La. Admin. Code tit. 50 § I-4195

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-4195 - Corrective Actions Plans

A. The following procedures are established for the purpose of attempting to resolve problems prior to the issuing of a notice of sanction or for resolution during the informal hearing or administrative hearing.

1. Corrective Action Plan-Notification

a. The director of BHSF and the director of Program Integrity may at any time issue a notice of corrective action to a provider or provider-in-fact, agent of the provider, or affiliate of the provider. The provider, provider-in-fact, agent of the provider, or affiliate of the provider shall comply with the corrective action plan within 10 working days of receipt of the corrective action plan. The purpose of a corrective action plan is to identify potential problem areas and correct them before they become significant discrepancies, deviations or violations. This is an informal process.

i. The provider, provider-in-fact, agent of the provider, or affiliate of the provider must submit their agreement with the corrective action plan in writing, signed by the provider, the provider-in-fact, agent of the provider, or affiliate of the provider.

b. Corrective action plans are also used to resolve matters at or before the informal hearing or administrative appeal process. When so used they serve the same function as a settlement agreement.

2. Corrective Action Plan-Inclusive Criteria. The corrective action plan must be in writing and contain at least the following:

a. the nature of the discrepancies or violations;

b. the corrective action(s) that must be taken; and

c. notification of any action required of the provider, provider-in-fact, agent of the provider, billing agent or affiliate of the provider.

3. Corrective Action Plans-Restrictions. Corrective actions, which may be included in a corrective action plan, are the following:

a. issuing a warning through written notice or consultation;

b. require that the provider, provider-in-fact, agent of the provider, or affiliate receive education and training in the law, rules, policies, criteria and procedures related to the Medical Assistance Program, including billing practices or programmatic requirements and practices. Such education or training is at the provider or provider-in-fact's expense;

c. require that the provider receive prior authorization for any or all goods, services, or supplies to be rendered;

d. place the provider's claims on manual review status before payment is made;

e. restrict or remove the provider = s privilege to submit bills or claims electronically;

f. impose any restrictions deemed appropriate by the director of BHSF and the director of Program Integrity; or

g. any other items mutually agreed to by the provider, provider-in-fact, agent of the provider, billing agent, affiliate of the provider or other person and the director of BHSF or the director of Program Integrity, including, but not limited to, one or more of the sanctions listed in this Chapter and an agreement to repay.

4. Only restrictions in Subparagraphs A.3.a-f above can be imposed on a provider, provider-in-fact, agent of the provider, billing agent, or affiliate of the provider without their agreement. Any other items included in a corrective action plan must be mutually agreed to among the parties to the corrective action plan.

5. No right to an informal hearing or administrative appeal can arise from a corrective action plan, unless the corrective action plan violates the provisions of this Chapter.

La. Admin. Code tit. 50, § I-4195

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 25:1648 (September 1999), repromulgated LR 29:601 (April 2003), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38: 2787 (November 2012).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, 46:437.4 and 46:437.1-46:440.3 (Medical Assistance Program Integrity Law).