La. Admin. Code tit. 48 § I-12513

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

Section I-12513 - Intermediate Care Facilities for the Developmentally Disabled

A. Except as otherwise provided in this Chapter, no ICF-DD shall be certified or enrolled to participate in the Title XIX program unless the FNR program has granted an approval for an additional ICF-DD facility or additional ICF-DD beds to be enrolled in the Title XIX program.

B. The geographic service area for a proposed or existing ICF-DD facility is designated as the LDH administrative region in which the facility or proposed facility is or will be located. The administrative regions and the parishes that comprise these regions are as follows:

1. Region I: Jefferson, Orleans, Plaquemines, and St. Bernard;

2. Region II: Ascension, East Baton Rouge, East Feliciana, Iberville, Pointe Coupee, West Baton Rouge, and West Feliciana;

3. Region III: Assumption, Lafourche, St. Charles, St. James, St. John, St. Mary, and Terrebonne;

4. Region IV: Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin, and Vermilion;

5. Region V: Allen, Beauregard, Calcasieu, Cameron, and Jefferson Davis;

6. Region VI: Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon, and Winn;

7. Region VII: Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine, and Webster;

8. Region VIII: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, and West Carroll; and

9. Region IX: Livingston, St. Helena, St. Tammany, Tangipahoa, and Washington.

C. The beds and population of the geographic service area where the facility is located, or is proposed to be located, will be considered in determining the need for the facility or additional beds. The beds that are counted in determining the need for community and group homes are licensed and approved Medicaid-enrolled beds as of the due date for a decision on application.

D. Data sources utilized include information compiled by the FNR program and the middle population projections recognized by the State Planning Office as official projections. The population projections utilized are those for the year that the beds are to be enrolled in the Medicaid program.

E. In accordance with the department's policy of least restrictive environment, there is currently no identified need for additional facilities with 16 or more beds. Therefore, applications for facilities of 16 or more beds shall not be accepted for review, and applications to increase existing facilities to 16 or more beds shall not be accepted for review.

F. At the present time, the recommended bed-to-population ratio for community and group homes has been achieved. However, special needs and circumstances may arise that the department may consider as indicators of need for additional beds such as occupancy rates, availability and accessibility of clients in need of placements, patient origin studies, and requests for special types of beds or services.

1. For service areas in which average annual occupancy for the four most recent quarters (as reported in the MR-2) is in excess of 93 percent, the department may review the census data, utilization trends, and other factors described in this Section to determine if additional beds are needed.

G. If the department determines that there is a need for beds in a parish with an average annual occupancy in excess of 93 percent, a Request for Proposals (RFP) or Request for Applications (RFA) will be issued. No applications will be accepted under these provisions unless the department declares a need and issues a RFP or RFA. Applications will be accepted for expansion of existing facilities and/or for the development of new facilities. However, no applications will be considered for any facility with 16 or more beds.

1. The RFP or RFA will indicate the region in need of beds, the number of beds needed, the date that the beds are to be available to the target population (fully licensed and enrolled in Medicaid), and the factors that the department considers relevant in determining the need for the additional beds.

2. The RFP or RFA will specify the MR-2 that the determination of need is based.

3. The RFP or RFA will be issued and will specify the dates that the department will accept applications.

4. Applications will be accepted for a period to be specified in the RFP or RFA. Once submitted, an application cannot be changed and additional information will not be accepted.

5. The RFP or RFA shall specify the following:

a. application submission requirements;

b. a due date for applications;

c. process of review by the FNR committee of any applications timely received, including any supplemental review process;

d. notice of selection;

e. information on appeals processes for applicants that are not granted FNR approval; and

f. other information or requirements for the RFP or its process, as determined by the department.

H. The FNR committee will review the proposals and independently evaluate and assign points to each of the following 10 items on the application for the quality and adequacy of the response to meet the need of the project:

1. work plan for Medicaid certification;

2. availability of the site for the proposal;

3. relationship or cooperative agreements with other healthcare providers;

4. accessibility to other healthcare providers;

5. availability of funds and financial viability;

6. experience and availability of key personnel, as well as compliance history if the applicant is or has been previously licensed as an ICF-DD;

7. range of services, organization of services, and program design;

8. methods to achieve community integration;

9. methods to enhance and assure quality of life; and

10. plan to ensure client rights, maximize client choice, and family involvement.

I. A score of 0-20 will be given to the applicant's response to each item using the following guideline:

1. 0 = inadequate response;

2. 5 = marginal response;

3. 10 = satisfactory response;

4. 15 = above average response; and

5. 20 = outstanding response.

J. In the case of a tie for the highest score for a specific facility or additional beds, the FNR committee will conduct a comparative review of the top scoring proposals that will include prior compliance history. The FNR committee may request and review data from OCDD and HSS on prior compliance history. Subject to Subsection L of this Section, the FNR committee will make a decision to approve one of the top scoring applications based on the comparative review of the proposals.

K. If no proposals are received that adequately respond to the need, the FNR committee may opt not to approve an application. However, the evaluation period may be extended, if provided for in the RFP or RFA.

L. At the end of the 90-day review period, each applicant will be notified of the department's decision to approve or disapprove the application. However, the evaluation period may be extended, if provided for in the RFP or RFA. Applicants will be given 30 days from the date of receipt of the notification by the department in which to file an appeal.

1. The issuance of the approval of the proposal with the highest number of points shall be suspended during the 30-day period for filing appeals and during the pendency of any administrative appeal. All administrative appeals shall be consolidated for purposes of the hearing.

M. Proposals approved under these provisions are bound to the description in the application with regard to type of beds and/or services proposed as well as to the location as defined in the RFP issued by the department.

1. Approval for Medicaid shall be revoked if these aspects of the proposal are altered.

2. Beds to meet a specific disability need approved through this exception shall be used to meet the need identified.

N. Prior approval from the OCDD is required before admission of all Medicaid recipients to facilities in beds approved to meet a specific disability need identified in an RFP issued by the department.

O. Exception for approved beds in downsizing large residential ICF-DD facilities (16 or more beds).

1. A facility with 16 or more beds that voluntarily downsizes its enrolled bed capacity in order to establish a group or community home shall be exempt from the bed need criteria.

a. Beds in group and community homes that are approved under this exception are not included in the bed-to-population ratio or occupancy data for group and community homes approved under the FNR program.

2. Any enrolled beds in the large facility will be disenrolled from the Title XIX program upon enrollment of the same number of group or community home beds.

3. When the department intends to downsize the enrolled bed capacity of a state-owned facility with 16 or more beds in order to develop one or more group or community homes, and the approved beds will be owned by the state, a cooperative endeavor agreement (CEA) will be issued.

a. The CEA will be issued and beds shall be made available in accordance with the methods described in this Section;

4. For private facility beds downsized to privately owned group or community homes, these facilities should contact the regional OCDD in the region where the proposed community or group home beds will be located. These proposals do not require FNR approval.

P. Exception for Additional Beds for Certain ICFs-DD

1. Any ICFs-DD that serve children or adults suffering from developmental disabilities, autism, or behavioral problems and that had no less than 150 and no more than 180 approved beds as of August 15, 2003, shall, upon application to the department, be granted approval for up to 50 additional beds without being required to meet the standards set forth in this Section, §12505, or §12513 Q

Q. Group and community home beds shall be enrolled in the Title XIX program within 12 months of the date of approval by the FNR program.

1. A one-time 90-day extension may be granted, at the discretion of the department, when delays are caused by circumstances beyond the control of the applicant (e.g. acts of God). Inappropriate zoning is not a basis for an extension.

2. If the beds are not enrolled in the Title XIX program within the time limits specified in this Subsection, the approval will automatically expire.

R. Approval of a group or community home bed shall be revoked when the OCDD advises that the bed that was approved for Title XIX reimbursement to meet a specific disability need identified in a RFP issued by the department, is not being used to meet that identified need based on the facility serving a Medicaid recipient in the bed without prior approval from the OCDD.

La. Admin. Code tit. 48, § I-12513

Repromulgated 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 34:2617 (December 2008), amended LR 35:2438 (November 2009), Promulgated by the Department of Health, Health Standards Section, LR 50226 (2/1/2024).

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