This chapter establishes admission criteria for Louisiana Department of Health and Hospitals inpatient facilities across three offices: the Office of Mental Health (OMH) inpatient psychiatric facilities (with separate adult and children's criteria based on severity of illness and intensity of service), ICF/MR facilities operated by OMH and OCDD for persons with mental retardation/developmental disabilities, and inpatient substance abuse treatment programs operated by the Office for Addictive Disorders (OAD). Facility operators must screen prospective admissions against detailed clinical criteria—including danger to self/others, grave disability, and multi-dimensional substance use assessments—before admitting any individual. The rule also specifies exclusionary criteria and special population requirements for each facility type.
View official sourceChapter 16.Admissions Criteria for Inpatient Facilities §1601.Purpose and Scope A.In accordance with the requirements of Act 1249 of the 2003 Regular Session of the Louisiana Legislature, the Department of Health and Hospitals adopts admission criteria for inpatient facilities operated by the Department of Health and Hospitals. Admission criteria are specific to each DHH Office that operates inpatient facilities as indicated in this Rule. In accordance with R.S. 28:20(B) no person shall be admitted voluntarily, involuntarily, by court order, or by commitment to a department facility unless the person meets the criteria set forth in this Rule and Act 1249. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:47 (January 2004). §1603.Definitions Adult—anyone age 18 and over. Axis I Diagnosis—a reporting group in the Diagnostic and Statistical Manual for all the various mental disorders or conditions in the Classification except for Personality Disorders and Mental Retardation. Child—anyone under age 18. DSM—the Diagnostic and Statistical Manual that has a multi-axial system that includes an assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment and predict outcomes. Level of Functioning Scale—assessment tool that passes defined standards for use as an evaluative tool and is thereby provided for professional use to define the degree to which an individual is capable of accomplishing various skills associated with managing activities of daily living. Mental Retardation—significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period. OAD—the Office for Addictive Disorders in the Department of Health and Hospitals. OMH—the Office of Mental Health in the Department of Health and Hospitals. Related Condition—a severe chronic disability that meets all the following criteria: 1.it is attributable to: a.cerebral palsy or epilepsy; or b.any other condition, other than mental illness, found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires treatment or services similar to those required for these persons; 2.it is manifested before the person reached age 22; 3.it is likely to continue indefinitely; and 4.it results in substantial functional limitations in three or more of the following areas of major life activity: a.self-care; b.understanding and use of language; c.learning; d.mobility; e.self-direction; or f.capacity for independent living. Single Point of Entry (SPOE)—that process by which an individual is screened by an agent within an Office of Mental Health (OMH) service area who is responsible for certifying that the individual meets the criteria for admission to an OMH inpatient facility. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:47 (January 2004). §1605.Inpatient Facilities Operated by the Office of the Secretary A.The following admission requirements apply to New Orleans Home and Rehabilitation Center and Villa Feliciana Medical Complex, both of which are long term care facilities operated by the Office of the Secretary. B.Initial Requirements for Admission Consideration 1.The person has a medical condition(s) that require the supervision and treatment in a facility that provides 24-hour nursing care. 2.Pre-admission screening procedures for the Medicaid program must be followed to ensure appropriateness of admission. C.Facilities Admission Criteria: 1.the person's medical/rehabilitation needs can be met within the resources and staffing available at the facilities; 2.the admission does not exceed the capacity, the services and/or population for which the facility is budgeted and operated; and 3.a means of financing the cost of care for each person admitted is available. D.Exclusions 1.Persons who are dangerous to self and others, or who are charged with a crime, and who require the availability of a secure and locked area in order to ensure the safety and well being of other residents and employees of the facility. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:47 (January 2004). §1607.Inpatient Mental Health Facilities Operated by the Office of Mental Health A.In order to be admitted a person must qualify as a candidate for services in an inpatient setting as indicated on a published Level of Functioning Scale or other instrument identified by the Office of Mental Health as clinically appropriate. Such Level of Functioning Scale must be based on scientifically accepted practice standards and must demonstrate adequate psychometric properties of validity and reliability. The person must also meet the standard for inpatient care as specified in the Office of Mental Health Single Point of Entry (SPOE) Admissions Criteria, which is specified in the following. B.Adult Admission Criteria. At least one criterion from Severity of Illness must be met and all of the Intensity of Service Criteria must be met. 1.Severity of Illness Criteria (Must meet one or more of a, b, or c) a.Patient presents as a danger to self as evidenced by: i.a suicide attempt within the past 72 hours; or ii.documentation that the patient has a current suicide plan, specific suicide intent, or recurring suicidal ideation; or iii.documentation of self-mutilative behavior occurring within the past 72 hours. b.Patient presents as a danger to others due to a DSM Axis I diagnosis as evidenced by any of the following: i.dangerously aggressive behavior during the past seven days due to a DSM Axis I diagnosis; or ii.threats to kill or seriously injure another person with the means to carry out the threat and the threatening behavior is due to a DSM Axis I diagnosis; or iii.documentation that the patient has a current homicide plan, specific homicidal intent, or recurrent homicidal ideation and this is due to a DSM Axis I diagnosis. c.Patient is gravely disabled and unable to care for self due to a DSM Axis I diagnosis as evidenced by: i. documentation of a serious impairment in function (as compared to others of the same age) in one or more major life roles (school, job, family, interpersonal relations, self-care, etc.) due to a DSM Axis I diagnosis; and ii.patient presents with acute onset or acute exacerbation of hallucinations, delusions, or illusions of such magnitude that the patient's well-being is threatened; or iii.an inability of the patient to comply with prescribed psychiatric and/or medical health regimens as evidenced by the following: (a).patient has a history of de-compensation without psychotropic medications and patient refuses to use these medications as an outpatient; or (b).patient is at risk of health or life due to non-compliance with medical regimens (e.g., insulin-dependent diabetes, etc.) and patient refuses these medical regimens as an outpatient. 2.Intensity of Service Criteria a.Treatment of the patient's psychiatric condition requires services on an inpatient hospital basis. These services include, but are not limited to: i.suicide precautions, unit restrictions, and continual observation and limiting of behavior to protect self or others; ii.active intervention by a psychiatric team to prevent assaultive behavior; iii.24 hour observation and medication stabilization necessitated by patient behaviors that indicate a therapeutic level of medication has not been reached; and b.services provided in the hospital can reasonably be expected to improve the patient's condition or prevent further regression so that the services will no longer be needed by the patient; and c.services in the community do not meet, and/or do not exist to meet the treatment needs of the patient, or the patient has been unresponsive to treatment at a less intensive level of care. C.Children's Admission Criteria. At least one criterion from Severity of Illness must be met, and all of the Intensity of Service Criteria must be met. 1.Severity of illness criteria must meet one or more of Subparagraph a, b, or c: a.the child is a danger to self (Clauses i, ii, iii or iv and v must exist to meet this criterion): i.the child has made an attempt to take his/her own life in the last 24 hours. Details of the attempt must be documented; or ii.the child has demonstrated self-mutilative behavior within the past 24-hours. Details of behavior must be documented; or iii.the child has a clear plan to seriously harm him/herself, overt suicidal intent, recurrent suicide thoughts, and lethal means available to follow the plan. This information can be from the child or a reliable source. Details of the plan must be documented; or iv.due to a DSM Axis I diagnosis, the child is in serious danger of dying or sustaining grave bodily injury to him/her self; and v.it is the judgment of a mental health professional that the child is at a significant risk of making a suicide attempt or due to a DSM Axis I diagnosis, is in serious danger of dying or sustaining grave bodily injury to him/herself without immediate inpatient intervention; b.the child is a danger to others or property due to a DSM Axis I diagnosis as indicated by: (Clauses i, ii, or iii and iv must exist and include the specific DSM criteria that justify this diagnosis): i.the child has actually engaged in behavior harmful or potentially harmful to others or caused serious damage to property, which would pose a serious threat of injury, or harm to others within the last 24 hours. Description of the behavior and extent of injury or damage must be documented, as well as the time the behavior occurred relative to present; or ii.the child has made threats to kill or seriously injure others or seriously damage property, which would pose a threat of injury or harm to others, and has effective means to carry out the threats. Details of the threats must be documented; or iii.a mental health professional has information from the child or a reliable source that the child has a current plan, specific intent, or recurrent thoughts to seriously harm others or property. Details must be documented; and iv.it is the judgment of a mental health professional that the child is at a significant risk of making a homicide attempt or engaging in other seriously aggressive behavior without immediate inpatient intervention; c.the child is gravely disabled due to a DSM Axis I diagnosis as indicated by (Clauses i, and either ii, iii or iv must exist and include the specific DSM criteria that justify this diagnosis): i.the child has serious impairment of functioning compared to others of the same age in one or more major life roles (school, family, interpersonal relations, self-care, etc.) Specific descriptions of the following must be documented: (a).deficits in control, cognition or judgment; (b).circumstances resulting from those deficits in self-care, personal safety, social/family functioning, academic or occupational performance; (c).prognostic indicators which predict the effectiveness of inpatient treatment; and ii.severe thought disorganization or clinical deterioration or the acute onset of psychosis has rendered the child unmanageable and unable to cooperate in non-hospital treatment; or iii.there is a need for medication therapy or complex diagnostic testing where the child's level of functioning precludes cooperation with treatment in an outpatient or non-hospital based regimen, and may require close supervision of medication and/or forced administration of medication; or iv.a medical condition co-exists with a DSM Axis I diagnosis which, if not monitored/treated appropriately, places the child's life or well-being at serious risk. 2.Intensity of Service Criteria a.Treatment of the patient's psychiatric condition requires services on an inpatient hospital basis. These services include, but are not limited to: i.suicide precautions, unit restrictions, and continual observation and limiting of behavior to protect self or others; ii.active intervention by a psychiatric team to prevent assaultive behavior; iii.24 hour observation and medication stabilization necessitated by patient behaviors that indicate a therapeutic level of medication has not been reached; and b.services provided in the hospital can reasonably be expected to improve the patient's condition or prevent further regression so that the services will no longer be needed by the patient; and c.services in the community do not meet, and/or do not exist to meet the treatment needs of the patient, or the patient has been unresponsive to treatment at a less intensive level of care. D.Exclusionary Criteria-Adult. If one or more of the following is met, admission is denied. 1.Patient has a major medical or surgical illness or injury that would prevent active participation in a psychiatric treatment program (patients must be medically stable). 2.Patient has criminal charges pending and does not have a DSM Axis I diagnosis. 3.Patient has anti-social behaviors that are a danger to others and those anti-social behaviors are characterological rather than due to a DSM Axis I diagnosis. 4.Patient has a DSM Axis II diagnosis of mental retardation without an accompanying DSM Axis I diagnosis. 5.Patient has a Substance Abuse Disorder as defined in DSM and does not otherwise meet the severity of illness and intensity of service criteria. E.Exclusionary Criteria-Children. If one or more of the following is met, admission is denied. 1.The child has a major medical or surgical illness or injury that prevents active participation in a psychiatric treatment program. 2.The child has criminal charges pending and does not otherwise meet severity of illness and intensity of service criteria. 3.The child has anti-social behaviors that are a danger to others and does not have a DSM Axis I diagnosis. 4.The child has a DSM Axis II diagnosis of mental retardation and does not otherwise meet severity of illness and intensity of service criteria. 5.The child lacks a place to live and/or family supports and does not otherwise meet severity of illness and intensity of service criteria. 6.The child has been suspended or expelled from school and does not otherwise meet severity of illness and intensity of service criteria. 7.The child has a substance abuse disorder as defined in DSM and does not otherwise meet the severity of illness and intensity of service criteria. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:47 (January 2004), repromulgated LR 30:241 (February 2004). §1609.Intermediate Care Facilities/Mental Retardation (ICF/MR) Facilities Operated by the Office of Mental Health A.Referral for persons not currently residents of an ICF/MR facility should come through the State Office for Citizens with Developmental Disabilities (OCDD) Regional Office System responsible for serving the individual but referrals from other community sources or the individual's family will also be considered. Persons seeking admission or for whom admission is sought to an ICF/MR facility must meet the following admissions criteria: 1.age 18 years or above; 2.DSM diagnosis of Mental Retardation and/or Developmental Disability; 3.DSM diagnosis of mental illness; 4.can reasonably be expected to benefit from Community Home (CH) active treatment program; 5.must demonstrate compatibility with the physical, cognitive, social and behavioral development exhibited by the individuals in the home where the applicant is to reside and also in the day program as indicated by a published Level of Functioning Scale or other instrument identified by the Office of Mental Health (OMH) as clinically appropriate. Such Level of Functioning Scale must be based on scientifically accepted practice standards and must demonstrate adequate psychometric properties of validity and reliability; 6.must be certifiable for SSI and Medicaid Services; 7.must demonstrate ability to control self and not present a danger to self or others as evidenced by a lack of suicide attempts, suicide plans or self-injurious behaviors within the last three months, and a lack of aggressive behaviors or threatening behaviors towards others within the last three months; and 8.must volunteer for admission and agree to follow rules and actively participate in the program. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:49 (January 2004). §1611.The Office for Citizens with Developmental Disabilities (OCDD) A.The following admission requirements apply to the developmental centers and community- homes operated by the OCDD. 1.Initial Requirements for Admission Consideration a.The person must meet the criteria for participation in the Mental Retardation/Developmental Disabilities (MR/DD) Services System in Louisiana's MR/DD law. The person's generic service plan (Plan of Support) must contain a recommendation for admission to an Intermediate Care Facility for the Mentally Retarded. The plan must also document the team (which includes the individual and/or family) consideration of what meets the individual's needs, and no more, and the most natural living option available, consistent with an individual's community peers. 2.Residential Facilities Admission Criteria a.The person has mental retardation or a related condition and has additional complex medical or behavioral needs; and b.the person's programmatic and supervisory needs as established in the person's Individual Program Plan (IPP) can be met within the resources and staffing available at the developmental center or community home; and c.the person's age and sex as well as physical, cognitive, social and behavioral development are compatible with the individuals currently residing within the developmental center or community home wherein the vacancy exists; and d.the admission does not exceed the capacity, the services and/or population for which the facility is licensed. 3.Exclusions: a.persons who cannot benefit from active treatment services in an Intermediate Care Facility for the Mentally Retarded (ICF-MR); b.persons who have a primary diagnosis of mental illness; c.persons who are dangerous to self or others, or are charged with a crime, and who require the availability of a secure and locked area in order to ensure the safety and well being of other residents and employees of the developmental center or community home. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:50 (January 2004). §1613.Inpatient Substance Abuse Treatment Programs Operated by the Office for Addictive Disorders A.Admissions 1.Admission to primary treatment centers will be from a statewide population. 2.Any client exhibiting major medical symptoms or major psychiatric symptoms, indicating immediate need, will be referred for services of an acute care hospital or acute psychiatric unit. Once stabilized, OAD will evaluate for admission to an inpatient treatment program. B.Eligibility Criteria 1.The client must have been screened by a single point of entry, which includes: a.OAD Outpatient or Detoxification Programs or other programs approved by the accepting facility; b.have a primary diagnosis of no less than alcohol abuse, drug abuse, or compulsive gambling; c.have a recent history of uncontrollable alcohol or drug use or compulsive gambling and have been unable to remain drug-free through outpatient intervention; or d.have been unable to access outpatient services due to unavailability related to distance and transportation; and 2.the client shall be involved in an intensive outpatient substance abuse treatment program while awaiting placement in an inpatient facility. If intensive treatment is not available at the referring clinic, the client should be evaluated and provided the maximum level of services available while awaiting admission; 3.the patient who is appropriately admitted to an inpatient program meets specifications in two of the six dimensions, at least one of which is in Dimension 1,2, or 3. a.Dimension 1: Acute Intoxication and/or Withdrawal. The patient has no signs or symptoms of withdrawal, or his or her withdrawal needs can be safely managed in a inpatient program setting. b.Dimension 2: Biomedical Conditions and Complications. The patient's status in Dimension 2 is characterized by one of the following. i.The interaction of the patient's biomedical condition and continued alcohol or other drug use places the patient in imminent danger of serious damage to physical health or concomitant biomedical conditions (such as pregnancy with vaginal bleeding or ruptured membranes). ii.A current biomedical condition requires 24-hour nursing and medical monitoring or active treatment, but not the full resources of an acute care hospital. The patient who has a biomedical problem that requires a degree of staff attention (such as monitoring of medications or assistance with mobility) that is not available on other inpatient programs is in need of Biomedical enhanced services. c.Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications. Problems in Dimension 3 are not necessary for admission to an inpatient program. However, if any of the Dimension 3 conditions are present, the patient must be admitted to a Dual Diagnosis Enhanced program (depending on his or her level of function, stability, and degree of impairment). i.The patient's psychiatric condition is unstable. Depression and/or other emotional, behavioral, or cognitive symptoms (which may include compulsive behaviors, suicidal or homicidal ideation with a recent history of attempts but no specific plan, or hallucinations and delusions without acute risk to self or others) are interfering with abstinence, recovery, and stability to such a degree that the patient needs a structured 24-hour, medically monitored (but not medically managed) environment to address recovery efforts; or ii.the patient exhibits stress behaviors associated with recent or threatened losses in work, family, or social domains, to a degree that his or her ability to manage the activities of daily living are significantly impaired. The patient thus requires a secure, medically monitored environment in which to address self-care problems (such as those associated with eating, weight loss, sleeplessness or personal hygiene) and to focus on his or her substance abuse or mental health problems; or iii.the patient has significant functional deficits that require active psychiatric monitoring. They may include-but are not limited to- problems with activities of daily living, problems with self-care, lethality or dangerousness, and problems with social functioning. These deficits may be complicated by problems in Dimensions 2 through 6; or iv.the patient is at moderate risk of behaviors endangering self, others, or property, and is in imminent danger of relapse (with dangerous emotional, behavioral, or cognitive consequences) without 24-hour support and structure of an inpatient program; or v.the patient is actively intoxicated, with resulting violent or disruptive behavior that poses imminent danger to self or others; or vi.the patient has a thought disorder or cognitive limitations that require stabilization but not medical management. d.Dimension 4: Readiness to Change. The patient's status in Dimension 4 is characterized by one of the following: i.despite experiencing serious consequences or effects of the addictive disorder or mental health problem, the patient does not accept or relate the addictive disorder to the severity of these problems; or ii.the patient is in need of intensive motivation strategies, activities, and processes available only in a 24-hour structured, medically monitored setting; or iii.the patient needs ongoing 24-hour psychiatric monitoring to assure persistence with the treatment regimen and to deal with issues such as ambivalence about compliance with psychiatric medications. e.Dimension 5: Relapse, Continued Use, or Continued Problem Potential. The patient's status in Dimension 5 is characterized by one of the following: i.the patient is experiencing acute psychiatric or substance use crisis, marked by intensification of symptoms of his or her addictive or mental disorder (such as difficulty postponing immediate gratification, drug-seeking behavior, or increasing severity of anxiety or depressive symptoms). This situation poses an imminent danger of harm to self or others in the absence of 24-hour monitoring and structured support; or ii.the patient is experiencing an escalation of relapse behaviors and/or reemergence of acute symptoms. This situation poses an imminent danger of harm to self or others in the absence of the type of 24-hour monitoring and structured support found in a medically monitored setting; or iii.the modality of treatment or protocols to address relapse (such as aversion therapy and similar behavioral therapy techniques) require that the patient receive care in an inpatient program. f.Dimension 6: Recovery Environment. The patient's status in Dimension 6 is characterized by one of the following: i.the patient requires continuous medical monitoring while addressing his or her substance use and/or psychiatric problems because his or her current living situation is characterized by a high risk of initiation or repetition of physical, sexual, or emotional abuse, or substance abuse so endemic that the patient is assessed as being unable to achieve or maintain recovery at a less intensive level of care. For example, because of mania (which is treated with mood stabilizing medications), the patient believes he or she is able to control the people in his or her environment who pose the risk; or ii.family members or significant others living with the patient are not supportive of his or her recovery goals and are actively sabotaging treatment. This situation requires structured treatment services and relief from the home environment in order for the patient to focus on recovery; or iii.the patient is unable to cope, for even limited periods of time, outside of 24-hour care. The patient needs staff monitoring to learn to cope with Dimension 6 problems before he or she can be transferred safely to a less intensive setting. C.Incarcerated Individuals 1.Persons referred for inpatient care who are incarcerated at the time of referral must meet the above criteria and be eligible for full release from incarceration within 15 days after the planned admission to an inpatient unit, or otherwise be able to participate in any and all follow-up recovery programs which would be recommended within a continuum of care treatment plan, including aftercare, half-way house, and self-help support groups. 2.Persons being detained in criminal justice programs who are awaiting arraignment, trial or post-trial sentencing must meet the above criteria and have an agreement from the District Attorney, prosecuting attorney, or trial judge. a.This agreement must be binding on the client and provide the client with assurance of ability to participate in continuum of care as recommended by the treatment team, unless the client violates any judicial agreement, or condition placed upon him and in effect during the term of recommended treatment. 3.Clients are not to be admitted who are subject to return to incarceration during the period of recommended treatment, including after-care, absent a new violation, infraction of probation or condition of suspension, or charge being filed. D.Special Populations 1.Treatment facilities shall make arrangements for the temporary employment of staff/equipment/specialized services which may be reasonably needed in order for the program to adequately serve persons with special needs or physical disabilities, specifically, but not limited to, the hearing and speech impaired. a.Specialized service arrangements will be within reason and only when similar services are not available through an alternate resource for which the client is eligible and/or entitled. Funding for the specialized service must have prior approval of the Assistant Secretary. AUTHORITY NOTE:Promulgated in accordance with R.S. 28:20 and R.S. 28:311(11). HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Office of the Secretary, LR 30:50 (January 2004).