicians, dentists and other ambulatory care providers should consider the
cost-effectiveness of mobile or "no-frills" type services which can be offered
at a lower consumer cost in underserved poverty areas.
b. The Medicaid Program should consider the
feasibility of instituting coverage of adult dental services beyond the current
denture program, with the possibility of implementing a "co-pay" coverage
whereby the recipient would bear 50 percent of the costs.
c. Medicare, Medicaid and major health
insurance companies should develop policies that promote the utilization of
ambulatory surgical services when medically appropriate, such as patient rebate
for same day discharge or cost incentives for hospitals for same day
discharge.
d. Assistance from L. S.
U. and Tulane Medical Schools and/or Louisiana State Board of Medical Examiners
in locating primary care physicians willing to establish practice in the
designated manpower shortage areas of the area.
B. Mid-Louisiana Health System Area
1. In Mid-Louisiana are several urban,
economically sound areas with adequate physicians and other ambulatory health
care. However, there is a significant number of rural sections in the area,
some of which are relatively isolated, with ambulatory health care inaccessible
to residents. Dental services are inaccessible to some of the poorer residents
of Baton Rouge.
2. Mortality rates
are high in Mid-Louisiana, as they are elsewhere in the state, but especially
so in the 15-24 year old age group. Suicides and accidents are a major reason
for the high mortality rate in this age group.
3. Planning Objectives for Ambulatory Care in
HSA II
a. Ambulatory or mobile health care
settings which provide low cost screening, diagnosis and treatment or referral
should be available and accessible to all residents of the area within 30
minutes travel time. Programs directed toward screening for heart disease,
hypertension, arteriosclerosis and cancer are especially needed.
b. Primary care physician services should be
available in Ascension, Cameron, East and West Feliciana, Evangeline,
Iberville, Jefferson Davis, Livingston, Pointe Coupee, St. Helena and West
Baton Rouge Parishes; also in St. Martin, Eden Park (Baton Rouge), Merryville
and North Lake Charles by 1985.
c.
Ambulatory or mobile dental services which provide low-cost screening and
treatment should be available to all residents of the area within 30 minutes
travel time, with emphasis on providing services to residents of the Eden Park
area in Baton Rouge.
d. A
comprehensive effort to screen and refer young people with symptoms of mental
health and/or chemical dependency problems should be initiated by ambulatory
health care providers.
e. By 1987,
30 percent of all surgical procedures performed in the area should be performed
on an ambulatory basis.
f. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for radiation therapy services.
g. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for computed
tomography services.
h. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for end stage renal disease services.
i. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for ambulatory
surgical services.
j. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for preventive health services.
4. Recommended Actions
a. Primary care physicians, dentists and
other ambulatory care providers should consider the cost-effectiveness of
mobile or "no-frills" type services which can be offered at a lower consumer
cost in underserved poverty areas.
b. The Medicaid Program should consider the
feasibility of instituting coverage of adult dental services beyond the current
denture program, with the possibility of implementing a "co-pay" coverage
whereby the recipient would bear 50 percent of the cost.
c. Primary care physicians and other
providers of ambulatory health care should devote attention to the screening
and referral of persons in the 15-24 age group who may have symptoms of mental
health and/ or chemical dependency problems.
d. Medicare, Medicaid and major health
insurance companies should develop policies that promote the utilization of
ambulatory surgical services when medically appropriate, such as patient rebate
for same day discharge or cost incentives for hospitals for same day
discharge.
e. Assistance from L. S.
U. and Tulane Medical Schools and/or Louisiana State Board of Medical Examiners
in locating primary care physicians willing to establish practice in the
designated manpower shortage areas of the area.
C. North Louisiana Health System Area
1. North Louisiana is a predominantly rural
area of the state, with a larger geographic area and a smaller population than
the other areas of the state. There is a higher level of poverty in the area,
especially concentrated in the Cenla and Northeast districts. This type of
setting portends a shortage of ambulatory care, accessible within 30 minutes
travel time, just as is found in the area. Creative planning and implementation
activities are needed to improve the accessibility and availability of
ambulatory care in the rural sections of North Louisiana.
2. There are designated primary care
physician shortages in Bienville, Bossier, Caldwell, Catahoula, DeSoto, Grant,
Jackson, Madison, Tensas, Vernon, Webster, West Carroll and Winn Parishes, and
in Zwolle, West Union and a poverty area of Shreveport. There is also a
designated shortage of primary care physicians for the state-operated hospital
in Ouachita Parish, E.A. Conway Memorial Hospital.
3. There are designated dental manpower
shortages in Bienville, Caldwell, Catahoula, Concordia, DeSoto, East and West
Carroll, Franklin, Grant, Jackson, Lincoln, Madison, Morehouse, Natchitoches,
Red River, Tensas, Union, and Vernon Parishes.
4. Despite the general lack of accessible
primary care, the mortality rate in North Louisiana is lower than in other
parts of the state except for motor vehicular accidents, cerebrovascular
disease and infant mortality, which are the highest in the state. The area also
has the highest rate of illegitimate births and the highest fertility rates for
females age 10-19, who are at high risk for complicated pregnancy and neonatal
illness.
5. The North Louisiana
area has a very high percentage of persons over the age of 65 years (11.8
percent), making ambulatory care for the chronic diseases of the aged
important, especially in light of the area's high utilization among the + 65
population of nursing home services.
6. Planning Objectives for Ambulatory Care in
HSA III
a. Ambulatory or mobile health care
settings which provide low cost screening, diagnosis and treatment or referral
should be available and accessible to all residents of the area within 30
minutes travel time. Programs directed toward screening for cerebrovascular and
heart disease and screening and treatment of chronic diseases of the aged (such
as diabetes, respiratory disease, vision problems and eye disease) are
especially needed.
b. Primary care
physician services should be available in designated shortage areas by 1987, if
not through permanent location, through mobile units or special placement of
interns and residents.
c.
Ambulatory or mobile dental services which provide low-cost screening and
treatment should be available to all residents of the area within 30 minutes
travel time, with emphasis on providing services to the residents of designated
dental manpower shortage areas.
d.
Increased visibility, availability and accessibility of health education and
family planning services directed toward low-income females in the 10-19 year
age group, especially in the Northeast district, should be implemented by
1985.
e. Low-cost pre-natal care
programs for the low-income population should be available within 30 minutes
travel time for all residents of the area, with appropriate referral services
for high risk patients.
f. By 1987,
30 percent of all surgical procedures performed in the area should be performed
on an ambulatory basis.
g. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for radiation therapy services.
h. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for computed
tomography services.
i. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for end-stage renal disease services.
j. By 1987, there should be conformity to
goals and standards established in the 1982-87 State Health Plan for ambulatory
surgical services.
k. By 1987,
there should be conformity to goals and standards established in the 1982-87
State Health Plan for preventive health services.
7. Recommended Actions
a. Primary care physicians, dentists and
other ambulatory care providers should consider the cost-effectiveness of
mobile or "no-frills" type services which can be offered at lower consumer
cost, especially in under-served, rural poverty areas.
b. The Medicaid Program should consider the
feasibility of instituting coverage of adult dental services beyond the current
denture program, with the possibility of implementing a "co-pay" coverage
whereby the recipient would bear 50 percent of the cost.
c. Rural hospitals with occupancy rates less
than 60 percent should research the feasibility of converting underutilized
capacity to outpatient clinics and obtaining the services at least on a
part-time basis of primary care physicians. Especially needed are prenatal
services and care for the chronic diseases of the aged directed toward
low-income groups.
d. The Office of
Health Services and Environmental Quality should implement more effective
outreach and delivery of family planning services in the North Louisiana area,
especially in the Northeast district among the 10-19 age group.
e. Medicare, Medicaid and major health
insurance companies should develop policies that promote the utilization of
ambulatory surgical services when medically appropriate, such as patient rebate
for same day discharge or cost incentives for hospitals for same day
discharge.
f. Assistance from L.
S.U. and Tulane Medical Schools and/or Louisiana State Board of Medical
Examiners in locating primary care physicians willing to establish practice in
the designated manpower shortage areas of the area.
AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R.S. 36:256(b).
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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