La. Admin. Code tit. 48 § I-12507

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

Section I-12507 - Supplemental Application 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. If the applicant decides to request a supplemental review of the denied initial application, a written request for supplemental application review must be received by the department within 30 days of receipt of notice of the denial letter.

B. Upon receipt of the applicant's timely written request to supplement its FNR application, a written confirmation notice will be sent to the applicant informing the applicant of the deadline to submit any additional documentation and evidence in support of the FNR application, pursuant to the provisions of this Rule.

1. If the applicant fails to timely submit the supplemental materials, the supplemental application is automatically denied. Written notice of the denial shall be forwarded to the applicant, with information regarding the applicant's right to file an administrative appeal with the DAL.

C. Upon timely receipt of the supplemental materials from the applicant, the FNR committee shall conduct a supplemental application review.

1. As part of the supplemental application review, the applicant is provided with an opportunity to meet with the FNR committee, or its designees. The meeting may be conducted in-person or, at the discretion of LDH, through virtual means, including by telephone or virtual technology that facilitates synchronous interaction, and includes an opportunity for questions from the applicant and/or committee member(s)/designee(s).

2. If the FNR applicant fails to attend the supplemental review meeting, then the FNR committee may proceed to complete the supplemental review by reviewing any supplemental material submitted by the applicant and issue a supplemental review decision. The FNR committee may, at its discretion, elect to re-schedule the supplemental review meeting upon good cause shown by the FNR applicant.

D. Following the meeting, the applicant will have an additional 30 days to submit any other evidence, data, and documentation to further supplement the FNR application. At the conclusion of this step, the FNR committee will meet to consider all the supplemental documentation, data, and evidence submitted by the applicant, as well as the issues discussed at the meeting with the applicant, if applicable.

1. All members of the FNR committee shall meet in-person or through virtual means, including telephone or virtual technology that facilitates synchronous interaction, to complete the supplemental application review process.

2. The FNR committee shall render a decision on the supplemental application within 60 days of the deadline for submission of any additional documentation and evidence by the applicant after the supplemental review meeting; such decisions are to be by simple majority decision.

3. The FNR committee will issue a final decision to either approve the FNR application or deny the FNR application, and shall forward written notice to the applicant of such decision.

a. The written notice of the supplemental application review decision from the FNR committee will be sent to the applicant by certified mail or by electronic mail with a request for acknowledgement and a read delivery receipt.

b. The written notice shall include information on the applicant's right to file an administrative appeal of the denial with the DAL within 30 calendar days of receipt of the supplemental application denial notice.

c. Failure to file timely for an administrative appeal shall exhaust the applicant's remedies with the department, and the decision to deny FNR approval is final.

La. Admin. Code tit. 48, § I-12507

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 21:806 (August 1995), amended LR 25:1250 (July 1999), LR 28:2190 (October 2002), LR 30:1023 (May 2004), LR 32:845 (May 2006), amended LR 34:2613 (December 2008), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:2279 (October 2010), Promulgated by the Department of Health, Health Standards Section, LR 50225 (2/1/2024), Amended LR 50986 (7/1/2024).

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