La. Admin. Code tit. 50 § XXI-5503

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

Section XXI-5503 - Denial of Admission or Discharge Criteria

A. Beneficiaries shall be denied admission to, or discharged from, the supports waiver if one of the following criteria is met:

1. the beneficiary does not meet the financial eligibility requirements for the Medicaid Program;

2. the beneficiary does not meet the requirement for an ICF/IID level of care;

3. the beneficiary is incarcerated or placed under the jurisdiction of penal authorities, courts or state juvenile authorities;

4. the beneficiary resides in another state or has a change of residence to another state;

5. the beneficiary is admitted to an ICF/IID or nursing facility with the intent to stay and not to return to waiver services:

a. the waiver beneficiary may return to waiver services when documentation is received from the treating physician that the admission is temporary and shall not exceed 90 days;

b. the beneficiary will be discharged from the waiver on the ninety-first day if the participant is still in the ICF/IID or nursing facility;

6. the health and welfare of the beneficiary cannot be assured through the provision of supports waiver services within the beneficiary's approved plan of care;

7. the beneficiary fails to cooperate in the eligibility determination/re-determination process and in the development or implementation of the approved plan of care; and/or

8. continuity of services is interrupted as a result of the beneficiary not receiving a supports waiver service during a period of 30 or more consecutive days. This does not include interruptions in supports waiver services because of hospitalization, institutionalization (such as ICFs/DD or nursing facilities), or non-routine lapses in services where the family agrees to provide all needed or paid natural supports. There must be documentation from the treating physician that this interruption will not exceed 90 days. During this 90-day period, the OCDD will not authorize payment for supports waiver services.

La. Admin. Code tit. 50, § XXI-5503

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 40:2584 (12/1/2014), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 481575 (6/1/2022), Amended LR 50212 (2/1/2024).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.