Part XXI. Home and Community-Based Services Waivers

A. - B. …

C. Children who reach their nineteenth birthday while participating in the Children’s Choice Waiver will transfer into an appropriate waiver for adults as long as they remain eligible for waiver services, with the exception of the reserved waiver opportunities allocated to Chisholm class members in need of Applied Behavioral Analysis (ABA) services who have received a Children’s Choice waiver slot. Their name will be returned to the Developmental Disabilities Request for Services Registry with the original date of request.

D. Children’s Choice Waiver services shall also be available to children who have been identified as Chisholm class members who are on the Development Disabilities Request for Services Registry and have a clinically documented diagnosis of Pervasive Developmental Disorder or Autism Spectrum Disorder, and who are in need of Applied Behavioral Analysis (ABA) services.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 35:1892 (September 2009), LR 39:2498 (September 2013), LR 39:

A. - A.8.c. …

B. Children who reach their nineteenth birthday while participating in the Children’s Choice Waiver will transfer into an appropriate waiver for adults as long as they remain eligible for waiver services. Participants in the ABA reserved capacity group will not automatically transfer into a New Opportunities Waiver slot for adults upon reaching their nineteenth birthday. They will return to the Request for services Registry with their original request date unless otherwise indicated.

C. Once ABA services are available as Medicaid State Plan services, Chisholm class members who received a waiver opportunity because they were in need of ABA services will be discharged from the waiver with no right to an administrative appeal. The Chisholm class members will be transferred to the Medicaid State Plan ABA services.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 39:2498 (September 2013), LR 39:

A. The order of entry in the Children’s Choice Waiver is first come, first served from a statewide list arranged by date of application for the Developmental Disabilities Request for Services Registry for the New Opportunities Waiver. Families shall be given a choice of accepting an opportunity in the Children’s Choice Waiver or remaining on the DDRFSR for the NOW.

1. The only exceptions to the first come, first served allocation of waiver opportunities shall be for the:

a. Money Follows the Person Rebalancing Demonstration waiver opportunities which are allocated to demonstration participants only;

b. waiver opportunities which are allocated to children who have been determined to need more services than what is currently available through state funded family support services; and

c. the reserved waiver opportunities which are allocated solely to Chisholm class members in need of ABA services.

B. - B.1.b. …

C. - C.6. Reserved.

D. Effective September 19, 2013, 165 Children’s Choice Waiver opportunities shall be reserved for Chisholm class members who have a clinically documented diagnosis of Pervasive Developmental Disorder or Autism Spectrum Disorder and who are in need of Applied Behavioral Analysis services. These waiver opportunities must only be filled by a class member and no alternate may utilize a Chisholm class member waiver opportunity.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 35:1892 (September 2009), LR 39:

Chapter 113. Services

§11301. Service Cap

A. - C. …

D. Effective August 1, 2012, Children’s Choice services are capped at $16,410 per individual per plan of care year.

1. The capped amount shall not apply to ABA services provided to persons entering the waiver under the reserved slots for Chisholm class members.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 28:1983 (September 2002), amended by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2440 (November 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 37:2157 (July 2011), LR 39:507 (March 2013), LR 39:2498 (September 2013), LR 39:

A. - G.7.j. …

H. Applied Behavioral Analysis-Based Therapy

1. - 2. …

3. Services must be prior authorized.

I. - M.3.a. …

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 28:1983 (September 2002), amended by the Department of Health and Hospitals, Office of the Secretary, Office for Citizens with Developmental Disabilities, LR 33:1871 (September 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 36:324 (February 2010), LR 39:2498 (September 2013), LR 39:

A. …

1. - 1.b. …

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, Bureau of Health Services Financing, repromulgated for LAC, LR 28:1984 (September 2002), LR 39:2501 (September 2013), LR 39:

A. Both support coordination and direct services providers must comply with the requirements of this §11523 in order to participate as Children Choice providers, with the exception of ABA service providers who are exempt from the requirements of §11523.H. Agencies will not be added to the freedom of choice (FOC) list of available providers maintained by OCDD until they have received a Medicaid provider number.

B. - N. …

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 28:1984 (September 2002), amended LR 28:2533 (December 2002), repromulgated LR 29:38 (January 2003), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 39:2501 (September 2013), LR 39:

§11529. Professional Services Providers

A. - H. …

I. Applied behavioral analysis-based therapy services must be provided by persons enrolled in the Medicaid Program who:

1. meet the following licensure and/or certification requirements:

a. be a board-certified behavior analyst (BCBA) through the Behavior Analyst Certification Board (BACB); or

b. be a currently Louisiana licensed psychologist, licensed clinical social worker, licensed professional counselor, licensed marriage and family therapist, licensed addiction counselor, or advanced practice registered nurse, with coursework that includes, at a minimum, 40 hours of coursework in behavior analysis, behavior management theory, techniques, interventions and ethics, and autism spectrum disorders, and includes:

i. at a minimum, one year (1500 hours) of supervised clinical experience inclusive of:

(a). a minimum of one year of direct care services to children;

(b). a minimum of one year of direct care utilizing applied behavior analysis, behavior techniques, interventions, and monitoring of behavior plan implementation; and

(c). experience that must have included work with individuals with autism spectrum disorders; or

c. possess a master’s degree or doctoral degree in psychology, social work, professional counseling, or other human services related field, with coursework that includes, at a minimum, 40 hours of coursework in behavior analysis, behavior management theory, techniques, interventions and ethics, and autism spectrum disorders; and

i. at a minimum, one year (1,500 hours) of supervised clinical experience inclusive of:

(a). a minimum of one year of direct care services to children; and

(b). a minimum of one year of direct care utilizing applied behavior analysis, behavior techniques, interventions and monitoring of behavior plan implementation; and

(c). experience that must have included work with individuals with autism spectrum disorders;

2. are covered by professional liability insurance to limits of $1,000,000 per occurrence, $1,000,000 aggregate;

3. have no sanctions or disciplinary actions on BCBA or BCBA-D certification and/or state licensure;

4. have no Medicare/Medicaid sanctions and are not excluded from participation in federally-funded programs (OIG-LEIE listing, system for award management (SAM) listing and state Medicaid sanctions listings); and

5. must have a completed criminal background check to include federal criminal, state criminal, parish criminal and sex offender reports for the state and parish in which the behavior analyst master’s/doctoral is currently working and residing:

a. evidence of this background check shall be provided by the service provider or by his/her employer;

b. criminal background checks must be performed at the time of hire and at least every five years thereafter.

J. Behavior AnalystBachelor’s Level

1. Behavior analyst Bachelor’s Level providers must meet one of the following criteria:

a. be a board-certified assistant behavior analyst (BCaBA) through the BACB; or

b. hold a state-issued certificate, registration, credential, or other designation as a behavior analyst-bachelor’s level.

2. Behavior analyst Bachelor’s Level providers must work under the supervision of a service provider listed in §11529.I. This supervisory relationship must be documented in writing.

3. The provider must be covered by professional liability insurance to limits of $1,000,000 per occurrence, $1,000,000 aggregate through their employer or group (if not professional liability insurance, then covered under general liability insurance through employer or group).

4. The provider must have no sanctions or disciplinary actions if state-certified or board-certified by the BACB.

5. The provider must not have Medicaid or Medicare sanctions or be excluded from participation in federally-funded programs (OIG-LEIE listing, System for Award Management (SAM) listing and state Medicaid sanctions listings).

6. The provider must have a completed criminal background check to include federal criminal, state criminal, parish criminal and sex offender reports for the state and parish in which the behavioral analyst Bachelor’s level is currently working and residing.

a. Evidence of this background check shall be provided by the employer.

b. Criminal background checks must be performed at the time of hire and at least every five years thereafter.

K. Enrolled providers may employ support staff who meet the following requirements to assist in the delivery of ABA services.

1. Applicants must meet one of the following criteria:

a. possess a Master’s degree;

b. be a register nurse (RN) or licensed practical nurse (LPN) without a bachelor’s degree;

c. possess a bachelor’s degree; or

d. have completed two years in psychology education, social work, behavioral science, human development or related fields with no degree.

2. Providers must have 40 hours minimum in applied behavior analysis by a recognized organization such as:

a. a United States or Canadian institution of higher education fully or provisionally accredited by a regional, state, provincial or national accrediting body;

b. a Joint Commission or Commission on Accreditation of Rehabilitation Facilities or accredited health care facility;

c. a private agency whose primary business activity is the delivery of services to children with developmental disabilities and whose governing board includes one or more BCBAs; or

d. web-based instruction provided by an accredited institution of higher education.

3. Behavior analyst support staff must work under the supervision of a behavior analyst Masters/Doctoral or behavior analyst Bachelors Level who is themselves supervised by a behavior analyst Masters/Doctoral practitioner.

a. No fewer than two hours every two weeks of formal, documented supervision must be provided.

b. The supervisory relationship must be described in a formal, written document.

4. Applicants must meet all of the following requirements:

a. covered by professional liability insurance to limits of $1,000,000 per occurrence, $1,000,000 aggregate through their employer or group (if not professional liability insurance, then covered under general liability insurance through their employer or group);

b. may not have Medicaid/Medicare sanctions or be excluded from participation in federally-funded programs (OIG-LEIE listing, System for Award Management (SAM) listing and state Medicaid sanctions listings); and

c. must have a completed criminal background check to include federal criminal, state criminal, parish criminal and sex offender reports for the state and parish in which the support staff is currently working and residing:

i. Evidence of this background check is provided by the employer. Criminal background checks must be performed at the time of hire and at least every five years thereafter.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 39:2501 (September 2013), LR 39:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to J. Ruth Kennedy, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. She is responsible for responding to inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.
Kathy H. Kliebert

Secretary

1310#050
DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Inpatient Hospital Services

The Department of Health and Hospitals, Bureau of Health Services Financing amends LAC 50:V.1301-1309 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

Act 347 of the 2009 Regular Session of the Louisiana Legislature revised the qualifying criteria for major teaching hospitals. In compliance with Act 347, the department amended the provisions governing the qualifying criteria for major teaching hospitals and repromulgated the provisions of the March 20, 2000 Rule governing teaching hospitals in a codified format for inclusion in the Louisiana Administrative Code (Louisiana Register, Volume 39, Number 2). The department promulgated an Emergency Rule which amended the provisions of the February 20, 2013 Rule governing the qualifying criteria for teaching hospitals in order to correlate with Medicare guidelines, and to clarify deadlines for submissions of qualifying documentation and provisions for conversion to private ownership (Louisiana Register, Volume 39, Number 6). This Emergency Rule is being promulgated to continue the provisions of the July 1, 2013 Emergency Rule. This action is being taken to promote the health and welfare of Medicaid recipients by encouraging provider participation in the Medicaid Program to assure sufficient access to hospital services.

Effective October 30, 2013, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing inpatient hospital services rendered by non-rural, non-state hospitals designated as teaching hospitals.

A. The Louisiana Medical Assistance Program's recognition of a major teaching hospital is limited to facilities having a documented affiliation agreement with a Louisiana medical school accredited by the Liaison Committee on Medical Education (LCME). A major teaching hospital shall meet one of the following criteria:

1. be a major participant in at least four approved medical residency programs and maintain at least 15 intern and resident un-weighted full time equivalent positions. For purposes of this rule full time equivalent positions will be calculated as defined in 42 CFR 413.78. At least two of the programs must be in medicine, surgery, obstetrics/gynecology, pediatrics, family practice, emergency medicine or psychiatry; or

2. maintain at least 20 intern and resident un-weighted full time equivalent positions, with an approved medical residency program in family practice located more than 150 miles from the medical school accredited by the LCME. For purposes of this rule full time equivalent positions will be calculated as defined in 42 CFR 413.78.

B. For the purposes of recognition as a major teaching hospital, a facility shall be considered a "major participant" in a graduate medical education program if it meets the following criteria. The facility must participate in residency programs that:

1. require residents to rotate for a required experience;

a. - c. Repealed.

2. require explicit approval by the appropriate Residency Review Committee (RRC) of the medical school with which the facility is affiliated prior to utilization of the facility; or

a. - c. Repealed.

3. provide residency rotations of more than one sixth of the program length or more than a total of six months at the facility and are listed as part of an accredited program in the Graduate Medical Education Directory of the Accreditation Council for Graduate Medical Education (ACGME).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:324 (February 2013), amended LR 39:

A. The Louisiana Medical Assistance Program's recognition of a minor teaching hospital is limited to facilities having a documented affiliation agreement with a Louisiana medical school accredited by the LCME. A minor teaching hospital shall meet the following criteria:

1. …

2. maintain at least six intern and resident un-weighted full time equivalent positions. For purposes of this rule full time equivalent positions will be calculated as defined in 42 CFR 413.78.

1. require residents to rotate for a required experience;

a. - c. Repealed.

2. require explicit approval by the appropriate Residency Review Committee of the medical school with which the facility is affiliated prior to utilization of the facility; or

a. - c.i. Repealed.

3. provide residency rotations of more than one sixth of the program length or more than a total of six months at the facility and are listed as part of an accredited program in the Graduate Medical Education Directory of the Accreditation Council for Graduate Medical Education.

a. If not listed, the sponsoring institution must have notified the ACGME, in writing, that the residents rotate through the facility and spend more than one sixth of the program length or more than a total of six months at the facility.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:324 (February 2013), amended LR 39:

§1305. Approved Medical Residency Program

A. An approved medical residency program is one that meets one of the following criteria:

1. is approved by one of the national organizations listed in 42 CFR 415.152;

2. may count towards certification of the participant in a specialty or subspecialty listed in the current edition of either of the following publications:

a. the Directory of Graduate Medical Education Programs published by the American Medical Association, and available from American Medical Association, Department of Directories and Publications; or

b. the Annual Report and Reference Handbook published by the American Board of Medical Specialties, and available from American Board of Medical Specialties;

3. is approved by the Accreditation Council for Graduate Medical Education (ACGME) as a fellowship program in geriatric medicine; or

4. is a program that would be accredited except for the accrediting agency's reliance upon an accreditation standard that requires an entity to perform an induced abortion or require, provide, or refer for training in the performance of induced abortions, or make arrangements for such training, regardless of whether the standard provides exceptions or exemptions.

B. - B.2. Repealed.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:324 (February 2013), amended LR 39:

§1307. Graduate Medical Education

Repealed.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:325 (February 2013), repealed LR 39:

A. Qualification for teaching hospital status shall be re-established at the beginning of each fiscal year.

B. To be reimbursed as a teaching hospital, a facility shall submit a signed “Certification For Teaching Hospital Recognition” form to the Bureau of Health Services, Supplemental Payments Section at least 30 days prior to the beginning of each state fiscal year or at least 30 days prior to the effective date of the conversion of a state owned and operated teaching hospital to private ownership in accordance with a Public/Private Partnership Cooperative Endeavor Agreement that was instituted to preserve graduate medical education training and access to healthcare services for indigent patients.

1. - 3. Repealed.

C. Each hospital which is reimbursed as a teaching hospital shall submit the following documentation with their Medicaid cost report filing:

1. - 2. ...

D. Copies of all affiliation agreements, contracts, payroll records and time allocations related to graduate medical education must be maintained by the hospital and available for review by the state and federal agencies or their agents upon request.

E. If it is subsequently discovered that a hospital has been reimbursed as a major or minor teaching hospital and did not qualify for that peer group for any reimbursement period, retroactive adjustment shall be made to reflect the correct peer group to which the facility should have been assigned. The resulting overpayment will be recovered through either immediate repayment by the hospital or recoupment from any funds due to the hospital from the department.

F. - G. Repealed.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:325 (February 2013), amended LR 39:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to J. Ruth Kennedy, Bureau of Health Service Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. She is responsible for responding to all inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.
Kathy H. Kliebert

Secretary

1310#056
DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Inpatient Hospital Services

The Department of Health and Hospitals, Bureau of Health Services Financing amends LAC 50:V.1703 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

The Department of Health and Hospitals, Bureau of Health Services Financing promulgated an Emergency Rule which amended the provisions governing inpatient hospital services to establish supplemental Medicaid payments to non-state owned hospitals in order to encourage them to take over the operation and management of state-owned and operated hospitals that have terminated or reduced services. Participating non-state owned hospitals shall enter into a cooperative endeavor agreement with the department to support this public-provider partnership initiative (Louisiana Register, Volume 39, Number 11). The department promulgated an Emergency Rule which amended the provisions governing the reimbursement methodology for inpatient psychiatric hospital services provided by non-state owned hospitals participating in public-private partnerships (Louisiana Register, Volume 39, Number 1). In April 2013, the department promulgated an Emergency Rule to continue the provisions of the January 2, 2013 Emergency Rule (Louisiana Register, Volume 39, Number 4).

The department amended the provisions governing the reimbursement methodology for inpatient services provided by non-state owned major teaching hospitals participating in public-private partnerships which assume the provision of services that were previously delivered and terminated or

reduced by a state-owned and operated facility to establish an interim per diem reimbursement (Louisiana Register, Volume 39, Number 4). In June 2013, the department determined that it was necessary to rescind the January 2, 2013 and the May 3, 2013 Emergency Rules governing Medicaid payments to non-state owned hospitals for inpatient psychiatric hospital services (Louisiana Register, Volume 39, Number 6). The department promulgated an Emergency Rule which amended the provisions of the April 15, 2013 Emergency Rule in order to revise the formatting of these provisions as a result of the promulgation of the June 1, 2013 Emergency Rule to assure that these provisions are promulgated in a clear and concise manner in the Louisiana Administrative Code (LAC) (Louisiana Register, Volume 39, Number 7). This Emergency Rule is being promulgated to continue the provisions of the July 20, 2013 Emergency Rule. This action is being taken to promote the health and welfare of Medicaid recipients by maintaining recipient access to much needed hospital services.

Effective November 18, 2013, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing Medicaid payments for inpatient hospital services provided by non-state owned hospitals participating in public-private partnerships.