La. Admin. Code tit. 48 § I-11529

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11529 - Comprehensive Physical Rehabilitation Facilities (Inpatient)

A. Definition. In general, rehabilitation is the process of restoring disabled persons to the fullest degree of physical, mental, social, vocational, and economic usefulness of which they are capable. Within this context, Comprehensive Physical Rehabilitation Facilities, (CPRF's) are medical facilities which emphasize physical restoration activities for patients with physiologically based disease and disabilities. These facilities are either freestanding or a component of a general hospital. They provide a comprehensive, integrated rehabilitation program of medical, psychological, social, and vocational services, using a multi-disciplinary approach, centered on the patient.

B. Scope of Services

1. Services provided by CPRF's vary in nature and intensity according to the degree of disability and the general condition of the patient. The combination of services provided is designed to meet the individual patient's needs. CPRF's provide or arrange for such services as medical services, rehabilitation, nursing services, occupational therapy, physical therapy, speech therapy, audiology, social services, psychological services, vocational services, prosthetic and orthotic services. The services may be provided directly by staff members or through consultation or affiliation agreements.

2. Comprehensive physical rehabilitation facilities may be highly specialized, and treat only selected conditions or age groups, or treat all or various types of disabilities. Many CPRF's also provide outpatient and/ or follow up care for patients they have rehabilitated. Some of the conditions treated within CPRF's are hemiplegia, paraplegia, quadriplegia, cerebral palsy, multiple sclerosis, amputations, arthritis, cervical/lower back pain syndrom, emphysema, stroke, and hip fracture. The conditions vary greatly, in that some primarily affect certain age groups, some result from accidents, some result from acute diseases, and some are chronic.

C. Coordination of Services

1. The team approach provides comprehensive care within the CPRF by involving different rehabilitation professionals in evaluating and treating the patient. Some experts believe that a physician, preferably a physiatrist, should manage the team, while others believe that a program coordinator may be a physician or another team member. The second option allows team members to serve in different roles on different patients' team. Decisions should be made by each CPRF, based on staffing and affiliation arrangements, staff size, and types and volume of patients.

D. Cost

1. Payment sources for services in comprehensive physical rehabilitation facility are Medicare, Medicaid, Blue Cross and private insurers, selfpaying patients, and charitable organizations. Although the cost of rehabilitation is high, studies have shown that CPRF services, when delivered to appropriate candidates, are cost effective. For example, stroke victims, who would otherwise have been placed in nursing homes, where rehabilitated (in 1977) for an average of $7,000 per patient; the cost of the institutional care would have been from $18,000 to $36,000 per patient per year. In these and many other cases, the cost of intensive short term rehabilitation care is less than the expense of long term maintenance care.

E. Setting/Accessibility

1. Questions have been raised regarding the most appropriate setting for CPRF's. Although there are proponents for both free-standing and hospital-based CPRF's, the appropriateness varies with the availability of specialized personnel, the location of the CPRF's and other health care facilities, and the patient's condition. It is generally agreed that all CPRF's should have working relationships with other segments of the health care system because rehabilitation should begin as soon as possible in the course of an illness. Free-standing CPRF's are usually affiliated with acute care institutions.

2. Availability and planning for CPRF services on a regional basis would serve to reduce costs and to promote the most effective rehabilitation, since utilization of rehabilitation services depends heavily on the spatial and temporal accessibility to the target population. Therefore, the bed need for rehabilitation hospitals or rehabilitation units in general hospitals is determined on a health planning district basis.

F. Service Area

1. The service area for all comprehensive physical rehabilitation beds is the health planning district in which the facility or proposed facility is located.

G. Resource Goals

1. The rehabilitation bed supply should be less than .325 beds per 1,000 population.

a. The methodology for establishing the bed to population ratio for rehabilitation beds is the methodology is based on the Orange County (California) Health Systems Plan published in 1981. The methodology utilizes an incidence-prevalence projection of the numbers of Louisiana citizens who would have one or more of the disabling conditions most commonly treated in a rehabilitation hospital. The formula also includes a percentage estimate of the patients who would actually seek treatment in a rehabilitation hospital.

b. In determining the bed to population ratio for the proposed or existing facility, Division of Policy, Planning and Evaluation will use population projections for the anticipated opening date (year) of the facility, which in no case shall exceed five years subsequent to the year in which the application is declared complete.

c. In determining bed supply, beds which are counted are (1) licensed but not Section 1122 approved beds which are in use or could be put into use within 24 hours*, (2) 1122 approved and licensed beds which are in use or could be put into use within 24 hours*, and (3) 1122 approved beds which are not yet licensed.

2. Occupancy Rate

a. Free-standing Comprehensive Physical Rehabilitation Hospitals

i. A comprehensive physical rehabilitation hospital shall maintain annual occupancy rates relative to the number of beds in the facility:

0- 49-50%

50- 99-60%

100-199-70%

200 + -75%

ii. In determining occupancy rates, beds used in the calculations include: (a.) licensed but not Section 1122 approved beds which are in use or could be put into use within 24 hours, and (b.) 1122 approved and licensed beds which are in use or could be put into use within 24 hours.

iii. *Beds that can be brought into service within 24 hours shall be construed to mean the appropriate number of beds in rooms originally constructed and equipped as hospital rooms that either (1) have not been converted to other uses, or (2) retain all essential nonmobable equipment and connections necessary for patient care in accordance with licensing standards. Nonmovable equipment shall include equipment which can be removed only through reconstruction or renovation.

iv. For any additional comprehensive rehabilitation beds to be approved:

(a). The bed to population ratio shall not exceed .325 per 1000 population and

(b). Either optimal occupancy must be reached by all freestanding comprehensive physical rehabilitation; hospitals in all bed size categories or a 75 percent occupancy of all rehabilitation hospitals in the health planning district must be attained.

H. Rehabilitation Unit of a General Hospital

1. A rehabilitation unit of general hospital shall maintain annual occupancy rates relative to the number of beds in the facility:

0- 49-50%

50- 99-60%

100-199-70%

200 + -75%

2. In determining occupancy rates, beds used in the calculations include:

i. licensed but not Section 1122 approved beds which are in use or could be put into use within 24 hours; and

ii. 1122 approved and licensed beds which are in use or could be put into use within 24 hours.

3. *Beds that can be brought into service within 24 hours shall be construed to mean the appropriate number of beds in rooms originally constructed and equipped as hospital rooms that either (1) have not been converted to other uses, or (2) retain all essential nonmovable equipment and connections necessary for patient care in accordance with licensing standards. Nonmovable equipment shall include equipment which can be removed only through reconstruction or renovation.

4. For any additional comprehensive rehabilitation beds of a general hospital to be approved:

a. the bed to population ration shall not exceed .325 per 1000 population; and

b. either optimal occupancy must be reached by all rehabilitation units of general hospitals in all bed size categories or a 75 percent occupancy of all rehabilitation units of all general hospital in the health planning district must be attained;

c. Adjustment. An existing rehabilitation hospital or rehabilitation unit of a general hospital which has operated at a level of 10 percent or more above its optimal occupancy, as determined by bed size category, for a period of 12 consecutive months will be allowed to add a number of beds that would bring its occupancy down to the optimal down to the optimal occupancy level for its bed size. The occupancy rate for the 12 consecutive months shall be determined by Division of Policy, Planning and Evaluation from the four most recent quarters of data due to have been reported by the hospital to the Division of Licensing and Certification;

d. a proposal to provide rehabilitation services as described herein shall indicate that the facility will meet licensing requirements and Medicare certification criteria as a hospital;

e. the proposal shall indicate that the hospital or rehabilitation unit of a general hospital will meet the following criteria:

i. At least 75 percent of the inpatient population will require intensive rehabilitative services for treatment of one or more of the following conditions:

(a). stroke;

(b). spinal cord injury;

(c). congenital deformity;

(d). amputation;

(e). major multiple trauma;

(f). fracture of femur (hip fracture);

(g). brain injury;

(h). Polyarthritis, including rheumatoid arthritis;

(i). Neurological disorders, including multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy, and Parkinson's disease; and

(j) burns.

ii. A preadmission screening procedure under which each prospective patient's condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient hospital program or assessment.

iii. The facility will furnish through the use of qualified personnel, close medical supervision, rehabilitation nursing, physical therapy, speech therapy, occupational therapy, orthotic and prosthetic services, and social services or psychological services.

iv. The facility shall employ a full time director of rehabilitation who is a doctor of Medicine or Osteopathy, is licensed under state law to practice medicine or surgery, and has had, after completing a 1-year hospital internship, at least 1 year of training in the medical management of patients requiring rehabilitation services, or is board-certified in physiatry, neurology, neurosurgery, orthopedic surgery or rheumatology.

v. The facility shall have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient.

vi. The facility shall use a coordinated multidisciplinary team approach to the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient's medical record to note the patient's status in relationship to goal attainment, and that team conferences to determine the appropriateness of treatment will be held at least every 2 weeks.

5. A rehabilitation unit of a general hospital must present a proposal indicating it will meet the following criteria:

a. written admission criteria must apply uniformly to both Medicare and non-Medicare patients;

b. the unit must have admission and discharge records that are separately identified from those of the hospital in which it is located and are readily retrievable. The unit's policies must provide that necessary clinical information will be transferred to the unit when a patient of the hospital is admitted to the unit;

c. the hospital's utilization review plan must include separate standards for the type of care offered by the unit;

d. the beds assigned to the unit must be physically separate from (i.e. not commingled with) beds not included in the unit;

e. the unit and the hospital in which it is located must be services by the same fiscal intermediary;

f. the unit must be treated as a separate cost center for cost finding and apportionment purposes;

g. the accounting system of the hospital in which the unit is located must provide for the proper allocation of costs and maintain statistical data that are adequate to support the basis of allocation;

h. the cost report for the hospital must include the costs of the unit, must cover a single fiscal period and must reflect a single method of cost apportionment.

La. Admin. Code tit. 48, § I-11529

Promulgated by the Department of Health and Human Resources, Office of Management and Finance LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P. L. 96-79, and R. S. 36:256(b).