La. Admin. Code tit. 50 § XXI-16901
Current through Register Vol. 50, No. 11, November 20, 2024
Section XXI-16901 - Unit of ReimbursementA.Reimbursement for the following services shall be a prospective flat rate for each approved unit of service provided to the waiver beneficiary. One quarter hour (15 minutes) is the standard unit of service and reimbursement shall not be made for less than one quarter hour of service. This covers both the service provision and administrative costs for these services: 2. housing stabilization transition; 3. housing stabilization; 4. community living supports (CLS); a. up to three beneficiaries may share CLS services if they share a common provider of this service;b. there is a separate reimbursement rate for CLS when these services are shared;5. professional services furnished by a/an: d. occupational therapist;7. adult day health care;8. pre-vocational service; andB. The following services are reimbursed at the cost of adaptation device, equipment or supply item: 1. environmental accessibility adaptations; and a. Upon completion of the environmental accessibility adaptations and prior to submission of a claim for reimbursement, the provider shall give the beneficiary a certificate of warranty for all labor and installation work and supply the beneficiary with all manufacturers' warranty certificates.2. assistive technology/specialized medical equipment and supplies.C. The following services are reimbursed at a per diem rate: 2. companion care services;3. shared living services; a. per diem rates are established based on the number of individuals sharing the living service module for both shared living non-conversion and shared living conversion services; and4. monitored in-home caregiving services. a. The per diem rate for monitored in-home caregiving services does not include payment for room and board, and federal financial participation is not claimed for room and board.D. The reimbursement for transportation services is a flat fee based on a capitated rate. E. Nursing services are reimbursed at either an hourly or per visit rate for the allowable procedure codes.F. Installation of a personal emergency response system (PERS) is reimbursed at a one-time fixed rate and maintenance of the PERS is reimbursed at a monthly rate.G. Transition expenses from an ICF/IID or nursing facility to a community living setting are reimbursed at the cost of the service(s) up to a lifetime maximum rate of $3,000.H. Dental Services. Dental services are reimbursed according to the LA Dental Benefit Program.I. The assessment performed by the monitored in-home caregiving provider shall be reimbursed at the authorized rate or approved amount of the assessment when the service has been prior authorized by the plan of care.J. Reimbursement Exclusion. No payment will be made for room and board under this waiver program.La. Admin. Code tit. 50, § XXI-16901
Promulgated by the Department of Health and Hospitals, Office for Citizens with Developmental Disabilities, LR 33:2456 (November 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 39:1049 (April 2013), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 412170 (10/1/2015), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 4263 (1/1/2016), Amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities LR 42900 (6/1/2016), Amended by the Department of Health, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities, LR 432530 (12/1/2017), Amended LR 451769 (12/1/2019), Amended LR 471527 (10/1/2021), Amended LR 481573 (6/1/2022).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.