La. Admin. Code tit. 48 § I-4615

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

Section I-4615 - Denial of Medicaid Payment

A. The department may impose the sanction of "denial of Medicaid payment" with respect to any individual admitted to or provided services by a facility for any violation of statute, rule or regulation including, but not limited to:

1. a violation of a rule or regulation that creates a condition or occurrence relating to the maintenance and/or operation of a facility which results in death or serious harm to a resident, patient or client;

2. a violation of a rule or regulation in which a condition or occurrence relating to the maintenance and/or operation of a facility is created and results in the substantial probability of death or serious physical or mental harm to a resident, patient or client will result from the violation;

3. a repeat violation of a rule or regulation in which a condition or occurrence relating to the maintenance and/or operation of a facility creates a potential for harm by directly threatening the health, safety, rights, or welfare of a client; or

4. more than two substantiated complaint surveys in two years.

B. This sanction shall remain in effect until:

1. the department determines that the facility is in compliance with the requirements; and

2. the department has provided notice to the facility of its compliance and the lifting of the sanction.

C. The department has the discretion to apply this sanction to new admissions only.

D. The facility shall notify all clients and all potential new clients of the imposition of this sanction.

E. The facility is prohibited from seeking reimbursement from a Medicaid recipient for services provided during the imposition of this sanction.

F. This sanction may be used in conjunction with other sanctions including, but not limited to, removal from the freedom of choice list and transfer of clients to another facility.

La. Admin. Code tit. 48, § I-4615

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:3079 (November 2013).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:2009.11, 40:2009.23, 40:2199 and 40:2199.1.