La. Admin. Code tit. 48 § I-12505

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-12505 - Initial Application and Review Process for ICF-DD, HCBS Providers of RC, PCA, SIL, or MIHC Services, Hospice Providers, PDHC Facilities, BHSP of PSR, CPST, and OTP Services

A. Facility need review (FNR) applications as defined in the Chapter except for FNR applications that are submitted pursuant to a Request for Proposal (RFP) or Request for Application (RFA) issued by the department will follow the initial application and review process, the supplemental application review process, and the appeal provisions set forth in this licensing Rule. Facility need review applications that are submitted pursuant to a RFP or RFA will follow the application process, the review process, the supplemental review process, the notice provisions, and the appeal provisions that are contained in the individual RFP or RFA.

B. Facility need review applications shall be submitted on 8.5 inch by 11 inch paper that shall not include Health Insurance Portability and Accountability Act (HIPAA) protected information, to the HSS, FNR program manager by one of the following means:

1. via postal service to the designated FNR program mailing address; or

2. electronically via the HSS designated system or software.

C. Application forms may be requested in writing or by telephone from the FNR program, or accessed via the department's designated website.

D. The applicant shall also submit with its application, any written documentation or evidence the applicant believes supports its FNR application, including but not limited to the following examples.

1. Any data/documents regarding waiting lists for the proposed services in the applicant's service area.

2. Any letters from healthcare facilities, medical professionals or others, who have clients/patients/recipients awaiting the proposed services in the applicant's service area.

3. Any data/documentation of complaints about clients/patients/recipients not being able to access the proposed services in the applicant's service area.

4. Any data/documentation about population groups that do not have access to the proposed services in the applicant's service area, to whom the applicant will provide such services.

5. Other data/documentation about the need in the applicant's service area for the proposed services.

6. Other data/documentation about the probability of serious adverse consequences to recipient's ability to access healthcare if the applicant was not allowed to be licensed.

E. The applicant representative specified on the application will be the only person to whom the FNR program will send written notification in matters relative to the status of the application during the review process. If the applicant's application information or representative changes at any time during the review process, the applicant is required to notify the FNR program in writing.

F. The required nonrefundable FNR application fee of $200 shall be submitted either by mail to the designated payment address or electronically via the HSS designated system or software.

G. The review period of the initial application will be no more than 90 days from receipt of the FNR application, or within the deadlines established in an RFP or RFA; thereafter, a decision will be rendered by the FNR committee. The review period begins on the first day after the date of receipt of the completed application, or, in the case of issuance of an RFP, on the first day after the period specified in the RFP.

1. Each FNR committee member shall receive a copy of the initial application and all documentation submitted for review.

2. The FNR committee shall meet as a committee to review the initial application within the specified time limits, as provided herein.

a. The FNR committee shall meet in-person or through virtual means, including telephone or virtual technology that facilitates synchronous interaction.

b. All members of the FNR committee shall attend the meeting, either in-person or by virtual means. The members shall review the initial application, and the members may request information from the department in considering an application.

c. The FNR committee shall render a decision on the initial application, and such decisions are to be by simple majority decision.

d. The FNR committee's decision may approve the initial application or may deny the initial application. Alternatively, the FNR committee may request that the applicant submit additional or clarifying information and documentation.

e. If the FNR committee decision is to approve or deny the initial application, the FNR committee shall forward written notice to the applicant of such decision. The notice shall include information on supplemental review, appeals, and any additional instructions.

f. If the FNR committee decision is to request additional or clarifying information and documentation from the applicant, the FNR committee shall send written notice to the applicant, requesting the information and documentation by a specific date. The initial application and any additional or clarifying information and documentation shall be considered at the next FNR committee meeting, wherein the FNR committee shall make a decision on the initial application and forward written notice to the applicant of such decision. The notice shall include information on supplemental review, appeal rights, and any additional instructions.

3. Written notice of FNR decision along with required follow-up instructions shall be sent to the applicant by certified mail or by electronic mail with a request for an acknowledgement and a read and delivery receipt, to the applicant representative. Written notice of the FNR committee's request for additional or clarifying information and documentation shall be sent to the applicant by electronic mail with a request for an acknowledgement and a read and delivery receipt.

4. Unless otherwise stated in a specific RFP or RFA, the initial review and decision by the FNR committee shall consider all written materials and documentation submitted by the applicant and shall be conducted as a paper review.

5. If the FNR committee approves the FNR application, then the applicant may proceed with seeking licensure or certification to participate in the Title XIX program, as applicable.

6. If the FNR application is denied, the applicant may choose within 30 calendar days of receipt of notice of denial, to do one of the following:

a. Unless otherwise stated in a specific RFP or RFA, the applicant may file a request for a supplemental review by the FNR committee pursuant to the provisions of this Rule; or

b. In lieu of supplemental review, the applicant may file an administrative appeal, pursuant to the provisions of this Rule. Such request for administrative appeal shall be filed with the Division of Administrative Law (DAL) within 30 calendar days of receipt of the notice of the denial letter.

i. The applicant is not required to request a supplemental review and may elect to proceed directly to an administrative appeal.

La. Admin. Code tit. 48, § I-12505

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 21:812 (August 1995), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 34:2612 (December 2008),, amended LR 35:2438 (November 2009), LR 36:323 (February 2010), LR 38:1593 (July 2012), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 412636 (12/1/2015), Promulgated by the Department of Health, Health Standards Section, LR 50224 (2/1/2024), Amended LR 50985 (7/1/2024).

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