Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part II - Nursing Facilities
Subpart 3 - Standards for Payment
Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
Subchapter G - Admission Review
Section II-10353 - Utilization Reviews
Current through Register Vol. 50, No. 9, September 20, 2024
NOTE: Federal regulations pertaining to ICFs are found at 42 CFR 456.350 through 456.438.
A. If it is determined by HSS that continued stay is not needed, the client's attending physician or Qualified Mental Retardation Professional (QMRP) shall be notified within one working day and given two working days from the notification date to present his/her views before a final decision on continued stay is made.
B. If the attending physician or QMRP does not present additional information or clarification of the need for continued stay, the decision of the UR group is final.
C. If the attending physician or QMRP presents additional information or clarification, the need for continued stay is reviewed by the physician member(s) of the UR group in cases involving a medical determination.
D. The decision of the UR group is the final medical eligibility decision. Recourse for the client is to exercise his/her appeal rights according to the Administrative Procedure Act.
AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.
