The Louisiana Department of Health issued two Emergency Rules in the September 20, 2016 Louisiana Register amending licensing standards governing Pediatric Day Health Care Facilities in an effort to avoid a budget deficit in the medical assistance program. The Emergency Rules revised the PDHC’s Program description and criteria to provide that in order to receive PDHC services, a Medicaid recipient must not only have a medically fragile condition, but also must have a medically complex condition involving one or more physiological or organ systems and requires skilled nursing and therapeutic interventions performed by a registered nurse or licensed practical nurse on an ongoing basis in order to:
- preserve and maintain health status;
- prevent death;
- treat/cure disease;
- ameliorate disabilities or other adverse health conditions; and/or
- prolong life.
The above list is new and supersedes the former list of medically necessary interventions that could previously be performed by “professionals” at the PDHC centers, but now require performance by a licensed nurse.
The Emergency Rules further require that a physician must order the PDHC services and prepare a plan of care not to exceed 90 days specifying the frequency and duration of services. The Emergency Rules also changed the requirement that a re-evaluation of PDHC services be performed at least every one hundred and twenty (120) to now mandate that the PDHC’s medical director review the plan of care with the PDHC staff and the prescribing physician every ninety (90) days. The evaluation must include a review of the current plan of care and the provider agency’s documented current assessment and progress toward goals. A face-to-face evaluation must also be held every ninety (90) days by the child’s prescribing physician.
Finally, the Emergency Rules clarify that a parent, legal guardian or legally responsible person providing care to a medically complex child in a home or any other extended care or long-term care facility is not considered a PDHC facility and shall not be enrolled in the Medicaid Program as a PDHC services provider.
The Emergency Rules took effect September 1, 2016, and are expected to reduce expenditures in the Medicaid Program by $527,764.00 in state fiscal year 2016-2017.