La. Admin. Code tit. 48 § I-12517

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

Section I-12517 - Nursing Facilities

A. Except as otherwise provided in this Chapter, no nursing facility (NF) shall be licensed and certified or enrolled to participate in the Title XIX program unless the FNR program has granted an approval for an additional NF or additional nursing beds to be licensed and enrolled in the Title XIX program.

NOTE: The statutory moratorium in R.S. 40:2116.1(B), or any successor statute, prohibits the department from issuing new FNR approvals for NF or additional beds in NF until the statutory moratorium expires.

B. The geographic service area for proposed or existing NF or beds is the parish in which the physical location is located.

1. Exception. Any parish that has any portion of the parish below Interstate 10, and that is intersected by the Mississippi River, will be composed of two separate service areas as divided by the Mississippi River.

C. Nursing facility beds located in distinct parts of acute care general hospitals shall be approved through FNR in order to be enrolled to participate in the Medicaid program.

D. In reviewing the need for beds, all proposed beds shall be considered available as of the projected date of the project. The FNR program does not recognize the concept of phasing-in beds, whereby an applicant provides two or more opening dates.

E. For FNRs in which the bed to population ratio is a factor, the bed inventory that will be used is that which is current on the date that the complete application is received.

1. The bed to population ratio will be recomputed during the review period when the report is incorrect due to an error by the department.

F. For FNRs in which utilization is a factor, the occupancy report that will be used is that which is current on the date that the complete application is received.

1. The occupancy rate will be recomputed during the review period when the report is incorrect due to an error by the department.

G. The determination of occupancy rates of nursing facilities or beds shall be as follows:

1. Beds for which occupancy shall be based shall include NF beds that are enrolled in Title XIX.

2. Each licensed bed shall be considered as available for utilization for purposes of calculating occupancy; and

3. A bed shall be considered in use, regardless of physical occupancy, based on payment for nursing services available or provided to any individual or payer through formal or informal agreement.

H. The beds and population of the geographic service area where the NF is located, or is proposed to be located, will be considered in determining the need for the facility or beds.

1. The beds that are counted in determining need for nursing facilities, are beds that are approved, licensed beds or are approved, unlicensed beds as of the due date for decision on an application.

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

J. In order for additional beds or facilities to be added in a service area, the bed-to-population ratio for NF beds shall not exceed 65 Medicaid approved beds per 1,000 elderly population in a service area, and the average annual occupancy for the four most recent quarters (as reported in the LTC-2) shall exceed 95 percent in the service area.

K. Exceptions for areas with high occupancy rates may be considered in the following situations.

1. A Medicaid enrolled NF that maintains 98 percent average annual occupancy of its enrolled beds for the four most recent quarters (as reported in the LTC-2) may apply for approval of additional beds to be enrolled in the Medicaid program.

a. In order for an application to be considered, all approved beds in the facility shall be enrolled in Title XIX.

b. In order for a facility to reapply for additional beds, all approved beds shall be enrolled in Title XIX for the four most recent quarters, as reported in the LTC-2.

c. The number of beds that application may be made shall not exceed 10 beds.

d. In determining occupancy rates for purposes of this exception, only an adjustment of one additional day after the date of death for the removal of personal belongings, shall be allowed if used for that purpose.

i. This adjustment shall not be allowed if nursing services available or provided to another individual are paid for through formal or informal agreement in the same bed for that time period.

e. In determining occupancy rates, more than one NF bed enrolled in Title XIX shall not be considered occupied by the same resident, regardless of payment for nursing services available or provided.

f. For a Medicaid enrolled NF with high occupancy to apply for additional bed approval, documentation of availability of health manpower for the proposed expansion shall be required.

g. For a Medicaid enrolled NF with high occupancy to apply for additional bed approval, for the most recent 36 months preceding the date of application, compliance history and quality of care performance of the applicant facility shall be void of any of the following sanctions:

i. appointment of a temporary manager;

ii. termination, non-renewal or cancellation, or initiation of termination or non-renewal of provider agreement; or

iii. license revocation or non-renewal.

2. When average annual occupancy for the four most recent quarters (as reported in the LTC-2) exceeds 95 percent in a parish, the department will determine whether additional beds are needed, and if indicated, may issue a Request for Proposals (RFP) or Request for Applications (RFA) to develop the needed beds.

a. Upon issuance of the utilization report, the department will identify the parishes with average annual occupancy in excess of 95 percent. The LTC-2 is issued by the department in the fourth month following the end of each calendar quarter.

b. In order to determine if additional beds are needed for each parish that average annual occupancy is in excess of 95 percent, the department may review the census data, utilization trends, and other factors such as:

i. special needs in an area;

ii. information received from other healthcare providers and other knowledgeable sources in the area;

iii. waiting lists in existing nursing facilities;

iv. requests from the community;

v. patient origin studies;

vi. appropriateness of placements in an area;

vii. remoteness of an area;

viii. occupancy rates in adjoining and/or adjacent parishes;

ix. availability of alternatives;

x. reasonableness of distance to nursing facilities;

xi. distribution of beds within a geographic service area; and

xii. such other factors as the department may deem relevant.

c. The number of beds that can be added shall not exceed 15 percent of the existing approved beds in the parish, or 120 beds, whichever is less. The department will strive to assure that occupancy in existing NF in the area will not decline below 85 percent as a result of the additional beds.

3.If the department determines that there is, in fact, a need for beds in a parish with average annual occupancy in excess of 95 percent, a RFP or 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 expansions of existing facilities and/or for the development of new nursing facilities.

a. The RFP will be issued and will specify the dates that the department will accept applications. Also, NF in the geographic service area and adjoining parishes will be notified of the issuance of the RFP.

b. The RFP will indicate the parish and/or geographic service area in need of beds, the number of beds needed, the date that the beds are needed to be available to the target population enrolled in Medicaid, and the factors that the department considers relevant in determining need for the additional beds. The RFP will specify the LTC-2 that the determination of need is based.

c. Applications will be accepted for a 30-day period, to be specified in the RFP. Once submitted, an application cannot be changed and additional information will not be accepted.

d. The RFP or RFA shall specify the following:

i. application submission requirements;

ii. a due date for applications;

iii. process of review by the department of any applications timely received, including any supplemental review process;

iv. notice of selection;

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

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

e. The department will review the proposals and independently evaluate and assign points (out of a possible 120) to the applications as follows:

i. 0-20 points: availability of beds to the Title XIX population;

ii. 0-20 points: appropriateness of location or proposed location.

iii. 0-20 points: responsiveness to groups with special needs (e.g., Acquired Immunodeficiency Syndrome patients, ventilator assisted patients, technology dependent patients);

iv. 0-20 points: experience and availability of key personnel (e.g., director of nursing, administrator, medical director);

v. 0-20 points: distribution of beds/facilities within the geographic service area. Geographic distribution of existing beds and population density will be taken into account.

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

i. 0 = inadequate response;

ii. 5 = marginal response;

iii. 10 = satisfactory response;

iv. 15 = above average response; and

v. 20 = outstanding response.

g. If there is a tie for the highest score for a specific facility or beds, the department will conduct a comparative review of the top scoring proposals that will include prior compliance history, if applicable. The department may request and review data from OAAS and HSS on prior compliance history. Subject to K.3.h of this Section, the department will make a decision to approve one of the top scoring applications based on comparative review of the proposals.

h. If no proposals are received that adequately respond to the need, the department may opt not to approve an application.

i. At the end of the 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 department's notification in which to file an appeal.

j. The issuance of the approval of the application 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.

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

a. Approval for licensing and Medicaid certification shall be revoked if these aspects of the proposal are altered.

L. The following timelines are established for additional NF or beds in NF approved through FNR.

1. Beds that are approved to be added to an existing licensed facility, shall be licensed and enrolled in the Title XIX program within one year of the date of approval by the FNR program.

2. New NF that are approved to be constructed, shall be licensed and enrolled in the Title XIX program within 24 months of the date of the approval by the FNR program.

3. An 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 extension.

La. Admin. Code tit. 48, § I-12517

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:2617 (December 2008), Promulgated by the Department of Health, Health Standards Section, LR 50229 (2/1/2024), Amended LR 50987 (7/1/2024).

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