Current through Register Vol. 50, No. 12, December 20, 2024
A.
Except as otherwise provided in this Chapter, no nursing facility (NF) shall be
licensed and certified or enrolled to participate in the Title XIX program
unless the FNR program has granted an approval for an additional NF or
additional nursing beds to be licensed and enrolled in the Title XIX program.
NOTE: The statutory moratorium in
R.S.
40:2116.1(B), or any
successor statute, prohibits the department from issuing new FNR approvals for
NF or additional beds in NF until the statutory moratorium expires.
B. The geographic service area for
proposed or existing NF or beds is the parish in which the physical location is
located.
1. Exception. Any parish that has
any portion of the parish below Interstate 10, and that is intersected by the
Mississippi River, will be composed of two separate service areas as divided by
the Mississippi River.
C.
Nursing facility beds located in distinct parts of acute care general hospitals
shall be approved through FNR in order to be enrolled to participate in the
Medicaid program.
D. In reviewing
the need for beds, all proposed beds shall be considered available as of the
projected date of the project. The FNR program does not recognize the concept
of phasing-in beds, whereby an applicant provides two or more opening
dates.
E. For FNRs in which the bed
to population ratio is a factor, the bed inventory that will be used is that
which is current on the date that the complete application is received.
1. The bed to population ratio will be
recomputed during the review period when the report is incorrect due to an
error by the department.
F. For FNRs in which utilization is a factor,
the occupancy report that will be used is that which is current on the date
that the complete application is received.
1.
The occupancy rate will be recomputed during the review period when the report
is incorrect due to an error by the department.
G. The determination of occupancy rates of
nursing facilities or beds shall be as follows:
1. Beds for which occupancy shall be based
shall include NF beds that are enrolled in Title XIX.
2. Each licensed bed shall be considered as
available for utilization for purposes of calculating occupancy; and
3. A bed shall be considered in use,
regardless of physical occupancy, based on payment for nursing services
available or provided to any individual or payer through formal or informal
agreement.
H. The beds
and population of the geographic service area where the NF is located, or is
proposed to be located, will be considered in determining the need for the
facility or beds.
1. The beds that are
counted in determining need for nursing facilities, are beds that are approved,
licensed beds or are approved, unlicensed beds as of the due date for decision
on an application.
I.
Data sources to be used include information compiled by the FNR program and the
middle population projections recognized by the State Planning Office as
official projections. Population projections to be used are those for the year
that the beds are to be enrolled in the Medicaid program.
J. In order for additional beds or facilities
to be added in a service area, the bed-to-population ratio for NF beds shall
not exceed 65 Medicaid approved beds per 1,000 elderly population in a service
area, and the average annual occupancy for the four most recent quarters (as
reported in the LTC-2) shall exceed 95 percent in the service area.
K. Exceptions for areas with high occupancy
rates may be considered in the following situations.
1. A Medicaid enrolled NF that 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
shall be enrolled in Title XIX.
b.
In order for a facility to reapply for additional beds, all approved beds shall
be enrolled in Title XIX for the four most recent quarters, as reported in the
LTC-2.
c. The number of beds that
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 NF 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 NF 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 NF 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
shall 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) or Request for Applications
(RFA) 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 that 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 healthcare providers and other knowledgeable sources in the
area;
iii. waiting lists in
existing nursing 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 nursing facilities;
xi. distribution of beds within a geographic
service area; and
xii. such other
factors as the department may deem relevant.
c. The number of beds that 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 NF 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 or RFA will be issued.
No applications will be accepted under these provisions unless the department
declares a need and issues a RFP or RFA. Applications will be accepted for
expansions of existing facilities and/or for the development of new nursing
facilities.
a. The RFP will be issued and
will specify the dates that the department will accept applications. Also, NF
in the geographic service area and adjoining parishes will be notified of the
issuance of the RFP.
b. The RFP
will indicate the parish and/or geographic service area in need of beds, the
number of beds needed, the date that the beds are needed to be available to the
target population enrolled in Medicaid, and the factors that the department
considers relevant in determining need for the additional beds. The RFP will
specify the LTC-2 that 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 RFP or RFA shall specify the
following:
i. application submission
requirements;
ii. a due date for
applications;
iii. process of
review by the department of any applications timely received, including any
supplemental review process;
v. information
on appeals processes for applicants that are not granted FNR approval;
and
vi. other information or
requirements for the RFP or its process, as determined by the
department.
e. 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;
ii. 0-20
points: appropriateness of location or proposed location.
iii. 0-20 points: responsiveness to groups
with special needs (e.g., Acquired Immunodeficiency Syndrome 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 geographic service area. Geographic
distribution of existing beds and population density will be taken into
account.
f. 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.
g. If there is
a tie for the highest score for a specific facility or beds, the department
will conduct a comparative review of the top scoring proposals that will
include prior compliance history, if applicable. The department may request and
review data from OAAS and HSS on prior compliance history. Subject to K.3.h of
this Section, the department will make a decision to approve one of the top
scoring applications based on comparative review of the proposals.
h. If no proposals are received that
adequately respond to the need, the department may opt not to approve an
application.
i. At the end of the
review period, each applicant will be notified of the department's decision to
approve or disapprove the application. However, the evaluation period may be
extended, if provided for in the RFP or RFA. Applicants will be given 30 days
from the date of receipt of the department's notification in which to file an
appeal.
j. 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 licensing and Medicaid certification shall be revoked if these aspects of
the proposal are altered.
L. The following timelines are established for additional NF or
beds in NF approved through FNR.
1. Beds that
are approved to be added to an existing licensed facility, shall be licensed
and enrolled in the Title XIX program within one year of the date of approval
by the FNR program.
2. New NF that
are approved to be constructed, shall be licensed and enrolled in the Title XIX
program within 24 months of the date of the approval by the FNR
program.
3. An extension may be
granted, at the discretion of the department, when delays are caused by
circumstances beyond the control of the applicant (e.g., acts of God).
Inappropriate zoning is not a basis for
extension.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
40:2116 et
seq.
