Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part VII - Long Term Care
Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities
Chapter 303 - Provider Enrollment
Section VII-30309 - Provider Agreement
Universal Citation: LA Admin Code VII-30309
Current through Register Vol. 50, No. 9, September 20, 2024
A. In order to participate as a provider of ICF/MR services under Title XIX, an ICF/MR must enter into a provider agreement with DHH. The provider agreement is the basis for payments by the Medical Assistance Program. The execution of a provider agreement and the assignment of the provider's Medicaid vendor number is contingent upon the following criteria.
1.
Facility Need Review Approval Required. Before the ICF/MR can enroll and
participate in Title XIX, the Facility Need Review Program must have approved
the need for the ICF/MR's enrollment and participation in Title XIX. The
Facility Need Review process is governed by Department of Health and Hospitals
regulations promulgated under authority of Louisiana
R.S.
40:2116.
a.
The approval shall designate the appropriate name of the legal entity operating
the ICF/MR.
b. If the approval is
not issued in the appropriate name of the legal entity operating the ICF/MR,
evidence shall be provided to verify that the legal entity that obtained the
original Facility Need Review approval is the same legal entity operating the
ICF/MR.
2. ICF/MR's
Medicaid Enrollment Application. The ICF/MR shall request a Title XIX Medicaid
enrollment packet from the Medical Assistance Program Provider Enrollment
Section. The information listed below shall be returned to that office as soon
as it is completed:
a. two copies of the
Provider Agreement Form with the signature of the person legally designated to
enter into the contract with DHH;
b. one copy of the Provider Enrollment Form
(PE 50) completed in accordance with accompanying instructions and signed by
the administrator or authorized representative;
c. one copy of the Title XIX Utilization
Review Plan Agreement Form showing that the ICF/MR accepts DHH's Utilization
Review Plan;
d. copies of
information and/or legal documents as outlined in §30307(Ownership)
3. The Effective Date of the
Provider Agreement. The ICF/MR must be licensed and certified by the BHSF/HSS
in accordance with provisions in 42 CFR 442.100-115 and provisions determined
by DHH. The effective date of the provider agreement shall be determined as
follows.
a. If all federal requirements
(health and safety standards) are met on the day of the BHSF/HSS survey, then
the effective date of the provider agreement is the date the on-site survey is
completed or the day following the expiration of a current agreement.
b. If all requirements are specified in
Subparagraph a above are not met on the day of the BHSF/HSS survey, the
effective date of the provider agreement is the earliest of the following
dates:
i. the date on which the provider
meets all requirements; or
ii. the
date on which the provider submits a corrective action plan acceptable to the
BHSF/HSS; or
iii. the date on which
the provider submits a waiver request approved by the BHSF/HSS; or
iv. the date on which both Clause ii and
Clause iii above are submitted and approved.
4. ICF/MR's "Per Diem" Rate. After the ICF/MR
facility has been licensed and certified, a per diem rate will be issued by the
department.
5. Provider Agreement
Responsibilities. The responsibilities of the various parties are spelled out
in the Provider Agreement Form. Any changes will be promulgated in accordance
with the Administrative Procedure Act.
6. Provider Agreement Time Periods. The
provider agreement shall meet the following criteria in regard to time periods.
a. It shall not exceed 12 months.
b. It shall coincide with the certification
period set by the BHSF/HSS.
c.
After a provider agreement expires, payment may be made to an ICF/MR for up to
30 days.
d. The provider agreement
may be extended for up to two months after the expiration date under the
following conditions:
i. it is determined
that the extension will not jeopardize the client's health, safety, rights and
welfare; and
ii. it is determined
that the extension is needed to prevent irreparable harm to the ICF/MR or
hardship to its clients; or
iii. it
is determined that the extension is needed because it is impracticable to
determine whether the ICF/MR meets certification standards before the
expiration date.
7. Tuberculosis (TB) Testing as Required by
the OPH. All residential care facilities licensed by DHH shall comply with the
requirements found in LAC 51:II.Chapter 5 regarding screening for communicable
disease of employees, residents, and volunteers whose work involves direct
contact with clients. For questions regarding TB testing, contact the local
office of Public Health.
8.
Criminal History Checks. Effective July 15, 1996, the Office of State Police
will perform criminal history checks on nonlicensed personnel of health care
facilities in accordance with
R.S.
40:1300.51-R.S.
40:1300.56.
AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153 and 42 CFR 431.107, 442.10, 442.12, 442.13, 442.15, 442.16, 442.100 and 442.101.
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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