La. Admin. Code tit. 48 § I-4641

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

Section I-4641 - Notice of Sanctions and Appeals

A. Unless otherwise provided in the licensing standards or other promulgated state rule or regulation, the following notice and appeal procedures are applicable to all sanctions imposed by the department pursuant to a Louisiana state statute or regulation.

B. Notice to Facility of Sanctions. The department shall provide written notice to a health care facility of the imposition of a sanction. The notice shall contain the following information:

1. the nature of the violation(s) and whether the violation is a repeat violation;

2. the legal authority for the violation(s);

3. the sanction assessed for each violation and the effective date of the sanction;

4. notification that the facility has 10 calendar days from receipt of the notice within which to request an administrative reconsideration of the proposed sanction;

5. notification of the administrative reconsideration and/or administrative appeal procedures and the deadlines for each; and

6. notification that the department's decision becomes final and no administrative or judicial review may be obtained if the facility fails to timely request an administrative reconsideration and/or administrative appeal.

C. Waivers. When a civil fine for a class C violation is imposed, the facility may choose to waive its right to an administrative reconsideration and appeal hearing in exchange for paying 50 percent of the fine by submitting the waiver and payment to HSS within 30 days of receipt of the notice imposing the civil fine.

D. Administrative Reconsideration. The facility may request an administrative reconsideration of the department's decision to impose a sanction.

1. The facility's request for an administrative reconsideration must:

a. be in writing;

b. be received by HSS within 10 calendar days of the provider's receipt of the notice of the imposition of the sanction; and

c. include any documentation that demonstrates that the sanction was in error.

2. A reconsideration shall be conducted by designated employees of the department who did not participate in the initial decision to recommend imposition of the sanction.

3. Correction of the deficiency or violation cited for imposition of the sanction shall not be the basis for an administrative reconsideration.

4. A reconsideration shall be conducted as a desk review unless the facility elects to make an oral presentation. The facility may request an oral presentation by notifying HSS within the deadline provided in the notice scheduling the administrative reconsideration.

5. A sanction may be confirmed, reduced or rescinded as a result of the administrative reconsideration. A deficiency may not be altered or rescinded as a result of the administrative reconsideration, except a deficiency may be altered or rescinded in an administrative reconsideration of a revocation, denial of renewal or suspension.

6. A reconsideration decision shall be based upon all documents and the oral presentation furnished by the provider to the department at the time of the administrative reconsideration.

7. A reconsideration decision is final unless the facility timely requests an administrative appeal.

E. Administrative Appeal

1. The provider may request an administrative appeal of the department's decision to impose a sanction.

2. The issue that may be adjudicated in the appeal is the appropriateness of the sanction, including the classification of the violation(s).

3. A deficiency and its underlying facts may not be altered or rescinded as a result of the administrative appeal, except a state deficiency and its underlying facts may be altered or rescinded in an administrative appeal of a revocation, denial of renewal or suspension. For example, in an appeal of a fine due to a Class A violation, the DAL, after hearing the evidence, may decide to reduce the violation to a Class B and reduce the fine accordingly. However, the DAL may not reduce or alter the underlying deficiency on the survey report.

4. The facility's appeal request shall:

a. be in writing;

b. be received by the DAL within 30 days of the provider's receipt of the notice of the imposition of the sanction when no administrative reconsideration is requested, or when an administrative reconsideration is requested, within 30 days of the receipt of the notice of the results of the administrative reconsideration;

c. state what the facility contests and the specific reasons for the disagreement; and

d. shall include any documentation that demonstrates that the sanction was imposed in error.

5. In an appeal contesting a civil fine, the facility shall either post an appeal bond with the DAL as provided in R.S. 40:2009.11 for nursing facilities or R.S. 40:2199(D) for all other facilities, or the facility may choose to pay the fine and file a devolutive appeal.

6. Correction of the deficiency or violation cited for the imposition of the sanction will not be considered as a basis for the appeal.

7. The administrative hearing shall be limited to those issues specifically contested.

8. Except as hereinafter provided, when an administrative appeal is requested in a timely and proper manner, the DAL shall provide an administrative hearing in accordance with the provisions of the APA.

E. Judicial Review. The facility may request judicial review of the administrative appeal decision in the Nineteenth Judicial District Court in accordance with the APA.

La. Admin. Code tit. 48, § I-4641

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 39:3083 (November 2013).

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