La. Admin. Code tit. 48 § I-13703

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

Section I-13703 - Covered Services

A. All services provided under this program are to be performed in the home for HIV infected clients at a physician's order. Visits are limited to a maximum of once a day unless otherwise indicated.

B. Home Based Care

1. Skilled nursing including but not limited to:

a. medication preparation, administration, and monitoring;

b. care of peripheral and central access devices;

c. insertion, irrigation and maintenance of foley catheters;

d. complex wound care and dressing changes;

e. oxygen therapy and monitoring and other respiratory therapy;

f. venipuncture for laboratory studies;

g. client/significant other education:

i. medications and adverse effects;

ii. diet;

iii. self care;

iv. disease process;

v. treatments;

vi. custodial care;

vii. infection control procedures.

h. aerosolized pentamidine treatments (IM pentamidine is not covered by this program);

i. palliative care focusing on pain relief and symptom control.

2. Home health aides (maximum of five visits per week) to assist with activities of daily living.

3. Supplies, durable medical equipment rental.

4. Medications at a maximum of 30 percent above cost. IV therapy needed more than once a day up to three times a day can be covered for up to eight weeks. Daily IV therapy can continue for the duration of the home based care. Medications covered are those provided under the Level 1, 2, or 3 state formularies or a formulary approved by the department through the LHCA HIV Ambulatory Care Sites.

5. Physical therapy.

6. Social worker services (maximum of two visits a week).

7. Routine diagnostic tests.

8. Nutritional therapy following the Louisiana Medicaid Guidelines including supplements at a maximum of 30 percent above cost. (Physician order need not specify enteral via tube for this program). Total parenteral nutrition is not covered by this program.

C. Hospice Care

1. Skilled nursing services. Palliative care including but not limited to:

a. medication preparation, administration, and monitoring;

b. care of peripheral and central access devices;

c. insertion, irrigation and maintenance of foley catheters;

d. complex wound care and dressing changes;

e. oxygen therapy and monitoring and other respiratory therapy;

f. venipuncture for laboratory studies related to palliative care;

g. client/significant other education:

i. medications;

ii. comfort measures;

iii. self-care;

iv. disease process;

v. treatments;

vi. custodial care;

vii. infection control procedures;

viii. end stage care planning (anticipated signs and symptoms of approaching death);

h. palliative care focusing on pain relief and symptom control;

i. support for client, family, and significant others.

2. Home health aides (maximum of five visits per week) to assist with activities of daily living.

3. Supplies, durable medical equipment rental.

4. Medications at a maximum of 30 percent above cost. IV therapy needed more than once a day up to three times a day can be covered for up to eight weeks. Daily IV therapy can continue for the duration of the hospice care.

Medications covered are those provided under Level 1, 2, or 3 State Formularies or a formulary approved by the department through the LHCA HIV Ambulatory Care Sites.

5. Social worker services (maximum of two visits per week).

6. Pastoral care.

7. Bereavement follow-up for significant others and family members.

8. Trained volunteers to provide support to the client and family through tasks such as shopping, sitting, running errands, preparing meals, and listening.

NOTE: 6, 7, and 8 are not reimbursable services.

D. Personal Care Attendant Services. Personal care attendants to provide services including light housework, grocery shopping, and cooking (maximum of five visits per week and 160 hours per client per twelve month period). Clients may be eligible for an additional 320 hours if they meet one of the following criteria:

1. patients currently receiving care from a licensed hospice agency;

2. prognosis of less than one month as determined by the primary care physician;

3. nursing home or residential care facility placement is not feasible within 30 days.

La. Admin. Code tit. 48, § I-13703

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Resources Management, LR 20:1011 (September 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:256 et seq.

NOTE: Each agency would be strictly controlled in the use of the extension. The referral must come from the client's primary care physician and must meet one of the guidelines above. Approvals would be granted on a case-by-case basis for up to four weeks at a time. Authority for approvals would rest with the HIV Program Office.