La. Admin. Code tit. 50 § XIII-101

Current through Register Vol. 50, No. 11, November 20, 2024
Section XIII-101 - Definitions [Formerly LAC 50:XIX.101]
A. The following words and terms, when used in this Subpart 1, shall have the following meanings, unless the context clearly indicates otherwise:

Authorized Healthcare Provider-a physician, nurse practitioner, clinical nurse specialist, or physician assistant licensed, certified, registered, or otherwise authorized to order home healthcare services consistent with Louisiana la w.

Home Health Aide Services - direct care services to assist in the treatment of the patient's illness or injury provided under the supervision of a registered nurse and in compliance with the standards of nursing practice governing delegation, including assistance with the activities of daily living such as mobility, transferring, walking, grooming, bathing, dressing or undressing, eating, or toileting.

Home Health Services-patient care services provided in the patient's home or place of residence under the order of an authorized healthcare provider that are necessary for the diagnosis and treatment of the patient's illness or injury, including one or more of the following services:

a. skilled nursing;
b. physical therapy;
c. speech-language therapy;
d. occupational therapy;
e. home health aide services; or
f. medical supplies, equipment and appliances suitable for use in the patient's home or place of residence.

NOTE: Medical supplies, equipment and appliances for home health are reimbursed through the Durable Medical Equipment Program and must be prior authorized.

Occupational Therapy Services-medically prescribed treatment to improve, maintain or restore a function which has been impaired by illness or injury or, when the function has been permanently lost or reduced by illness or injury, to improve the individuals ability to perform those tasks required for independent functioning

Physical Therapy Services-rehabilitative services necessary for the treatment of the patient's illness or injury or, restoration and maintenance of function affected by the patient's illness or injury. These services are provided with the expectation, based on the authorized healthcare provider's assessment of the patient's rehabilitative potential, that:

a. the patient's condition will improve materially within a reasonable and generally predictable period of time; or
b. the services are necessary for the establishment of a safe and effective maintenance program.

Place of Residence-location where normal life activities take place but does not include a hospital, intermediate care facility for individuals with intellectual disabilities, or any setting in which payment is or could be made under Medicaid for inpatient services that include room and board.

Skilled Nursing Services - nursing services provided on a part-time or intermittent basis by a registered nurse or licensed practical nurse that are necessary for the diagnosis and treatment of a patient's illness or injury. These services shall be consistent with:

a. established Medicaid policy;
b. the nature and severity of the recipient's illness or injury;
c. the particular medical needs of the patient; and
d. the accepted standards of medical and nursing practice.

Speech-Language Therapy Services - those services necessary for the diagnosis and treatment of speech and language disorders that result in communication disabilities, and for the diagnosis and treatment of swallowing disorders (dysphagia), regardless of a communication disability.

La. Admin. Code tit. 50, § XIII-101

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:431 (March 2004), Amended by the Department of Health, Bureau of Health Services Financing, LR 4459 (1/1/2018), Amended LR 49876 (5/1/2023).
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.