La. Admin. Code tit. 50 § XV-12901
Current through Register Vol. 50, No. 11, November 20, 2024
Section XV-12901 - General ProvisionsA. The purpose of long term-personal care services (LT-PCS) is to assist individuals with functional impairments with their daily living activities. LT-PCS must be provided in accordance with an approved service plan and supporting documentation. In addition, LT-PCS must be coordinated with the other Medicaid and non-Medicaid services being provided to the participant and will be considered in conjunction with those other services.B. Each individual requesting or receiving long term-personal care services (LT-PCS) shall undergo a functional eligibility screening utilizing an eligibility screening tool called the level of care eligibility tool (LOCET), or a subsequent eligibility tool designated by the Office of Aging and Adult Services (OAAS).C. Each LT-PCS applicant/participant shall be assessed using a uniform inter RAI home care assessment tool or a subsequent assessment tool designated by OAAS. The assessment is designed to verify that an individual meets eligibility qualifications and to determine resource allocation while identifying an individual's need for support in performance of activities of daily living (ADLs). The assessment generates a score which measures the individual's degree of self-performance of the following activities of daily living: D. Based on the individual's ADL Index score, they are assigned and are eligible for a set allocation of weekly service hours associated with that score.1. If the individual is allocated less than 32 hours per week and believes that they are entitled to more hours, the individual or their responsible representative may request a fair hearing to appeal the decision.2. The individual may qualify for more hours if it can be demonstrated that: a. one or more answers to the questions involving the ADLs used in the ADL Index score are incorrect as recorded on the assessment; orb. they need additional hours to avoid entering into a nursing facility.E. Requests for LT-PCS shall be accepted from the following individuals:1. a Medicaid participant who wants to receive LT-PCS;2. an individual who is legally responsible for a participant who may be in need of LT-PCS; or3. a responsible representative designated by the participant to act on his/her behalf in requesting LT-PCS.F. Each individual who requests LT-PCS has the option to designate a responsible representative. For purposes of these provisions, a responsible representative shall be defined as the person designated by the individual to act on his/her behalf in the process of accessing and/or maintaining LT-PCS. 1. The appropriate form authorized by OAAS shall be used to designate a responsible representative. a. The written designation of a responsible representative does not give legal authority for that individual to independently handle the participant's business without his/her involvement.b. The written designation is valid until revoked by the participant. To revoke the written designation, the revocation must be submitted in writing to OAAS or its designee.2. The functions of a responsible representative are to: a. assist or represent, as needed, the participant in the assessment, care plan development and service delivery processes; andb. to aid the participant in obtaining all necessary documentation for these processes.3. No individual may concurrently serve as a responsible representative for more than two participants in OAAS-operated Medicaid home and community-based services. This includes but is not limited to: a. the Program of All-Inclusive Care for the Elderly;b. long term-personal care services;c. the community choices waiver; andd. the adult day health care waiver.G. The Department of Health may remove an LT-PCS provider from the LT-PCS provider freedom of choice list and offer freedom of choice to LT-PCS participants when: 1. one or more of the following departmental proceedings are pending against an LT-PCS participant's service provider: a. revocation of the providers home and community-based services license;b. exclusion from the Medicaid Program;c. termination from the Medicaid Program; ord. withholding of Medicaid reimbursement as authorized by the departments surveillance and utilization review (SURS) Rule (LAC 50:I.Chapter 41);2. the service provider fails to timely renew its home and community-based services license as required by the home and community-based services providers licensing standards Rule (LAC 48:I.Chapter 50); or3. the service providers assets have been seized by the Louisiana Attorney Generals office.H. The department may offer participants the freedom to choose another provider if/when the owner(s), operator(s), or member(s) of the governing body of the provider agency is/are under investigation related to: 2. tax evasion or tax fraud;4. securities or exchange fraud;6. violence against a person;7. act(s) against the aged, juveniles or infirmed; or8. any crime involving public funds.La. Admin. Code tit. 50, § XV-12901
Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 29:911 (June 2003), amended LR 30:2831 (December 2004), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 32:2082 (November 2006), LR 34:2577 (December 2008), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 35:2450 (November 2009), LR 39:2506 (September 2013), LR 41:540 (March 2015), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 42902 (6/1/2016), Amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services and the Office for Citizens with Developmental Disabilities, LR 431980 (10/1/2017), Amended LR 49878 (5/1/2023).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.