Current through Register Vol. 50, No. 9, September 20, 2024
A. ICF/MRs will
be subject to a review of each client's need for ICF/MR services.
B. Interdisciplinary Team (ID Team). Before
admission to an ICF/MR, or before authorization for payment, an
interdisciplinary team of health professionals will make a comprehensive
medical, social and psychological evaluation of each client's need for care in
the ICF/MR.
1. Other professionals as
appropriate will be included on the team, and at least one member will meet the
definition of Qualified Mental Retardation Professional (QMRP) as stated in
these standards.
2. Appropriate
participation of nursing services on this team should be represented by a
Louisiana licensed nurse.
C. Exploration of Alternative Services. If
the comprehensive evaluations recommend ICF/MR services for a client whose
needs could be met by alternative services that are currently unavailable, the
ICF/MR will enter this fact in the client's record and begin to look for
alternative services.
D. ICF/MR
Submission of Data
1. Evaluative data for
medical certification for ICF/MR level of care will be submitted to the
appropriate regional Health Standards Office on each client. This will include
the following information:
a. initial
application;
b. applications for
clients transferring from one ICF/MR to another;
c. applications for clients transferring from
an acute care hospital to an ICF/MR;
d. applications for clients who are patients
in a mental health facility; and
e.
applications for clients already in an ICF/MR program.
2. Time Frames for Submission of Data. A
complete packet of admission information must be received by BHSF/HSS within 20
working days following the completion of the ISP for newly admitted clients.
a. Notice within the 20-day time frame will
also be required for readmissions and transfers.
b. If an incomplete packet is received,
denial of certification will be issued with the reasons(s) for
denial.
c. If additional
information is subsequently received within the initial 20-working-day time
frame, and the client meets all requirements, the effective date of
certification is the date of admission.
d. If the additional information is received
after the initial 20-working-day time frame and the client meets all
requirements, the effective date of certification is no earlier than the date a
completed packet is received by HSS.
3. Data may be submitted before admission of
the client if all other conditions for the admission are met.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254, Title XIX of the Social Security Act,
and 42 CFR
456.350 -
456.438.
