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Chapter 93. Hospitals Subchapter A. General Provisions

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Chapter 93. Hospitals Subchapter A. General Provisions PUBLIC HEALTH—GENERAL a. diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or b. rehabilitation services for the rehabilitation of injured, disabled, or sick persons. 2. Exemptions. The following licensed hospitals are not subject to the primarily engaged provisions and/or requirements of this Chapter: a. a licensed hospital designated as a psychiatric hospital or a critical access hospital as defined by the Code of Federal Regulations; b. a licensed hospital designated as a rural hospital as defined by R.S. 40:1189.3; and c. a licensed hospital currently certified and enrolled as a Medicare/Medicaid certified hospital which has not been determined out of compliance with the federal definition of primarily engaged; if a hospital is currently Medicare/Medicaid certified, and has been determined to be currently meeting the federal definition of primarily engaged, it shall be exempt from compliance with the following provisions in this section regarding primarily engaged. 3. In reaching a determination as to whether or not an entity is primarily engaged in providing inpatient hospital services to inpatients of a hospital, the Department of Health will evaluate the total facility operations and consider multiple factors, subject to paragraph C.4 below. a. Total Facility Operations. In evaluating the total facility operations, the department will review the actual provision of care and services to two or more inpatients, and the effects of that care, to assess whether the care provided Chapter 93. Hospitals meets the needs of individual patients by way of patient outcomes. Subchapter A. General Provisions b. Multiple Factors. The factors that the department will consider include, but are not limited to: §9301. Purpose i. the average daily census (ADC) of the main A. The purpose of the hospital laws, rules and hospital and/or any off-site campus(es); regulations is to provide for the development, establishment and enforcement of standards for the care of individuals in ii. the average length of stay (ALOS) of patients hospitals and for the construction, maintenance and at the main hospital and/or any off-site campus(es); operation of hospitals which shall promote safe and adequate iii. the number of off-site campus outpatient treatment of individuals in hospitals. locations operated by the entity; B. A hospital shall be licensed in accordance with state iv. the number of provider-based emergency law, rules and regulations adopted and established by the departments for the entity; state agency responsible for the licensing of hospitals. v. the number of inpatient beds related to the size C. Primarily Engaged of the entity and the scope of the services offered; 1. Except as provided in §9301.C.2, hospitals shall be vi. the volume of outpatient surgical procedures primarily engaged, as defined by this Rule and determined compared to the inpatient surgical procedures (if surgical by the Department of Health, in providing inpatient hospital services are provided); services to inpatients, by or under the supervision of licensed physicians. Inpatient hospital services are services defined in vii. staffing patterns; and this licensing rule and are provided to inpatients of the viii. patterns of ADC by day of the week. hospital as one of the following: 4. Notwithstanding any other provision of this rule, an entity shall not be considered to be primarily engaged in Louisiana Administrative Code December 2020 64 Title 48, Part I providing inpatient hospital services to inpatients of a by the Department of Health, Bureau of Health Services Financing, hospital if a main hospital or a main hospital’s off-site LR 45:1474 (October 2019), LR 46:1682 (December 2020). campus(es) has an ADC of less than two, or an average §9303. Definitions length of stay of less than two. For purposes of determining whether a main hospital and its off-site campus(es) are A. The following definitions of selected terminology are primarily engaged, the ADC and the average length of stay used in connection with Chapter 93. shall be made independently for each entity. Accreditedthe approval by the Joint Commission on 5. Hospitals are not required to have a specific Accreditation of Healthcare Organizations, American inpatient bed to outpatient bed ratio in order to meet the Osteopathic Association, or Det Norske Veritas. definition of primarily engaged. Administrator―(see Chief Executive Officer). a. If the hospital has an emergency department Anesthesiologist―a physician, dentist, or osteopath (ED), the number of hospital inpatient beds shall be greater physician, who has successfully completed an approved than the number of ED beds, with a ratio of not less than 2:1. residency program in anesthesiology, or who is a diplomat of D. Except as otherwise provided herein, hospitals shall either the American Board of Anesthesiology or the provide directly or under arrangements the following American Osteopathic Board of Anesthesiology, or who was professional departments, services, facilities and functions made a Fellow of the American College of Anesthesiology which are essential to establish whether a facility is before 1972. primarily engaged in providing inpatient hospital services: Approved―acceptable to the authority having 1. organization and general services: jurisdiction. 2. nursing services; Authority Having Jurisdiction―an organization, office, or individual responsible for approving equipment, an 3. pharmaceutical services; installation, or a procedure. 4. radiological services; Average Daily Census (ADC)―calculated by adding the 5. laboratory services; midnight daily census of the main hospital or its off-site campus(es), independent of one another, for each day of the 6. nutritional and therapeutic dietetic services; 12-month period and dividing the total number by the number of days in the year. In calculating the ADC for 7. medical record services; purposes of determining whether an entity meets the 8. quality assessment and improvement; requirements of primarily engaged, LDH may utilize a period of between three months and 12 months. 9. physical environment; Average Length of Stay (ALOS)―the average of the 10. infection control; number of inpatient days a person is in the main hospital or 11. respiratory care services. its off-site campus(es). ALOS is calculated by dividing the total inpatient days by the total discharges during a specified E. Except as otherwise provided herein, hospitals may period of time, which results in an average number of days provide the following optional services directly or under in the main hospital or its off-site campus(es) for each arrangements: person admitted. In calculating ALOS, LDH may utilize a 1. surgical services; period of between three months and 12 months. For purposes of calculating the ALOS of the main hospital or its 2. anesthesia services; off-site campus(es), each facility shall be considered an 3. nuclear medicine services; independent entity. 4. outpatient services; Certified Nurse Midwife―an advanced practice registered nurse as defined by R.S. 37:913. 5. rehabilitation services; Certified Registered Nurse Anesthetist―an advanced 6. psychiatric services; practice registered nurse as defined by R.S. 37:913. 7. obstetrical and newborn services; Cessation of Business―when a hospital stops providing 8. pediatric services; services to the community. 9. emergency services. Chief Executive Officer (CEO)/Administrator―the person responsible for the operation of the hospital AUTHORITY NOTE: Promulgated in accordance with commensurate with the authority conferred by the governing R.S.36:254 and R.S. 40:2100-2115. HISTORICAL NOTE: Promulgated by the Department of body. Health and Human Resources, Office of the Secretary, LR 13:246 Clinical Nurse Specialist―an advanced practice (April 1987), amended by the Department of Health and Hospitals, registered nurse as defined by R.S. 37:913. Office of the Secretary, Bureau of Health Services Financing, LR 21:177 (February 1995), LR 29:2399 (November 2003), amended 65 Louisiana Administrative Code December 2020 PUBLIC HEALTH—GENERAL Crisis Receiving Center—a specialty unit of a hospital reports from health care providers, as are customarily that shall receive, examine, triage, refer or treat an individual catalogued and maintained by the hospital medical records who is experiencing a behavioral health crisis. department. Hospital records include reports of procedures such as X-rays and electrocardiograms, but they do not Department―Louisiana Department of Health. include the image or graphic matter produced by such Food Delivery Services―the transportation of the procedures, according to state law. nutritional and therapeutic dietetic services by a food Immediate and Serious Threat―a crisis situation in management company that is delivered to the hospital and which the health and safety of patients is at risk. It is a served to the patients of the hospital. deficient practice which indicates the operator's inability to Food Management Company―an off-site vendor who furnish safe care and services, although it may not have provides nutritional and therapeutic dietetic services to the resulted in actual harm. The threat of probable harm is real hospital through a contractual agreement and that is required and important and could be perceived as something which to meet the same standards for food and dietetic services as will result in potentially severe temporary or permanent provided by the hospital directly. injury, disability or death. Governing Body―the board of trustees, owner or Inpatient―a person who admitted to a hospital with the person(s) designated by the owner with ultimate authority status of inpatient for purposes of receiving hospital services and responsibility (both moral and legal) for the with the expectation that he/she will require hospital care management, control, conduct and functioning of the expected to span at least two nights and occupy a bed even hospital. though it is later determined that the patient can be discharged or transferred to another hospital and not actually Hospital―any institution, place, building, or agency, use a hospital bed overnight.
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