La. Admin. Code tit. 50 § II-10103

Current through Register Vol. 50, No. 12, December 20, 2024

Section II-10103 - Certification

A. Certification of title XVIII (Medicare)/ skilled nursing facilities (SNF). DHH shall obtain a certification notice from the Secretary of the Department of Health and Human Services (DHHS) that verifies a skilled nursing facility is qualified to participate in the Title XVIII Program. The facility shall request a certification packet from BHSF/HSS state office.

B. Certification of Title XIX (Medicaid)/Nursing Facilities (NF)

1. To participate in title XIX (Medicaid Program), a nursing facility must have facility need review approval, be enrolled as a provider, and be in compliance with the requirements for participation established by federal regulations. A nursing facility may participate in the Medicaid program by meeting the requirements.

2. A facility must obtain licensure of the beds prior to or in conjunction with the request for certification of beds. Licensure of beds is performed by BHSF/HSS. For Medicaid Program participation, all beds to be certified in the Medicaid Program shall be licensed nursing facility beds.

3. Instructions and forms are contained in the packet for the NF to follow to initiate the certification process. These include but are not limited to the following.

4. Facility Need Review. Facility need review approval must be obtained for Medicaid participation. The facility shall secure approval from the Facility Need Review Program to certify that there is no cause to deny the facility from participation in the Medicaid program on the basis of need. The approval shall designate the appropriate name of the legal entity operating the facility and the number of beds eligible for Medicaid program enrollment. If the approval is not issued in the complete name of the legal entity operating the facility, evidence shall be provided to verify that the legal entity which obtained the original approval is the same legal entity operating the facility.

5. Disclosure Requirement

a. As part of the certification requirement, all Medicaid Program participating facilities shall supply BHSF/HSS with a completed Disclosure of Ownership Control Interest statement, HCFA 1513, which requires information as to the identity of the following individuals:

i. each person having a direct or indirect ownership interest in the facility of five percent or more;

ii. each owner (in whole or in part) with a five percent interest in any property, assets, mortgage, deed of trust, note, or other obligation secured by the facility;

iii. each officer and director when a facility is organized as a corporation;

iv. each partner when a facility is organized as a partnership; and

v. within 35 days from the date of request, the provider shall submit full and complete information, as specified by the BHSF, regarding the following:

(a). the ownership of any subcontractor with whom the facility has had more than $25,000 in business transactions during the previous 12 months; and

(b). information as to any significant business transactions between the facility and the subcontractor or wholly owned suppliers during the previous five years.

b. The Department of Health and Hospitals Health Standards Section shall arrange for on-site surveys for compliance with Medicaid and title VI (civil rights), life safety, and sanitation. The effective date of certification can be no earlier than the completion date of the survey, assuming all requirements are met. If requirements are not met at the time of survey, then the certification date may be delayed at the discretion of the state agency either until the facility signs an acceptable plan of correction or a follow-up visit verifies substantial compliance.

6. Change in Certification

a. A facility wishing to change its participation from Medicare/Medicaid (SNF-NF) to Medicaid (NF) or from Medicaid (NF) to Medicare/Medicaid (SNF-NF) shall submit to the Health Standards Section a letter of intent. Once the facility has been determined eligible to participate, the Medicaid Program (Medicaid) provider agreement will be amended accordingly.

b. Bed certification change - a facility wishing to change the number of beds in either category (Medicare or Medicaid) shall submit to DHH a letter of intent.

La. Admin. Code tit. 50, § II-10103

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.