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services (exclusive of support coordination services) for a period of 30 consecutive days.
5.The health, safety and welfare of the individual cannot be assured through the provision of ADHC Waiver services.
6.The individual fails to cooperate in the eligibility determination process or in the performance of the CPOC.
7.It is not cost effective to serve the individual in the ADHC Waiver.

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

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 34:2163 (October 2008).

Chapter 27.Provider Participation

§2701.General Provisions

A.Each adult day health care center shall enter into a provider agreement with the department to provide services which may be reimbursed by the Medicaid Program, and shall agree to comply with the provisions of this Rule.

B.The provider agrees to not request payment unless the participant for whom payment is requested is receiving services in accordance with the ADHC Waiver program provisions.

C.ADHC providers shall ensure that all non-licensed direct care staff meet the minimum mandatory qualifications and requirements for direct service workers as required by R.S. 40:2179-2179.1 and be registered on the Louisiana Direct Service Worker Registry.

D. - G.Repealed.

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

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:2041 (September 2004), amended by the Department of Health and Hospitals, Office for Aging and Adult Services, LR 34:2164 (October 2008).

§2703.Reporting Requirements

A.Support coordinators and direct service providers, including ADHC providers, are obligated to report changes to the department that could affect the waiver recipient’s eligibility including, but not limited to, those changes cited in the denial or discharge criteria.

B.Support coordinators and direct service providers, including ADHC providers, are responsible for documenting the occurrence of incidents or accidents that affect the health, safety and welfare of the recipient and completing an incident report. The incident report shall be submitted to the department with the specified requirements.

C.Support coordinators shall provide the participant’s approved comprehensive plan of care to the ADHC provider in a timely manner.

D.ADHC providers shall provide the participant’s approved individualized service plan to the support coordinator in a timely manner.

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

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 34:2164 (October 2008).

Chapter 29.Reimbursement

§2901.General Provisions

A.Development. Adult Day Health Care providers shall be reimbursed a per diem rate for services provided under a

prospective payment system (PPS). The system shall be designed in a manner that recognizes and reflects the cost of direct care services provided. The reimbursement methodology is designed to improve the quality of care for all adult day health care waiver recipients by ensuring that direct care services are provided at an acceptable level while fairly reimbursing the providers.

B.Reimbursement shall not be made for ADHC Waiver services provided prior to the department’s approval of the CPOC.

C. - E.1.Repealed.

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

HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:2041 (September 2004), amended by the Department of Health and Hospitals, Office of Aging and Adult Services, LR 32:2257 (December 2006), LR 34:2164 (October 2008).

§2903.Cost Reporting

A.Cost Centers Components

1.Direct Care Costs. This component reimburses for in-house and contractual direct care staffing and fringe benefits and direct care supplies.
2.Care Related Costs. This component reimburses for in-house and contractual salaries and fringe benefits for activity and social services staff, raw food costs and care related supplies for activities and social services.
3.Administrative and Operating Costs. This component reimburses for in-house or contractual salaries and related benefits for administrative, dietary, housekeeping and maintenance staff. Also included are:
a.utilities;
b.accounting;
c.dietary;
d.housekeeping and maintenance supplies; and
e.all other administrative and operating type expenditures.
4.Property. This component reimburses for depreciation, interest on capital assets, lease expenses, property taxes and other expenses related to capital assets.

B.Providers of ADHC services are required to file acceptable annual cost reports of all reasonable and allowable costs. An acceptable cost report is one that is prepared in accordance with the requirements of this §3103 and for which the provider has supporting documentation necessary for completion of a desk review or audit. The annual cost reports are the basis for determining reimbursement rates. A copy of all reports and statistical data must be retained by the center for no less than five years following the date reports are submitted to the bureau. A chart of accounts and an accounting system on the accrual basis or converted to the accrual basis at year end are required in the cost report preparation process. The Bureau or its designee will perform desk reviews of the cost reports. In addition to the desk review, a representative number of the facilities shall be subject to a full-scope, annual on-site audit. All ADHC cost reports shall be filed with a fiscal year from July 1 through June 30.

C.The cost reporting forms and instructions developed by the bureau must be used by all ADHC facilities participating in the Louisiana Medicaid Program. Hospital based and other provider based ADHC which use Medicare

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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