Current through Register Vol. 50, No. 9, September 20, 2024
A. Purpose and
Scope. Under the provisions of Louisiana R.S. 40:2009.13-40:2009.20 and 14:4032
federal regulation
42 CFR
483.405,
483.420,
483.440
and the state Operations Manual published by the Department of Health and
Hospitals and Health Care Financing Administration, the following procedures
are established for receiving, evaluating, investigating, and correcting
grievances concerning client care in ICF/MR licensed and certified ICF/MR
facilities. The following procedures also provide mandatory reporting of abuse
and neglect in ICF/MR facilities.
B. Applicability
1. Any person having knowledge of the alleged
abuse or neglect of a client or knowledge of a client being denied care and
treatment may submit a complaint, preferably in writing.
2. Any person may submit a complaint if
he/she has knowledge that a state law, standard, rule, regulation, correction
order, or certification rule issued by the Department of Health and Hospitals
has been violated.
C.
Duty to Report. All incidents or allegations of abuse and/or neglect must be
reported by telephone or fax within 24hours to DHH's Health Standards Section.
This must be followed by a copy of the results of the facility's internal
investigation within five working days. Complete investigative reports with all
pertinent documents shall be maintained at the facility. Failure to submit this
information timely could result in a deficiency and/or a sanction. Those who
must make a report abuse and/or neglect are:
1. physicians or other allied health
professionals;
2. social services
personnel;
3. facility
administration;
4. psychological or
psychiatric treatment personnel;
5.
registered nurses;
6. licensed
practical nurses; and
7. direct
care staff.
D. Penalties
for Failure to Make Complaint. Any person who knowingly and willfully fails to
report an abuse or neglect situation shall be fined not more than $500 or
imprisoned not more than two months or both. The same sanctions shall apply to
an individual who knowingly and willingly files a false report. Penalties for
committing cruelty or negligent mistreatment to a resident of a health care
facility shall be not more than $10,000 or imprisoning with or without hard
labor for more than 10 years, or both.
E. Where to Submit Complaint
1. A complaint can be filed as follows:
a. it may be submitted in writing to the
Health Standards Section at Box 3767, Baton Rouge, LA 70821-3767; or
b. it may be made by calling Health Standards
Section at 1-888-810-1819, or (225) 342-0082, and the FAX number (225)
342-5292.
c. In addition, it may be
submitted to any local law enforcement agency.
2. DHH'S Referral of Complaints for
Investigation
a. Complaints involving clients
of ICF/MRs received by DHH shall be referred to the Health Standards
Section.
b. If it has been
determined that complaints involving alleged violations of any criminal law
concerning a facility are valid, the investigating office of DHH shall furnish
copies of the complaints for further investigation to the Medicaid Fraud
Control Unit of the Louisiana Attorney General Office.
F. Disposition of Complaints.
After the investigation DHH may take any of the following actions.
1. Valid Complaint with Deficiencies Written.
The Department of Health and Hospitals shall notify the administrator who must
provide an acceptable plan of correction as specified below.
a. If it is determined that a situation
presents a threat to the health and safety of the client, the facility shall be
required to take immediate corrective action. DHH may certify noncompliance,
revoke or suspend the license, or impose sanctions.
b. In all other instances of violation, an
expeditious correction, not to exceed 90 days, shall be required. If the
provider is unable or unwilling to correct the violation, DHH may take any of
the actions listed in Paragraph 1.a.
c. In cases of abuse and/or neglect, referral
for appropriate corrective action shall be made to the Medicaid Fraud Control
Unit of the Attorney General's Office.
2. Unsubstantiated Complaint. DHH shall
notify the complainant and the facility of this finding.
3. Repeat Violations. When violations
continue to exist after the corrective action was taken, the Department of
Health and Hospitals may take any of the actions listed in Paragraph
1.a.
G. Informal
Reconsideration. A complainant or a facility dissatisfied with any action taken
by DHH's response to the complaint investigation may request an informal
reconsideration as provided in
R.S.
40:2009.11 et seq.
H. Retaliation by ICF/MR Facility. Facilities
are prohibited from taking retaliatory action against complainants. Persons
aware of retaliatory action or threats in this regard should contact
DHH.
I. Tracking of Incidents. For
each client who is involved in an accident or incident, an incident report
shall be completed including the name, date, time, details of accident or
incident, circumstances under which it occurred, witnesses and action taken.
1. Incidents or accidents involving clients
must be documented in the client's record. These records should also contain
all pertinent medical information.
2. The examples listed below are not all
inclusive, but are presented to serve as a guideline to assist those facility
employees responsible for reporting incident reports.
a. Suspicious Death. Death of a client or
on-duty employee when there is suspicion of death other than by natural
causes.
b. Abuse and/or Neglect.
All incidents or allegations of abuse and/or neglect.
c. Runaways. Runaways considered to be
dangerous to self or others.
d. Law
Enforcement Involvement. Arrest, incarceration, or other serious involvement of
residents with Law Enforcement Authorities.
e. Mass Transfer. The voluntary closing of a
facility or involuntary mass transfer of residents from a facility.
f. Violence. Riot or other extreme
violence.
g. Disasters. Explosions,
bombings, serious fires.
h.
Accidents/Injuries. Severe accidents or serious injury involving residents or
on-duty employees caused by residents such as life threatening or possible
permanent and/or causing lasting damage.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
46:153.
