Title 48 PUBLIC HEALTH GENERAL Part I. General . - Louisiana
Title 48PUBLIC HEALTH—GENERALPart I. General AdministrationSubpart 3. Licensing and Certificationc. the Council on Accreditation for Children andFamily Services (COA).Chapter 90. Psychiatric ResidentialTreatment Facilities (under 21)Active Treatment—implementation of a professionallydeveloped and supervised individual plan of care that isdeveloped no later than 14 days after admission anddesigned to achieve the recipient’s discharge from inpatientstatus at the earliest possible time.Subchapter A. General Provisions§9001. PurposeA. The purpose of this Chapter 90 is to provide for thedevelopment, establishment and enforcement of statewidestandards for the care of residents in psychiatric residentialtreatment facilities (PRTFs) participating in the MedicaidProgram, to ensure maintenance of these standards, and toregulate conditions in these facilities through a program oflicensure which shall promote safe and adequate treatmentof residents of PRTFs participating in the Medicaid Program.Administrator—the person responsible for the on-site,daily implementation and supervision of the facility’s overalloperation commensurate with the authority conferred by thegoverning rventions and procedures applied in a systematic fashionto promote positive behavioral or functional changefostering the resident's self-control, and to prevent orinterrupt a resident's behavior which threatens harm to theresident or others.B. In addition to requirements stated herein, all licensedPRTFs shall comply with applicable local, state, and federallaws and regulations.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2181-2191 and Title XIX of the Social Security Act.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Office of the Secretary, Bureau of HealthServices Financing, LR 30:54 (January 2004), amended by theDepartment of Health and Hospitals, Bureau of Health ServicesFinancing, LR 38:371 (February 2012).Cessation of Business―when a PRTF participating inthe Louisiana Medicaid Program stops providing services tothe community.Change of Ownership (CHOW)―the sale or transferwhether by purchase, lease, gift or otherwise of a PRTF by aperson/corporation of controlling interest that results in achange of ownership or control of 30 percent or greater ofeither the voting rights or assets of a PRTF or that results inthe acquiring person/corporation holding a 50 percent orgreater interest in the ownership or control of the PRTF.§9003. DefinitionsA. The following defines selected terminology used inconnection with this Chapter 90.Abuse―any one of the following acts which seriouslyendangers the physical, mental or emotional health of theresident:Clinical Director―the person who has responsibilityfor the psychiatric aspects of the program and who has toprovide full-time coverage on an on-site or on-call basis.a. infliction, attempted infliction, or, as a result ofinadequate supervision, the allowance of the infliction orattempted infliction of physical or mental injury upon theresident;b.CMS―the Centers for Medicare and Medicaid Services,Department of Health and Human Services.Core Mental Health Disciplines―academic trainingprograms in psychiatry, psychology, social work andpsychiatric nursing.exploitation or overwork of a resident;c. involvement of the resident in sexual activityconstituting a crime under the laws of this state.DCFS—the Department of Children and FamilyServices.Accreditation—official notification given the providerof compliance to standards established by either:Department―the Department of Health and Hospitals.a. the Joint Commission (TJC), formerly known asthe Joint Commission on Accreditation of HealthcareOrganizations (JCAHO);Discipline―the ongoing practice of helping residentsdevelop inner control so they can manage their own behaviorin an appropriate and acceptable manner.b. theCommissiononRehabilitation Facilities (CARF); orDocumentation—written evidence or proof, includingsignatures of appropriate staff and date, must be maintainedon site and available for review.Accreditationof1Louisiana Administrative CodeFebruary 2015
PUBLIC HEALTH—GENERALDSS―the Department of Social Services.h. a licensed addiction counselor who is licensed assuch under the provisions of R.S. 37:3387.Emergency Safety Intervention―the use of restraint orseclusion as an immediate response to an emergency safetysituation.LSUCCC the Department of Public Safety andCorrections, Louisiana State Uniform Construction CodeCouncil.Emergency Safety Situation―unanticipated residentbehavior that places the resident or others at serious threat ofviolence or injury if no intervention occurs and that calls foran emergency safety intervention.Mechanical Restraint―any device attached or adjacentto the resident's body that he or she cannot easily removethat restricts freedom of movement or normal access to hisor her body.Governing Body―the board of trustees, owner orperson(s) designated by the owner with ultimate authorityand responsibility (both moral and legal) for themanagement, control, conduct, and functioning of the PRTF.Mental Health Professional (MHP)―an individual whois supervised by a LMHP and meets the following criteria asdocumented by the provider:Group (or Unit)―refers to the residents who share acommon space and relate to one primary staff person (whomay be assisted by others) on a consistent or daily basis.a.b. has a Master of Arts degree, Master of Sciencedegree or a Master of Education degree in a mental healthrelated field; andHSS―the Department of Health and Hospitals, HealthStandards Section.i.has a minimum of 15 hours of graduate levelcourse work and/or practicum in applied interventionstrategies/methods designed to address behavioral,emotional and/or mental problems. These hours may havebeen obtained as a part of, or in addition to, the master'sdegree.License—the legal authority to operate as a PRTF in thestate of Louisiana.Licensed Mental Health Professional (LMHP)—anindividual who meets one of the following education andexperience requirements:Mental Health-Related Field―academic trainingprograms based on the principles, teachings, research andbody of scientific knowledge of the core mental healthdisciplines. Programs which qualify include, but are notlimited to sociology, criminal justice, nursing, marriage andfamily counseling, rehabilitation counseling, psychologicalcounseling and other professional counseling. For any otherprogram to qualify as a related field, there must besubstantial evidence that the academic program has acurriculum content in which at least 70 percent of therequired courses for graduation are based on the knowledgebase of the core mental health disciplines.a. a physician duly licensed to practice medicine inthe state of Louisiana and has completed an accreditedtraining program in psychiatry; orb. a psychologist licensed as a practicingpsychologist under the provisions of R.S. 28:2351-2370; orc. a medical psychologist licensed under theprovisions of R.S. 28:2351-2370; ord. a social worker who holds a master’s degree insocial work from an accredited school of social work and isa licensed clinical social worker under the provisions of R.S.37:2701-2718, as amended; orMental Health Service Delivery Experience―mentalhealth service delivery experience at the professional orparaprofessional level delivered in an organized mentalhealth or psychiatric rehabilitation setting such as apsychiatric hospital, day treatment or mental health casemanagement program or community mental health center.e. an advanced practice registered nurse licensed asa registered nurse in the state of Louisiana by the Board ofNursing who may practice to the extent that services arewithin the nurse’s scope of practice; andi.who is a nurse practitioner specialist in adultpsychiatric and mental health and family psychiatric andmental health; orMental Health Specialist (MHS)―a person who deliversdirect care services under the direct supervision of a LMHPor MHP and who meets one or more of the following fourcriteria as documented by the provider:ii.who is a certified nurse specialist inpsychosocial, gerontological psychiatric mental health, adultpsychiatric and mental health and child-adolescent mentalhealth;a. is actively pursuing a Bachelor of Arts degree ina mental health-related field; orb. is actively pursuing a Bachelor of Science degreein a mental health-related field; orf. a licensed professional counselor who is licensedas such under the provision of R.S. 37:1101-1115 and has atleast two years post master’s supervised experiencedelivering services in the mental health-related field; orc. has a Bachelor’s degree and is a student pursuinga graduate degree in a mental health-related field and hascompleted at least two courses in that identified field; org. a licensed marriage and family therapist who islicensed as such under the provisions of R.S. 37:1116-1121;orLouisiana Administrative CodeFebruary 2015has a Master of Social Work degree; ord. has a high school degree or a GED and has twoyears experience providing direct services in a mental health,2
Title 48, Part Iphysical health, social services, educational or correctionalsetting.Staff―those individuals with responsibility formanaging a resident's health or participating in an emergencysafety intervention and who are employed by the facility ona full-time, part-time or contract basis.Minor―a minor as defined under state law and, for thepurpose of this Chapter, includes a resident who has beendeclared legally incompetent by the applicable state court.Time Out―the restriction of a resident for a period oftime to a designated area from which the resident is notphysically prevented from leaving, for the purpose ofproviding the resident an opportunity to regain self-control.Neglect—the unreasonable refusal or failure of a facilityto supply a resident with necessary food, clothing, shelter,care, treatment, or counseling for injury, illness, or conditionof the resident, as a result of which the resident’s physical,mental or emotional health and safety is substantiallythreatened or impaired.AUTHORITY NOTE: Promulgated in accordance with R.S.40:2181-2191 and Title XIX of the Social Security Act.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Office of the Secretary, Bureau of HealthServices Financing, LR 30:54 (January 2004), amended by theDepartment of Health and Hospitals, Bureau of Health ServicesFinancing, LR 38:371 (February 2012), LR 39:2510 (September2013).New Construction―any of the following started afterJanuary 1, 2004:a.new buildings to be used as a PRTF;b.additions to existing buildings to be used as aSubchapter B. LicensingPRTF;§9007. General Provisionsc. conversions of existing buildings or portionsthereof for use as a PRTF;A. All psychiatric residential treatment facilities shall belicensed by the department. A PRTF shall not be established,opened, operated, managed, maintained, or conducted in thisstate without a current valid license issued by thedepartment. The department is the only licensing authorityfor PRTFs in the state of Louisiana. It shall be unlawful tooperate a PRTF without possessing a current, valid licenseissued by the department. Each PRTF shall be separatelylicensed.d. alterations other than minor alterations to anexisting PRTF.Normal Business Hours—between the hours of 7 a.m.and 6 p.m. every Monday-Friday, except for holidays.OCS—the Department of Child and Family Services,Office of Community Services.OPH—the Department of Health and Hospitals, Officeof Public Health.B. A PRTF license shall:OSFM—the Department of PublicCorrections, Office of State Fire Marshal.Safetyand1. be issued only to the person or entity named in thelicense application;OYD―the Department of PublicCorrections, Office of Youth Development.Safetyand2. be valid only for the facility to which it is issuedand only for the specific geographic address of that facility;3. be valid for up to one year from the date ofissuance, unless revoked, suspended, modified, orterminated prior to that date, or unless a provisional licenseis issued;Personal Restraint―the application of physical force,without the use of any device, for the purpose of restrainingthe free movement of a resident's body. The term personalrestraint does not include briefly holding without undueforce a resident in order to calm or comfort him/her, orholding a resident's hand to safely escort a resident from onearea to another.4. expire on the expiration date listed on the license,unless timely renewed by the PRTF facility;5. not be subject to sale, assignment, donation, orother transfer, whether voluntary or involuntary; andPsychiatric Residential Treatment Facility (PRTF)—afacility other than a hospital, that provides inpatientpsychiatric services, as described in 42 CFR part 441 subpartD, to individuals under age 21, in a residential setting.6. be posted in a conspicuous place on the licensedpremises at all times.Restraint—a personal restraint, mechanical restraint, ordrug used as a restraint.C. In order for the PRTF to be considered operationaland retain licensed status, the facility shall meet thefollowing conditions.Seclusion―the involuntary confinement of a residentalone in a room or an area from which the resident isphysically prevented from leaving.1. The PRTF shall always have at least twoemployees, one of whom is a licensed nurse, on duty at thefacility location at all times.Serious Injury―any significant impairment of thephysical condition of the resident as determined by qualifiedmedical personnel. This includes, but is not limited to, burns,lacerations, bone fractures, substantial hematoma, andinjuries to internal organs, whether self-inflicted or inflictedby someone else.2. There shall be staff employed and available to beassigned to provide care and services to each resident.Services rendered shall be consistent with the medical needsof each resident.3Louisiana Administrative CodeFebruary 2015
PUBLIC HEALTH—GENERALD. The licensed PRTF shall abide by and adhere to anystate law, rules, policy, procedure, manual, or memorandapertaining to such facilities.ii.floor plans. These shall include architectural,mechanical, plumbing, electrical, fire protection, and ifrequired by code, sprinkler and fire alarm plans;E. A separately licensed PRTF shall not use a namewhich is substantially the same as the name of another suchfacility licensed by the department, unless such PRTF isunder common ownership with other PRTFs.iv.room finish, door and window schedules;vi.G. No new PRTF, except one that has a Child ResidentialLicense by DCFS, shall accept residents until the PRTF haswritten approval and/or a license issued by HSS.specifications for materials.2. Waivers. The secretary of DHH may, within his/hersole discretion, grant waivers to building and constructionguidelines which are not part of, or otherwise required under,the provisions of the state Sanitary Code. The facility mustsubmit a waiver request in writing to HSS. The facility mustdemonstrate how patient safety and quality of care offered isnot compromised by the waiver, and must demonstrate theundue hardship imposed on the facility if the waiver is notgranted. The facility must demonstrate their ability tocompletely fulfill all other requirements of service. Thedepartment will make a written determination of therequests.H. Plan Review. Construction documents (plans andspecifications) are required to be submitted and approved byboth the OSFM and the Department of Health and Hospitalsas part of the licensing procedure and prior to obtaining alicense.Submission Plansa.building elevations;v.details pertaining to the Americans withDisabilities Act (ADA) requirements; andF. No branches, satellite locations or offsite campusesshall be authorized for a PRTF.1.iii.Submittal Requirementsi.One set of the final construction documentsshall be submitted to the OFSM for approval. The FireMarshal’s approval letter and final inspection shall be sent tothe DHH.a. Waivers are not transferable in an ownershipchange and are subject to review or revocation upon anychange in circumstances related the waiver.ii.One set of the final construction documentsshall be submitted to DHH along with the appropriate reviewfee and a “plan review application form” for approval.AUTHORITY NOTE: Promulgated in accordance with R.S.36:254 and R.S. 40:2009.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Bureau of Health Services Financing, LR38:372 (February 2012).b. Applicable Projects. Construction documentsrequire approval for new construction and major alterations.§9009. Initial Licensing Application ProcessA. An initial application for licensing as a PRTF shall beobtained from the department. A completed initial licenseapplication packet for a PRTF shall be submitted to andapproved by the department prior to an applicant providingPRTF services.c. Design Criteria. The project shall be designed inaccordance with the following criteria:i.the latest OSFM adopted edition of theNational Fire Protection Agency (NFPA) 101-Life SafetyCode;B. Currently licensed DCFS child residential facilitiesthat are converting to PRTFs must comply with all of theinitial licensure requirements, except plan review, and maybe eligible for the exception to the bedroom spacerequirement of this Chapter.ii.the latest LSUCCC adopted edition of theInternational Building Code;iii.the current licensing standards for psychiatricresidential treatment facilities; andC. An applicant must submit a completed initiallicensing application packet to the department, which shallinclude:iv.the latest OPH adopted edition of theLouisiana State Plumbing Code.d. ConstructionDocumentPreparation.Construction documents submitted to DHH shall be preparedonly by a Louisiana licensed architect or licensed engineeras governed by the licensing laws of the state for the type ofwork to be performed. These documents shall be of anarchitectural or engineering nature and thoroughly illustratethe project that is accurately drawn, dimensioned, andcontain noted plans, details, schedules and specifications. Ata minimum the following shall be submitted:i.1. a completed PRTF licensure application and thenon-refundable licensing fee as established by statute;2. a copy of the approval letter of the architecturalfacility plans for the PRTF from the department and from theOSFM, and any other office/entity designated by thedepartment to review and approve the facility’s architecturalplans, if the facility must go through plan review;3. a copy of the on-site inspection report withapproval for occupancy by the Office of the State FireMarshal;site plans;Louisiana Administrative CodeFebruary 20154
Title 48, Part I4. a copy of the health inspection report with approvalof occupancy from the Office of Public Health (OPH);1. Full Initial License. The department shall issue afull license to the facility when the initial licensing surveyfinds that the PRTF is compliant with all licensing laws andregulations, and is compliant with all other required statutes,laws, ordinances, rules, regulations, and fees. The license fora PRTF shall be valid until the expiration date shown on thelicense, unless the license is revoked, suspended, modified,or terminated prior to that time. The initial license shallspecify the capacity of the facility.5. a copy of statewide criminal background checks onall individual owners with a 5 percent or more ownershipinterest in the PRTF entity, and on all administrators ormanaging employees;6. proof of financial viability, comprised of thefollowing:2. Provisional Initial License. The department mayissue a provisional initial license to the facility when theinitial licensing survey finds that the PRTF is noncompliantwith any licensing laws or regulations or any other requiredstatutes, laws, ordinances, Rules, regulations or fees, but thedepartment determines that the noncompliance does notpresent a threat to the health, safety or welfare of theresidents or participants. The provisional license shall bevalid for a period not to exceed six months.a. a line of credit issued from a federally insured,licensed lending institution in the amount of at least 100,000;b. general and professional liability insurance of atleast 300,000; andc.worker’s compensation insurance;7. if applicable, Clinical Laboratory ImprovementAmendments (CLIA) certificate or CLIA certificate ofwaiver;a. At the discretion of the department, theprovisional initial license may be extended for an additionalperiod not to exceed 90 days in order for the PRTF to correctthe noncompliance or deficiencies.8. a floor sketch or drawing of the premises to belicensed; and9. any other documentation or information required bythe department for licensure.b. The facility must submit a plan of correction tothe department for approval and the provider shall berequired to correct all such noncompliance or deficienciesprior to the expiration of the provisional initial license.D. If the initial licensing packet is incomplete whensubmitted, the applicant will be notified of the missinginformation and will have 90 days from receipt of thenotification to submit the additional requested information.If the additional requested information is not submitted tothe department within 90 days, the application will beclosed. After an initial licensing application is closed, anapplicant who is still interested in becoming a PRTF mustsubmit a new initial licensing packet with a new initiallicensing fee to start the initial licensing process.c. A follow-up survey shall be conducted prior tothe expiration of the provisional initial license.i.If all such noncompliance or deficiencies aredetermined by the department to be corrected on a follow-upsurvey, a full license will be issued.ii.If all such noncompliance or deficiencies arenot corrected on the follow-up survey, the provisional initiallicense shall expire and the provider shall be required tobegin the initial licensing process again by submitting a newinitial license application packet and fee.E. Once the initial licensing application packet has beenapproved by the department, notification of the approvalshall be forwarded to the applicant. Within 90 days of receiptof the approval notification, the applicant must notify thedepartment that the PRTF is ready and is requesting aninitial licensing survey. If an applicant fails to notify thedepartment within 90 days, the initial licensing applicationshall be closed. After an initial licensing application hasbeen closed, an applicant who is still interested in becominga PRTF must submit a new initial licensing packet with anew initial licensing fee to start the initial licensing process.3. Full Renewal License. The department may issue afull renewal license to an existing licensed PRTF who is insubstantial compliance with all applicable federal, state,departmental, and local statutes, laws, ordinances, Rules,regulations and fees. The license shall be valid until theexpiration date shown on the license, unless the license ismodified, revoked, suspended, or terminated.4. Provisional Renewal License. The department, inits sole discretion, may issue a provisional license to anexisting licensed PRTF for a period not to exceed sixmonths.F. Applicants must be in compliance with all appropriatefederal, state, departmental or local statutes, laws,ordinances, rules, regulations and fees before the PRTF willbe issued an initial license to operate.a. At the discretion of the department, theprovisional renewal license may be extended for anadditional period not to exceed 90 days in order for thePRTF to correct the noncompliance or deficiencies.AUTHORITY NOTE: Promulgated in accordance with R.S.36:254 and R.S. 40:2009.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Bureau of Health Services Financing, LR38:373 (February 2012), amended LR 39:2510 (September 2013).§9011. Types of Licensesb. A provisional renewal license may be issued forthe following reasons:A. The department shall have the authority to issue thefollowing types of licenses.i.the existing PRTF has more than five deficientpractices or deficiencies cited during any one survey;5Louisiana Administrative CodeFebruary 2015
PUBLIC HEALTH—GENERALii.the existing licensed PRTF has more than threevalidated complaints in a one year period;C. Occurrence of any of the following may be groundsfor the department to perform a survey on an accreditedPRTF provider with deemed status:iii.the existing PRTF has been issued a deficiencythat involved placing a resident or participant at risk forserious harm or death;1. any valid complaint in the preceding 12-monthperiod;iv.the existing PRTF has failed to correctdeficient practices within 60 days of being cited for suchdeficient practices or at the time of a follow-up survey; or2.3. a change of ownership in the preceding 12-monthperiod;v.the existing PRTF is not in substantialcompliance with all applicable federal, state, departmental,and local statutes, laws, ordinances, Rules regulations andfees at the time of renewal of the license.4. issuance of a provisional license in the preceding12-month period;5. serious violations of licensing standards orprofessional standards of practice that were identified in thepreceding 12-month period that placed residents at risk forharm;c. When the department issues a provisionalrenewal license to an existing licensed PRTF, the providershall submit a plan of correction to the department forapproval, and the provider shall be required to correct allsuch noncompliance or deficiencies prior to the expiration ofthe provisional license. The department shall conduct an onsite follow-up survey at the PRTF prior to the expiration ofthe provisional license.6. a report of inappropriate treatment or serviceresulting in death or serious injury; or7.a change in geographic location.D. A PRTF with deemed status is responsible forcomplying with all of the provisions of this Rule and issubject to all of the provisions of this Rule.i.If the on-site follow-up survey determines thatthe PRTF has corrected the deficient practices and hasmaintained compliance during the period of the provisionallicense, the department may issue a full license for theremainder of the year until the anniversary date of the PRTFlicense.1. The secretary of the DHH may, within his/her solediscretion, grant waivers to building and constructionguidelines. The facility must submit a waiver request inwriting to the Division of Engineering and ArchitecturalServices. The facility must demonstrate how patient safetyand quality of care offered is not comprised by the waiver.The facility must demonstrate their ability to completelyfulfill all other requirements of service. DHH will make awritten determination of the requests. Waivers are nottransferable in an ownership change and are subject toreview or revocation upon any change in circumstancesrelated to the waiver.ii.If the on-site follow-up survey determines thatthe PRTF has not corrected the deficient practices or has notmaintained compliance during the period of the provisionallicense, the provisional renewal license shall expire and thefacility shall be required to begin the initial licensing processagain by submitting a new initial license application packetand fee, if no timely informal reconsideration oradministrative appeal is filed pursuant to this Chapter.AUTHORITY NOTE: Promulgated in accordance with R.S.36:254 and R.S. 40:2009.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Bureau of Health Services Financing, LR38:374 (February 2012).AUTHORITY NOTE: Promulgated in accordance with R.S.36:254 and R.S. 40:2009.HISTORICAL NOTE: Promulgated by the Department ofHealth and Hospitals, Bureau of Health Services Financing, LR38:373 (February 2012).§9015. Licensing Surveys§9013. Deemed StatusA. Prior to the initial license being issued to the PRTF, aninitial licensing survey shall be conducted on-site at thefacility to assure compliance with licensing standards.Except for facilities that have a Child Residential Licenseissued by DCFS, every PRTF shall not provide services toany resident until the initial licensing survey has beenperformed and the facility found in compliance with thelicensing standards. The initial licensing survey shall be anannounced survey.A. A licensed PRTF may request deemed status from thedepartment. The department may accept accreditation in lieuof a routine on-site licensing survey provided that:1. the accreditation is obtainedorganization approved by the department;throughan2. all services provided under the PRTF license mustbe accredited; and3. the provider forwards the accrediting body’sfindings to the Health Standards Section within 30 days ofits accreditation.B. Once an initial license has been issued, thedepartment may conduct licensing and other surveys atintervals deemed necessary by the department to determinecompliance with licensing standards and regulations, as wellas other required statutes, laws, ordinances, Rules,regulations, and fees. These surveys shall be unannounced.B. If approved, accreditation will be accepted asevidence of satisfactory compliance with all of theprovisions of these requirements.Louisiana Administrative Codeaddition of services;February 20156
Title 48, Part IC. A follow-up survey may be conducted for any surveywhere deficiencies have been cited to ensure correction ofthe deficient practices. The department shall issue writtennotice to the provider of the results of the follow-up survey.D. A change of ownership (CHOW) of the PRTF shall bereported in writing to the department at least five days priorto the change of ownership.1. The license of a PRTF is not transferable orassignable. The license cannot be sold.D. An acceptable plan of correction may be required forany survey where deficiencies have been cited.2. In t
e. an advanced practice registered nurse licensed as a registered nurse in the state of Louisiana by the Board of Nursing who may practice to the extent that services are within the nurse's scope of practice; and i. who is a nurse practitioner specialist in adult psychiatric and mental health and family psychiatric and
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