J. Exceptions for areas with
high occupancy rates may be considered in the following situations.
1. A Medicaid enrolled nursing facility which
maintains 98 percent average annual occupancy of its enrolled beds for the four
most recent quarters (as reported in the LTC-2) may apply for approval of
additional beds to be enrolled in the Medicaid Program.
a. In order for an application to be
considered, all approved beds in the facility must be enrolled in Title
XIX.
b. In order for a facility to
reapply for additional beds, all approved beds must be enrolled in Title XIX
for the four most recent quarters, as reported in the LTC-2.
c. The number of beds for which application
may be made shall not exceed 10 beds.
d. In determining occupancy rates for
purposes of this exception, only an adjustment of one additional day after the
date of death, for the removal of personal belongings, shall be allowed if used
for that purpose.
i. This adjustment shall
not be allowed if nursing services available or provided to another individual
are paid for through formal or informal agreement in the same bed for that time
period.
e. In
determining occupancy rates, more than one nursing facility bed enrolled in
Title XIX shall not be considered occupied by the same resident, regardless of
payment for nursing services available or provided.
f. For a Medicaid enrolled nursing facility
with high occupancy to apply for additional bed approval, documentation of
availability of health manpower for the proposed expansion shall be
required.
g. For a Medicaid
enrolled nursing facility with high occupancy to apply for additional bed
approval, for the most recent 36 months preceding the date of application,
compliance history and quality of care performance of the applicant facility
must be void of any of the following sanctions:
i. appointment of a temporary
manager;
ii. termination,
non-renewal or cancellation, or initiation of termination or non-renewal of
provider agreement; or
iii. license
revocation or non-renewal.
2. When average annual occupancy for the four
most recent quarters (as reported in the LTC-2) exceeds 95 percent in a parish,
the department will determine whether additional beds are needed, and if
indicated, may issue a Request for Proposals (RFP) to develop the needed beds.
a. Upon issuance of the utilization report,
the department will identify the parishes with average annual occupancy in
excess of 95 percent. The LTC-2 is issued by the department in the fourth month
following the end of each calendar quarter.
b. In order to determine if additional beds
are needed for each parish in which average annual occupancy is in excess of 95
percent, the department may review the census data, utilization trends, and
other factors such as:
i. special needs in an
area;
ii. information received from
other health care providers and other knowledgeable sources in the
area;
iii. waiting lists in
existing facilities;
iv. requests
from the community;
v. patient
origin studies;
vi. appropriateness
of placements in an area;
vii.
remoteness of an area;
viii.
occupancy rates in adjoining and/or adjacent parishes;
ix. availability of alternatives;
x. reasonableness of distance to
facilities;
xi. distribution of
beds within a service area or geographical area; and
xii. such other factors as the department may
deem relevant.
c. The
number of beds which can be added shall not exceed 15 percent of the existing
approved beds in the parish, or 120 beds, whichever is less. The department
will strive to assure that occupancy in existing facilities in the area will
not decline below 85 percent as a result of the additional beds;
3. If the department determines
that there is, in fact, a need for beds in a parish with average annual
occupancy in excess of 95 percent, a RFP will be issued. No applications will
be accepted under these provisions unless the department declares a need and
issues a RFP. Applications will be accepted for expansions of existing
facilities and/or for the development of new facilities.
a. The RFP will be issued through newspaper
publication, and will specify the dates during which the department will accept
applications. Also, nursing facilities in the service area and adjoining
parishes will be notified of the issuance of the RFP.
b. The RFP will indicate the parish and/or
area in need of beds, the number of beds needed, the date by which the beds are
needed to be available to the target population (enrolled in Medicaid), and the
factors which the department considers relevant in determining need for the
additional beds. The RFP will specify the LTC-2 on which the determination of
need is based.
c. Applications will
be accepted for a 30-day period, to be specified in the RFP. Once submitted, an
application cannot be changed and additional information will not be
accepted.
d. The department will
review the proposals and independently evaluate and assign points (out of a
possible 120) to the applications as follows:
i. 0-20 points: Availability of beds to the
Title XIX population.
NOTE: Work plan for Medicaid certification and
availability of site for the proposal.
ii. 0-20 points: Appropriateness of location,
or proposed location.
NOTE: Accessibility to target population, relationship
or cooperative agreements with other health care providers, and distance to
other health care providers.
iii. 0-20 points: Responsiveness to groups
with special needs (e.g. AIDS patients, ventilator assisted patients;
technology dependent patients);
iv.
0-20 points: Experience and availability of key personnel (e. g., director of
nursing, administrator, medical director);
v. 0-20 points: Distribution of
beds/facilities within the service area. Geographic distribution of existing
beds and population density will be taken into account.
e. A score of 0-20 will be given to the
applicant's response to each item using the following guideline:
i. 0=inadequate response;
ii. 5=marginal response;
iii. 10=satisfactory response;
iv. 15=above average response; and
v. 20=outstanding response.
f. If there is a tie for highest
score for a specific facility or beds, a comparative review of the top scoring
proposals will be conducted. In the case of a tie, the department will make a
decision to approve one of the top scoring applications based on comparative
review of the proposals.
g. If no
proposals are received which adequately respond to the need, the department may
opt not to approve an application.
h. At the end of the 60-day review period,
each applicant will be notified of the department's decision to approve or
disapprove the application. However, the department may extend the evaluation
period for up to 30 days. Applicants will be given 30 days from the date of
receipt of the department's notification by in which to file an
appeal.
i. The issuance of the
approval of the application with the highest number of points shall be
suspended during the 30-day period for filing appeals and during the pendency
of any administrative appeal. All administrative appeals shall be consolidated
for purposes of the hearing.
4. Proposals submitted under these provisions
are bound to the description in the application with regard to the type of beds
and/or services proposed as well as to the site/location as defined in the
request issued by the department.
a. Approval
for Medicaid certification shall be revoked if these aspects of the proposal
are altered.
