La. Admin. Code tit. 48 § I-11531

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

Section I-11531 - Home Health Services

A. Definition/Description

1. Home health care is that component of comprehensive health care in which health services are provided to individuals and families in their places of residence for purpose of restoring health or maximizing the level of independence, while minimizing the effects of disability and illness, including terminal illness. Services appropriate to the needs of the individual patient and family are planned, coordinated, and made available by public or private providers organized for the delivery of home health care through the use of employed staff, contractual arrangements, or a combination of the two patterns.

2. Health services provided include, but are not limited to, the following:

a. skilled nursing respiratory therapy

b. home health aide occupational therapy

c. speech therapy and audiology medical social work

d. physical therapy medical supplies

e. nutrition durable medical equipment

3. The home health agency providing medical services maintains a plan for home health services for each patient in conformance with the patient's plan of treatment as prescribed by his/her physician. Such agencies provide care to patients with a wide range of diagnoses and at all levels of dependence, including those completely bed-ridden and those needing to be fed. Persons or groups in need of home health services include elderly persons whose activities are limited by physical and/or mental deterioration; persons who recuperating from a wide range of acute medical problems such as injuries, infections, diseases, and complications of pregnancy.

B. Advantages

1. Home health care provides an increased range of options for the provider, the community and the individual. Services are focused on the individual in need of care, rather than on groups, allowing for economy in the use of professional and other staff. The largest expenditure in home health care is for personal care and supportive services.

2. Studies have shown that patients generally respond more rapidly and fully to care in the home. At a lower cost than a hospitalization, the home health patient generally has an improved outcome in terms of early discharge from care; is less often institutionalized; and has increased contentment, improved mental functioning and increased social activity.

C. Alternatives to Institutionalization

1. A health care system should provide an array of services which provide care without institutionalization, and which match an individual's needs to the appropriate service available. Some of the possible alternatives to institutionalization are adult day care centers, subsidized housing complexes with health services, homemakers, and home health services. There is convincing evidence that such services may not only postpone but often prevent more costly institutionalization.

2. Care at home, through a home health agency, is the most desirable alternative and should be considered first. It should be noted, however, that home care is not a viable alternative to institutionalization for all patients. The environment at home may be inappropriate, the family may be unable to handle the responsibility, or the patient may not have a family. Some patients require the sheltered support of an institution. In the natural order of things, however, institutionalization should be an alternative to home health care.

D. Act 347 of the 1984 Regular Session of the Legislature. Act 347 amends and reenacts R.S. 40:2009.34 relative to home health care agencies, to require the Secretary of the Department of Health and Human Resources to promulgate rules to require approval by the agency responsible for the implementation of Section 1122 of the Social Security Act as a condition for licensure. Such approval will be required for the first licensing of all home health agencies not in existence as of April 20, 1985.

E. Utilization.

1. The benefits of home health care over institutional care have been documented in preceding paragraphs; however, underutilization of home health agencies can lead to lower quality of care and a proliferation of underutilized agencies is undersirable as an alternative to institutionalization. Optimal utilization of each home health agency should take into account the following factors:

a. the number of direct service staff available to provide home health services;

b. the number of home health visits/services which can be delivered by each direct service staff member per day;

c. the number of days available for the provision of such services;

d. the average length of time used for each visit.

F. Area of Analysis. The area of analysis for home health agencies is defined as the health planning district in which the agency or proposed agency is located.

G. Resource Goals

1. Applicant shall project a caseload of 30 patients or more, and shall provide a list of practicing physicians with referral agreements with the proposed agency.

2. Home health services shall be available at least 8 hours a day 5 days a week and shall be available on an emergency basis 24 hours a day 7 days a week. Home health services shall be available to an individual in need within 1-3 days, contingent upon the patient's condition and the physician's recommendation.

3. A proposal to provide home health services shall indicate that the proposed agency will meet licensing requirements and Medicare certification criteria. Applicants seeking private payor only funds are exempt from meeting Medicare certification criteria.

H. The Department of Health and Human Resources, Division of Licensing and Certification, shall deny licensure to any home health agency which does not receive a favorable recommendation from the department's Division of Policy, Planning and Evaluation as a result of the applicant's failing to meet the criteria stated in the Resource Goals and the General Criteria for Need Certification Reviews.

I. Should the party seeking licensure desired to appeal, he must respond in writing to the Division of Licensing and Certification not more than 30 days after the date for notification of non-licensure in order to request a fair hearing or he forfeits his right of appeal. The hearing shall conform to rules set forth in the Louisiana Administrative Procedure Act.

La. Admin. Code tit. 48, § I-11531

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).