LAC 48:V.2701. Criteria

A. Any resident of Louisiana, (exclusive of Orleans and Plaquemines parishes), who is essentially homebound, 21 years of age or older and in need of skilled nursing services ordered by a physician, may receive home care services. Services shall only be provided to clients who do not have third party coverage (i.e., Medicare, Medicaid or private insurance), and who meet financial eligibility guidelines established by the Office of Preventive and Public Health Services. B. Homebound. Clients shall be considered essentially homebound if they are unable to leave their home, or place of residence, without the aid of supportive devices such as crutches, canes, walkers or wheelchairs, the use of special transportation, the assistance of another person, or if they have a condition which is such that leaving their home is medically contraindicated. C. 21 Years of Age. Clients must be 21 years of age or older in order to receive home care services. D. Need of Skilled Nursing Services. Clients must be in need of skilled nursing services in order to receive home care services. These services shall be provided by a registered professional nurse (public health nurse) or a licensed practical nurse under the direct supervision of a registered nurse. All services shall be provided in accordance with the written orders of a physician licensed to practice in the state of Louisiana. Under normal circumstances, clients will be limited to two skilled nursing visits per week. Exceptions to this limit shall only be allowed for medical emergencies, or if the client's physician deems additional visits are medically necessary. E. Third Party Coverage. Home care services shall only be provided to clients who do not have third party coverage. Such coverage includes Medicare (Part A or Part B), Medicaid, (Title XIX Medical Assistance administered by the Office of Family Security), or private insurance (Blue Cross/Blue Shield or other commercial third party insurance coverage). Clients who are eligible for Medicare coverage (Part A or Part B) who have been denied coverage for home health services by the Medicare fiscal intermediary, shall be considered eligible for home care services. Clients who are eligible for home health services under Medicaid, but who have exhausted their 50 visit limitation, shall be considered eligible for home care services. F. Financial Eligibility Guidelines. Home care services shall be provided only to clients whose family income does not exceed the following financial eligibility guidelines. Family Size | Monthly Income 1 2 | $1,877 3 | $2,212 4 | $2,450 5 | $2,509 6 | $2,571 7 | $2,574