La. Admin. Code tit. 48 § I-12545

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

Section I-12545 - General Provisions

A. A NF may have all of its approved beds disenrolled from the Medicaid program and placed in abeyance if the department determines that the average annual occupancy in the service area where the facility is located is less than 85 percent. The department shall base this determination on the occupancy figures contained in the most recent LTC-2 report issued by the department prior to its receipt of a written request that the facility's beds be placed in abeyance in accordance with §12545 B

B. In order to request that a facility's beds be placed in abeyance, all persons or entities who are the holders of the approval, the NF license, and the Medicaid provider agreement shall submit to the department a written request signed by each such person or entity. The written request shall:

1. specify the date, that shall be no later than 120 days after the receipt of the request by the department that the intended closure of the facility will occur; and

2. designate an individual, referred to hereafter as the designated contact person, who shall serve as the contact between the party(ies) submitting the request and the department with respect to all matters involving the placing of the facility's beds in abeyance and their removal from abeyance.

a. The written request shall include the mailing address and telephone number of that person.

b. If the designated contact person is changed, a written notice thereof, signed by each person or entity who submitted the original request, shall be given to the department.

C. If the department determines that the requirements set forth in §12545.A and B have been met, it shall issue a written Notice of Abeyance and forward it to the designated contact person within 30 calendar days after its receipt of the request for abeyance, subject to the provisions of §12545,L. If the department determines that these requirements have not been met or that the issuance of a Notice of Abeyance would conflict with §12545 L, it shall issue a written denial and forward it to the designated contact person within 30 calendar days after its receipt of the request.

D. All of a facility's approved beds shall be disenrolled from the Medicaid Program within 120 days after the designated contact person's receipt of a Notice of Abeyance. An extension not to exceed 90 days may be granted if extenuating circumstances warrant said extension, such as safe transfer of patients. Otherwise, the Notice of Abeyance will automatically expire at the end of the 120-day period.

E. All of a facility's approved beds may be disenrolled before the designated contact person's receipt of a Notice of Abeyance. However, if he or she does not receive a Notice of Abeyance within 120 days after the beds are disenrolled, the provisions of §12527.D and E will be applicable.

F. With respect to the facility's beds that are not designated to be re-enrolled as Medicaid NF beds, the approval shall automatically expire after 120 days from receipt of the Notice of Abeyance by the designated contact person, unless the beds are re-enrolled by that date, thus rescinding the Notice of Abeyance.

G. A Notice of Abeyance shall remain in effect until the facility's beds are taken out of abeyance and are re-enrolled in Medicaid.

H. A facility's beds shall remain in abeyance until the average annual occupancy in the facility's service area, as shown in the most recent LTC-2 report, has exceeded 93 percent.

I. If the department determines that the average annual occupancy in the facility's service area, as shown in the most recent LTC-2 report has exceeded 93 percent, it shall give written notice thereof to the designated contact person.

1. The written notice shall specify the number of the facility's approved beds that must be taken out of abeyance and re-enrolled as Medicaid NF beds.

2. That number shall be determined by the department based upon the following criteria.

a. A NF with 120 or fewer enrolled beds at the time of the request may return all of its enrolled beds from abeyance.

b. A NF with 121 to 160 enrolled beds at the time of the request may return up to 80 percent of its beds from abeyance, but in no case shall it be required to return fewer than 120 beds.

c. A NF with 161 or more enrolled beds at the time of the request may return up to 75 percent of its beds from abeyance, but in no case shall it be required to return fewer than 128 beds, nor shall it be allowed to return more than 175 beds.

d. A NF may choose to return fewer beds from abeyance than are allowed by this Subparagraph and if it does so, the balance of the beds shall be disenrolled.

J. Within one year after the receipt of the written notice described in §12545 I, or in the case of new construction for a replacement facility, within 24 months after the receipt of such notice, the beds specified by the department shall be taken out of abeyance and re-enrolled as Medicaid NF beds.

1. An extension of that time 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).

2. Inappropriate zoning is not a basis for extension.

3. If the facility's beds that are designated to be re-enrolled as Medicaid NF beds are not re-enrolled within the specified time period, the approval for those beds will automatically expire at the end of that period.

K. If, after issuing the written notice provided in §12545.I to the designated contact person, the department determines that the requirement set forth in §12545.H is no longer met, the obligation to place the facility's beds back in service in accordance with §12545.J shall not be affected or negated.

L. If two or more requests to place beds in abeyance are pending at the same time, and the issuance of Notices of Abeyance for all of the pending requests would conflict with §12545 L, priority shall be assigned to the requests as follows.

1. If two or more facilities are located in the same service area, a request with respect to a facility having a lower average annual occupancy rate shall have priority over a request with respect to a facility having a higher average annual occupancy rate, based on the most recent LTC-2 report issued by the department.

M. While a facility's beds are in abeyance, the ownership of the approval for those beds may not be transferred and shall not be subject to any legal instrument purporting to transfer a bed.

N. All of a facility's beds that are taken out of abeyance and re-enrolled in the Medicaid program, shall remain located together in one facility that shall be either the original facility in which they were located before being placed in abeyance or another facility located in the same service area as the original facility.

La. Admin. Code tit. 48, § I-12545

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 35:2441 (November 2009), Promulgated by the Department of Health, Health Standards Section, LR 50237 (2/1/2024).

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