Current through Register Vol. 50, No. 9, September 20, 2024
A. Capacity. The ICF/MR will admit only the
number of individuals that does not exceed its rated capacity as determined by
the BHSF's HSS and its capacity to provide adequate programming.
B. Admission Requirements. Except on a short
term emergency basis, an ICF/MR may not admit individuals as clients unless
their needs can be met and an interdisciplinary professional team has
determined that admission is the best available plan for them. The team must do
the following:
1. conduct a comprehensive
evaluation of each individual that covers physical, emotional, social and
cognitive factors; and
2. perform
the following tasks prior to admission:
a.
define the individual's need for service without regard to the availability of
those services; and
b. review all
appropriate programs of care, treatment, and training and record the
findings;
3. ensure that
the ICF/MR takes the following action if admission is not the best plan but the
individual must nevertheless be admitted:
a.
clearly acknowledges that admission is inappropriate; and
b. initiates plans to actively explore
alternatives.
C. Prohibitions on Federal Financial
Participation
1. Federal funds in the Title
XIX ICF/MR program are not available for clients whose individual treatment
plans are totally or predominately vocational and/or educational. ICF/MR
services are designed essentially for those individuals diagnosed as
developmentally disabled; having developmental lags which are considered
amendable to treatment in a 24-hour managed care environment where they will
achieve maximum growth. Services to treat educational and vocational deficits
are available at the community level while the client lives in his home or in
another community level placement and are not considered amendable to treatment
in a 24-hour managed care environment.
2. Admissions through the Court System
a. Court ordered admissions do not guarantee
Medicaid vendor payment to a facility. A court can order that a client be
placed in a particular facility but cannot mandate that the services be paid
for by the Medicaid program.
b.
Incarcerated individuals are not eligible for Medicaid. The only instance in
which such an individual may qualify is if he/she is paroled or released on
medical furlough.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and
42 CFR
483.440.
