La. Admin. Code tit. 48 § I-12503

Current through Register Vol. 50, No. 4, April 20, 2024

Section I-12503 - General Information

A. No healthcare provider designated in R.S. 40:2116 or R.S. 40.2116.1 shall be licensed by LDH and/or certified to participate in the Title XIX program without first obtaining FNR approval and complying with any and all licensing regulations promulgated by LDH. Any person establishing, managing, or operating a facility, provider, service, or bed without the approval required by this Chapter shall immediately cease providing services and shall be prohibited from obtaining a license from LDH and/or participating in the Title XIX program, until FNR approval has been granted by the department.

B. The FNR committee shall consist of the following members:

1. the secretary of LDH, or his designee;

2. the assistant secretary of the Office of Behavioral Health (OBH) of LDH, or his designee;

3. the assistant secretary of the Office for Citizens with Developmental Disabilities (OCDD) of LDH, or his designee;

4. the assistant secretary of the Office of Aging and Adult Services (OAAS) of LDH, or his designee;

5. the assistant secretary of the Office of Public Health (OPH) of LDH, or his designee;

6. the Medicaid director of LDH, or his designee;

7. the Medicaid medical director of LDH, or his designee; and

8. any additional FNR committee members appointed by LDH secretary when necessary in reviewing applications of OTPs, including but not limited to the following individuals:

a. the LDH OBH medical director or physician who has expertise in substance use disorder treatment and, in particular, opioid treatment;

b. an addiction counselor licensed in the state of Louisiana by Addictive Disorder Regulatory Authority; and

c. the Louisiana State Opioid Treatment Authority.

C. The FNR committee will conduct an FNR to determine if there is a need for additional providers, facilities, or beds to be licensed by LDH and/or enrolled to participate in the Title XIX program for the following healthcare facility types, as defined under this Chapter:

1. nursing facilities (NF);

2. skilled nursing facilities;

3. intermediate care facilities for persons with developmental disabilities (ICF-DD);

4. home and community-based service (HCBS) providers of respite care (RC) services, personal care attendant (PCA) services, supervised independent living (SIL) services, and monitored in-home caregiving (MIHC) services;

5. hospice providers;

6. pediatric day health care facilities (PDHC);

7. behavioral health services providers of psychosocial rehabilitation (PSR) services, and community psychiatric support and treatment (CPST) services; and

8. behavioral health service providers of opioid treatment program (OTP) services.

D. The responsibilities and duties of the FNR committee include, but are not limited to:

1. conducting initial and supplemental reviews of each FNR application, as applicable;

2. determining whether each application meets the established criteria for FNR approval; and

3. sending FNR application approval and/or denial notices.

E. No FNR committee member shall have a proprietary or financial interest in any healthcare facility subject to FNR.

F. Except as otherwise provided in the grandfather provisions of these regulations, each healthcare provider designated in R.S. 40:2116 or R.S. 40:2116.1 shall first receive FNR approval before applying to be licensed by LDH and before being certified to participate in the Title XIX program.

G. Grandfather Provision. An approval shall be deemed to have been granted under this program without review for NFs, ICFs/DD, and/or beds that meet one of the following descriptions:

1. all valid Section 1122 approved healthcare facilities/beds;

2. all valid approvals for healthcare facilities/beds issued under the Medicaid Capital Expenditure Review Program prior to the effective date of this program;

3. all valid approvals for healthcare facilities issued under the FNR program; or

4. all NF beds that were enrolled in Medicaid as of January 20, 1991.

H. Additional Grandfather Provision. An approval shall be deemed to have been granted under FNR without review for HCBS providers of RC, PCA, SIL, or MIHC services, ICFs/DD, hospice providers, PDHC providers, or BHSPs that meet one of the following conditions:

1. Home and Community Based Service providers that were licensed by January 31, 2009 or had a completed initial licensing application submitted to the department by June 30, 2008;

2. existing licensed ICFs-DD that are converting to the Residential Options Waiver.

3. licensed Adult Day Health Care (ADHC) providers who are enrolled or will enroll in the Louisiana Medicaid Program as a Program for All-inclusive Care for the Elderly (PACE) provider and apply for an HCBS license to provide PCA services as required by the program;

4. hospice providers that were licensed or had a completed initial licensing application submitted to the department by March 20, 2012; or

5. pediatric day health care providers that were licensed by the department before March 1, 2014, or an entity that meets all of the following requirements:

a. has a building site or plan review approval for a PDHC facility from the Office of State Fire Marshal by March 1, 2014;

b. has begun construction on the PDHC facility by April 30, 2014, as verified by a notarized affidavit from a licensed architect submitted to the department, or the entity had a fully executed and recorded lease for a facility for the specific use as a PDHC facility by April 30, 2014, as verified by a copy of a lease agreement submitted to the department;

c. submits a letter of intent to the department's HSS by April 30, 2014, informing the department of its intent to operate a PDHC facility; and

d. became licensed as a PDHC by the department no later than December 31, 2014.

6. behavioral health services providers that are licensed to provide PSR and/or CPST, or that have submitted a completed application for licensure as a BHSP that includes PSR and/or CPST, prior to February 20, 2018;

7. behavioral health services providers that are licensed to provide OTP services, or that have submitted a complete application for licensure as a BHSP that includes OTP services prior to January 1, 2024; and

8. behavioral health services providers that fall within the provisions of Act 33 of the 2017 Regular Session of the Louisiana Legislature, commonly referred to as accredited mental health rehabilitation providers, that submit a completed BHSP licensing application by December 1, 2017 and become licensed by April 1, 2018.

I. Exemptions from the FNR process shall be made for:

1. a NF that needs to be replaced as a result of destruction by fire or a natural disaster, such as a hurricane; or

2. a NF and/or facility building owned by a government entity that is replaced due to a potential health hazard.

La. Admin. Code tit. 48, § I-12503

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 21:808 (August 1995), amended LR 28:2190 (October 2002), LR 30:1483 (July 2004), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 34:2612 (December 2008), amended LR 35:2437 (November 2009), LR 36:323 (February 2010), LR 38:1593 (July 2012), LR 38:1961 (August 2012), LR 41:136 (January 2015), Amended LR 41:136 (January 2015), LR 4261 (1/1/2016), Amended by the Department of Health, Bureau of Health Services Financing, LR 44281 (2/1/2018), Promulgated by the Department of Health, Health Standards Section, LR 50223 (2/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2116 et seq.