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-10355 - Appeals

Universal Citation: LA Admin Code II-10355

Current through Register Vol. 50, No. 9, September 20, 2024

NOTE: Code of Federal Regulations that pertain to this Section are as follows: 42 CFR 431.151 through 431.154.

A. DHH reserves the right to reject a request for Title XIX participation, impose sanctions or terminate participation status when an ICF/MR:

1. fails to abide by the rules and regulations promulgated by DHH;

2. fails to obtain compliance or is otherwise not in compliance with Title VI of the Civil Rights Act;

3. engages in practice not in the best interest of Medicaid (Title XIX) clients;

4. has previously been sanctioned for violation of state and/or federal rules and regulations; or

5. has previously been decertified from participation as a Title XIX provider. Prior to such rejection or termination, DHH may conduct an Informal Reconsideration at the ICF/MR's request. The ICF/MR also has the right to an Administrative Appeal pursuant to the Administrative Procedure Act.

B. Informal Reconsideration. When an ICF/MR receives a written notification of adverse action and a copy of the findings upon which the decision was based, the ICF/MR may provide written notification to BHSF/HSS within 10 calendar days of receiving the notification, and request an Informal Reconsideration.

1. The ICF/MR may submit written documentation or request an opportunity to present oral testimony to refute the findings of DHH on which the adverse action is based.

2. DHH will review all oral testimony and documents presented by the ICF/MR and, after the conclusion of the Informal Reconsideration, will advise the ICF/MR in writing of the results of the reconsideration which may be that:
a. the original decision has been upheld;

b. the original decision has been modified; or

c. the original decision has been reversed.

C. Evidentiary Hearing-General Requirements. The ICF/MR may also request an Administrative Appeal. To request such an appeal, the facility must submit their request in writing within 30 days of the receipt of the adverse action to the Bureau of Appeals, Box 4183, Baton Rouge, LA 70821-4183. The Bureau of Appeals will attempt to conduct the hearing within 120 days of the original notice of adverse action.

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.

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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