This chapter establishes statewide licensing standards for Level III Crisis Receiving Centers (CRCs) in Louisiana, which provide short-term (3–7 day) crisis identification, intervention, and stabilization services for individuals in behavioral health crisis. Operators must obtain and maintain a license from the Louisiana Department of Health, comply with application, survey, renewal, and change-of-ownership requirements, and meet ongoing operational standards including 24/7 availability and staffing. The chapter also governs cessation of business procedures, plan review for construction, and enforcement mechanisms such as provisional licenses, statements of deficiency, and informal reconsiderations.
View official sourceChapter 53.Level III Crisis Receiving Centers Subchapter A.General Provisions §5301.Introduction A.The purpose of this Chapter is to: 1.provide for the development, establishment, and enforcement of statewide licensing standards for the care of patients and clients in level III crisis receiving centers (CRCs); 2.ensure the maintenance of these standards; and 3.regulate conditions in these facilities through a program of licensure which shall promote safe and adequate treatment of clients of behavioral health facilities. B.The purpose of a CRC is to provide intervention and stabilization services in order for the client to achieve stabilization and be discharged and referred to the lowest appropriate level of care that meets the client's needs. The estimated length of short term stay in a CRC is 3-7 days. C.In addition to the requirements stated herein, all licensed CRCs shall comply with applicable local, state, and federal laws and regulations. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:101 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:472 (April 2021). §5303.Definitions Active Clienta client of the CRC who is currently receiving services from the CRC. Administrative Procedure ActR.S. 49:950 et seq. Administrative ReviewHealth Standards Section's review of documentation submitted by the center in lieu of an on-site survey. Adulta person that is at least 18 years of age. Authorized Licensed Prescribera physician or nurse practitioner licensed in the state of Louisiana and with full prescriptive authority authorized by the CRC to prescribe treatment to clients of the specific CRC at which he/she practices. Building and Construction Guidelinesstructural and design requirements applicable to a CRC; does not include occupancy requirements. Cessation of Business—provider is non-operational and/or has stopped offering or providing services to the community. Change of Ownership (CHOW)—the addition, substitution, or removal, whether by sale, transfer, lease, gift or otherwise, of a licensed health care provider subject to this rule by a person, corporation, or other entity, which results in a change of ownership (CHOW) or change of controlling interest of assets or other equity interests of the licensed entity may constitute a CHOW of the licensed entity. An example of an action that constitutes a CHOW includes, but is not limited to, the leasing of the licensed entity. CLIAclinical laboratory improvement amendment. Client Recorda single complete record kept by the CRC which documents all treatment provided to the client. The record may be electronic, paper, magnetic material, film or other media. Community Mental Health Center—a Medicare certified program as defined in 42 CFR §410.2. An entity that: 1.provides outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and clients of its mental health service area who have been discharged from inpatient treatment at a mental health facility; 2.provides 24-hour-a-day emergency care services; 3.provides day treatment or other partial hospitalization services, or psychosocial rehabilitation services; 4.provides screening for patients being considered for admission to state mental health facilities to determine the appropriateness of this admission; 5.meets applicable licensing or certification requirements for CMHCs in the state in which it is located; and 6.provides at least 40 percent of its services to individuals who are not eligible for benefits under title XVIII of the Social Security Act. Construction Documentsbuilding plans and specifications. Contrabandany object or property that is against the CRC's policies and procedures to possess. Coroner's Emergency Certificate (CEC)—a certificate issued by the coroner or his/her deputy pursuant to R.S. 28:53, or current law. Crisis Receiving Servicesservices related to the treatment of people in behavioral crisis, including crisis identification, intervention and stabilization. Departmentthe Louisiana Department of Health Direct Care Staffany member of the staff, including an employee or contractor, that provides the services delineated in the comprehensive treatment plan. Food services, maintenance and clerical staff and volunteers are not considered as direct care staff. Disaster or Emergencya local, community-wide, regional or statewide event that may include, but is not limited to: 1.tornados; 2.fires; 3.floods; 4.hurricanes; 5.power outages; 6.chemical spills; 7.biohazards; 8.train wrecks; or 9.declared public health crisis. Division of Administrative Law (DAL)—the Division of Administrative Law or its successor entity. Grievancea formal or informal written or verbal complaint that is made to the CRC by a client or the client's family or representative regarding the client's care, abuse or neglect when the complaint is not resolved at the time of the complaint by staff present. HSS—the Health Standards Section of the Department of Health, Office of the Secretary, Office of Management and Finance. Human Services Fieldan academic program with a curriculum content in which at least 70 percent of the required courses for the major field of study are based upon the core mental health disciplines. Level III Crisis Receiving Center (or Center or CRC)—an agency, business, institution, society, corporation, person or persons, or any other group, licensed by the LDH to provide crisis identification, intervention and stabilization services for people in behavioral crisis. CRCs receive, examine, triage, refer, or treat people in behavioral health crisis. A CRC shall have no more than: 1.36 chairs for crisis stabilization/observation; and 2.24 beds for short term stay (three to seven days). NOTE: Refer to physical environment Section of this Chapter for physical space requirements. Licensed Mental Health Professional (LMHP)an individual who is licensed in the state of Louisiana to diagnose and treat mental illness or substance abuse, acting within the scope of all applicable state laws and their professional license. A LMHP must be one of the following individuals licensed to practice independently: 1.a physician/psychiatrist; 2.a medical psychologist; 3.a licensed psychologist; 4.a licensed clinical social worker (LCSW); 5.a licensed professional counselor (LPC); 6.a licensed marriage and family therapist (LMFT); 7.a licensed addiction counselor (LAC); 8.an advanced practice registered nurse or APRN (must be a nurse practitioner specialist in adult psychiatric and mental health or family psychiatric and mental health); 9.a certified nurse specialist in one of the following: a.psychosocial, gerontological psychiatric mental health; b.adult psychiatric and mental health; or c.child-adolescent mental health. LSBMELouisiana State Board of Medical Examiners. Major Alteration—any repair or replacement of building materials and equipment which does not meet the definition of minor alteration. Mental Health Emergency Room Extension (MHERE)—a mental health emergency room extension operating as a unit of a currently licensed hospital. Minora person under the age of 18. Minor Alteration—repair or replacement of building materials and equipment with materials and equipment of a similar type that does not diminish the level of construction below that which existed prior to the alteration. This does not include any alteration to the function or original design of the construction. OBH—the Department of Health, Office of Behavioral Health. OHSEPOffice of Homeland Security and Emergency Preparedness. On Callimmediately available for telephone consultation and less than one hour from ability to be on duty. On Dutyscheduled, present, and awake at the site to perform job duties. OPCorder for protective custody issued pursuant to R.S. 28:53.2. OSFMthe Louisiana Department of Public Safety and Corrections, Office of State Fire Marshal. Physicianan individual who holds a medical doctorate or a doctor of osteopathy from a medical college in good standing with the LSBME and a license, permit, certification, or registration issued by the LSBME to engage in the practice of medicine in the state of Louisiana. Physician’s Emergency Certificate (PEC)—an emergency certificate executed by a physician, physician assistant, psychiatric mental health nurse practitioner, or other nurse practitioner, or psychologist pursuant to R.S. 28:53, or current law. Qualifying Experienceexperience used to qualify for any position that is counted by using one year equals 12 months of full-time work. Seclusion Rooma room that may be secured in which one client may be placed for a short period of time due to the client's increased need for security and protection. Shelter in Placewhen a center elects to stay in place rather than evacuate when located in the projected path of an approaching storm equal to or greater than tropical storm strength. Sleeping Areaa single constructed room or area that contains a minimum of three individual beds. Tropical Storm Strengtha tropical cyclone in which the maximum sustained surface wind speed (using the U.S. 1 minute average standard) ranges from 34 kt (39 mph 17.5 m/s) to 63 kt (73 mph 32.5 mps). AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.11 et seq. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:102 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:472 (April 2021), LR 48:301 (February 2022), LR 49:1930 (November 2023). Subchapter B.Licensing §5309.General Licensing Provisions A.All entities providing crisis receiving services shall be licensed by LDH. It shall be unlawful to operate as a CRC without a license issued by the department. LDH is the only licensing authority for CRCs in Louisiana. B.A CRC license authorizes the center to provide crisis receiving services. C.The following entities are exempt from CRC licensure under this Chapter, so long as they are providing CRC services to existing clients: 1.community mental health centers (CMHCs); 2.hospitals; 3.nursing homes; 4.psychiatric residential treatment facilities; 5.school-based health centers; 6.therapeutic group homes; 7.home and community based services (HCBS) waiver agencies limited to center-based respite; 8.substance use/addictive disorder facilities; 9.mental health clinics as defined in §5603; 10.center-based respites; 11.MHEREs; and 12.federally qualified health care centers (FQHCs). D.A CRC license is not required for individual or group practice of LMHPs providing services under the auspices of their individual professional license(s). E.A CRC license shall: 1.be issued only to the person or entity named in the license application; 2.be valid only for the CRC to which it is issued and only for the geographic address of that CRC approved by DHH; 3.be valid for up to one year from the date of issuance, unless revoked, suspended, or modified prior to that date, or unless a provisional license is issued; 4.expire on the expiration date listed on the license, unless timely renewed by the CRC; 5.be invalid if sold, assigned, donated or transferred, whether voluntary or involuntary; and 6.be posted in a conspicuous place on the licensed premises at all times. F.In order for the CRC to be considered operational and retain licensed status, the following applicable operational requirements shall be met. The CRC shall: 1.be open and operating 24 hours per day, 7 days per week; 2.have the required staff on duty at all times to meet the needs of the clients; and 3.be able to screen and either admit or refer all potential clients at all times. G.The licensed CRC shall abide by any state and federal law, rule, policy, procedure, manual or memorandum pertaining to crisis receiving centers. H.The CRC shall permit designated representatives of the department, in the performance of their duties, to: 1.inspect all areas of the center's operations; and 2.conduct interviews with any staff member, client, or other person as necessary. I.CRC Names 1.A CRC is prohibited from using: a.the same name as another CRC; b.a name that resembles the name of another center; c.a name that may mislead the client or public into believing it is owned, endorsed, or operated by the state of Louisiana when it is not owned, endorsed, or operated by the state of Louisiana. J.Plan Review 1.Any entity that intends to operate as a CRC, except one that is converting from a MHERE or an existing CRC, shall complete the plan review process and obtain approval for its construction documents for the following types of projects: a.new construction; b.any entity that intends to operate and be licensed as a CRC in a physical environment that is not currently licensed as a CRC; or c.major alterations. 2.The CRC shall submit one complete set of construction documents with an application and review fee to the OSFM for review. Plan review submittal to the OSFM shall be in accordance with R.S. 40:1574, and the current Louisiana Administrative Code (LAC) provisions governing fire protection for buildings (LAC 55:V.Chapter 3 as of this promulgation), and the following criteria: a.any change in the type of license shall require review for requirements applicable at the time of licensing change; b.requirements applicable to occupancies, as defined by the most recently state-adopted edition of National Fire Protection Association (NFPA) 101, where services or treatment for four or more patients are provided; c.requirements applicable to construction of business occupancies, as defined by the most recently state-adopted edition of NFPA 101; and d.the specific requirements outlined in the Physical Environment requirements of this Chapter. 3.Construction Document Preparation a.The CRC's construction documents shall be prepared by a Louisiana licensed architect or licensed engineer as governed by the licensing laws of the state for the type of work to be performed. b.The CRC's construction documents shall be of an architectural or engineering nature and thoroughly illustrate an accurately drawn and dimensioned project that contains noted plans, details, schedules and specifications. c.The CRC shall submit at least the following in the plan review process: i.site plans; ii.floor plan(s). These shall include architectural, mechanical, plumbing, electrical, fire protection, and if required by code, sprinkler and fire alarm plans; iii.building elevations; iv.room finish, door, and window schedules; v.details pertaining to Americans with Disabilities Act (ADA) requirements; and vi.specifications for materials. 4.Upon OSFM approval, the CRC shall submit the following to DHH: a.the final construction documents approved by OSFM; and b.OSFM's approval letter. K.Waivers 1.The secretary of DHH may, within his/her sole discretion, grant waivers to building and construction guidelines which are not part of or otherwise required under the provisions of the state Sanitary Code. 2.In order to request a waiver, the CRC shall submit a written request to HSS that demonstrates: a.how patient safety and quality of care offered is not comprised by the waiver; b.the undue hardship imposed on the center if the waiver is not granted; and c.the center's ability to completely fulfill all other requirements of service. 3.DHH will make a written determination of each waiver request. 4.Waivers are not transferable in an ownership change or geographic change of location, and are subject to review or revocation upon any change in circumstances related to the waiver. 5. DHH prohibits waivers for new construction. L.A person or entity convicted of a felony or that has entered a guilty plea or a plea of nolo contendere to a felony is prohibited from being the CRC or owner, clinical supervisor or any managing employee of a CRC. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:103 (January 2015), amended LR 48:302 (February 2022). §5311.Initial Licensure Application Process A.Any entity, organization or person interested in operating a crisis receiving center must submit a completed initial license application packet to the department for approval. Initial CRC licensure application packets are available from HSS. B.A person/entity/organization applying for an initial license must submit a completed initial licensing application packet which shall include: 1.a completed CRC licensure application; 2.the non-refundable licensing fee as established by statute; 3.the approval letter of the architectural center plans for the CRC from OSFM, if the center must go through plan review; 4.the on-site inspection report with approval for occupancy by the OSFM, if applicable; 5.the health inspection report from the Office of Public Health (OPH); 6.a statewide criminal background check, including sex offender registry status, on all owners and managing employees; 7.except for governmental entities or organizations, proof of financial viability, comprised of the following: a.a line of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000; b.general liability insurance of at least $500,000 per occurrence; c.worker's compensation insurance in the amount as required by state law; d.professional liability insurance of at least $100,000 per occurrence/$500,000 per annual aggregate, or proof of self-insurance of at least $100,000, along with proof of enrollment as a qualified health care provider with the Louisiana Patient’s Compensation Fund (PCF): i.if the CRC is not enrolled in the PCF, professional liability limits shall be $1,000,000 per occurrence/$3,000,000 per annual aggregate; and e.the LDH-HSS shall specifically be identified as the certificate holder on any policies and any certificates of insurance issued as proof of insurance by the insurer or producer (agent); 8.an organizational chart and names, including position titles, of key administrative personnel and the governing body; 9.a legible floor sketch or drawing of the premises to be licensed; 10.a letter of intent indicating whether the center will serve minors or adults and the center's maximum number of beds; 11.if operated by a corporate entity, such as a corporation or an limited liability corporation (LLC), current proof of registration and status with the Louisiana Secretary of State's office; 12.a letter of recommendation from the OBH regional office or its designee; and 13.any other documentation or information required by the department for licensure. C.If the initial licensing packet is incomplete, the applicant shall: 1.be notified of the missing information; and 2.be given 90 days from receipt of the notification to submit the additional requested information or the application will be closed. D.Once the initial licensing application is approved by LDH, notification of such approval shall be forwarded to the applicant. E.The applicant shall notify LDH of initial licensing survey readiness within the required 90 days of receipt of application approval. If an applicant fails to notify LDH of initial licensing survey readiness within 90 days, the application will be closed. F.If an initial licensing application is closed, an applicant who is still interested in operating a CRC must submit a: 1.new initial licensing packet; and 2.non-refundable licensing fee. G.Applicants must be in compliance with all appropriate federal, state, departmental or local statutes, laws, ordinances, rules, regulations and fees before the CRC will be issued an initial license to operate. H.An entity that intends to become a CRC is prohibited from providing crisis receiving services to clients during the initial application process and prior to obtaining a license, unless it qualifies as one of the following facilities: 1.a hospital-based CRC; 2.an MHERE; 3.an MHERE that has communicated its intent to become licensed as a CRC in collaboration with the department prior to February 28, 2013; or 4.a center-based respite. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:104 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:473 (April 2021). §5313.Initial Licensing Surveys A.Prior to the initial license being issued, an initial licensing survey shall be conducted on-site to ensure compliance with the licensing laws and standards. B.If the initial licensing survey finds that the center is compliant with all licensing laws, regulations and other required statutes, laws, ordinances, rules, regulations, and fees, the department shall issue a full license to the center. C.In the event that the initial licensing survey finds that the center is noncompliant with any licensing laws or regulations, or any other required rules or regulations, that present a potential threat to the health, safety, or welfare of the clients, the department shall deny the initial license. D.In the event that the initial licensing survey finds that the center is noncompliant with any licensing laws or regulations, or any other required rules or regulations, and the department determines that the noncompliance does not present a threat to the health, safety or welfare of the clients, the department: 1.may issue a provisional initial license for a period not to exceed six months; and 2.shall require the center to submit an acceptable plan of correction. a.The department may conduct a follow-up survey following the initial licensing survey after receipt of an acceptable plan of correction to ensure correction of the deficiencies. If all deficiencies are corrected on the follow-up survey, a full license will be issued. b.If the center fails to correct the deficiencies, the initial license may be denied. E.The initial licensing survey of a CRC shall be an announced survey. Follow-up surveys to the initial licensing surveys are unannounced surveys. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:105 (January 2015). §5315.Types of Licenses A.The department has the authority to issue the following types of licenses. 1.Initial License a.The department shall issue a full license to the CRC when the initial licensing survey indicates the center is compliant with: i.all licensing laws and regulations; ii.all other required statutes, laws, ordinances, rules, regulations; and iii.fees. b.The license shall be valid until the expiration date shown on the license, unless the license is modified, revoked, or suspended. 2.Provisional Initial License a.The department may issue a provisional initial license to the CRC when the initial licensing survey finds that the CRC is noncompliant with any licensing laws or regulations or any other required statutes, laws, ordinances, rules, regulations or fees, but the department determines that the noncompliance does not present a threat to the health, safety or welfare of the clients. i.The center shall submit a plan of correction to the department for approval, and the center shall be required to correct all such noncompliance or deficiencies prior to the expiration of the provisional license. ii.If all such noncompliance or deficiencies are corrected on the follow-up survey, a full license will be issued. iii.If all such noncompliance or deficiencies are not corrected on the follow-up survey, or new deficiencies affecting the health, safety or welfare of a client are cited, the provisional license will expire and the center shall be required to begin the initial licensing process again by submitting a new initial license application packet and the appropriate licensing fee. 3.Renewal License. The department may issue a renewal license to a licensed CRC that is in substantial compliance with all applicable federal, state, departmental, and local statutes, laws, ordinances, rules, regulations and fees. The license shall be valid until the expiration date shown on the license, unless the license is modified, revoked, suspended, or terminated. 4.Provisional License. The department may issue a provisional license to a licensed CRC for a period not to exceed six months. a.A provisional license may be issued for the following reasons: i.more than five deficiencies cited during any one survey; ii.four or more validated complaints in a consecutive 12-month period; iii.a deficiency resulting from placing a client at risk for serious harm or death; iv.failure to correct deficiencies within 60 days of notification of such deficiencies, or at the time of a follow-up survey; or v.failure to be in substantial compliance with all applicable federal, state, departmental and local statutes, laws, ordinances, rules regulations and fees at the time of renewal of the license. b.The department may extend the provisional license for an additional period not to exceed 90 days in order for the center to correct the deficiencies. c.The center shall submit an acceptable plan of correction to DHH and correct all noncompliance or deficiencies prior to the expiration of the provisional license. d.The department shall conduct a follow-up survey of the CRC, either on-site or by administrative review, prior to the expiration of the provisional license. e.If the follow-up survey determines that the CRC has corrected the deficiencies and has maintained compliance during the period of the provisional license, the department may issue a license that will expire on the expiration date of the most recent renewal or initial license. f.The provisional license shall expire if: i.the center fails to correct the deficiencies by the follow-up survey; or ii.the center is cited with new deficiencies at the follow-up survey indicating a risk to the health, safety, or welfare of a client. g.If the provisional license expires, the center shall be required to begin the initial licensing process by submitting a: i.new initial license application packet; and ii.non-refundable fee. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:105 (January 2015). §5317.Changes in Licensee Information or Personnel A.Within five days of the occurrence, the CRC shall report in writing to HSS the following changes to the: 1.CRC's entity name; 2.business name; 3.mailing address; or 4.telephone number. B.Any change to the CRC's name or "doing business as” name requires the applicable nonrefundable fee for the issuance of an amended license with the new name. C.A CRC shall report any change in the CRC's key administrative personnel within five days of the change. 1.Key administrative personnel include the: a.CRC manager; b.clinical director; and c.nurse manager. 2.The CRC's notice to the department shall include the incoming individual's: a.name; b.date of appointment to the position; and c.qualifications. D.Change of Ownership (CHOW) 1.A CRC shall report a CHOW in writing to the department at least five days prior to the change. Within five days following the change, the new owner shall submit: a.the legal CHOW document; b.all documents required for a new license; and c.the applicable nonrefundable licensing fee. 2.A CRC that is under license revocation, provisional licensure, or denial of license renewal may not undergo a CHOW. 3.Once all application requirements are completed and approved by the department, a new license shall be issued to the new owner. E.Change in Physical Address 1.A CRC that intends to change the physical address of its geographic location shall submit: a.a written notice to HSS of its intent to relocate; b.a plan review request; c.a new license application; d.a nonrefundable license fee; and e.any other information satisfying applicable licensing requirements. 2.In order to receive approval for the change of physical address, the CRC must: a.have a plan review approval; b.have approval from OSFM and OPH recommendation for license; c.have an approved license application packet; d.be in compliance with other applicable licensing requirements; and e.have an on-site licensing survey prior to relocation of the center. 3.Upon approval of the requirements for a change in physical address, the department shall issue a new license to the CRC. F.Any request for a duplicate license shall be accompanied by the applicable fee. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:106 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:473 (April 2021). §5319.Renewal of License A.A CRC license expires on the expiration date listed on the license, unless timely renewed by the CRC. B.To renew a license, the CRC shall submit a completed license renewal application packet to the department at least 30 days prior to the expiration of the current license. The license renewal application packet includes: 1.the license renewal application; 2.a current State Fire Marshal report; 3.a current OPH inspection report; 4.the non-refundable license renewal fee; 5.any other documentation required by the department; and 6.except for governmental entities or organizations, proof of financial viability, comprised of the following: a.a line of credit issued from a federally insured, licensed lending institution in the amount of at least $100,000; b.general liability insurance of at least $500,000 per occurrence; c.worker's compensation insurance in the amount as required by state law; d.professional liability insurance of at least $100,000 per occurrence/$500,000 per annual aggregate, or proof of self-insurance of at least $100,000, along with proof of enrollment as a qualified health care provider with the Louisiana Patient’s Compensation Fund (PCF): i.if the CRC is not enrolled in the PCF, professional liability limits shall be $1,000,000 per occurrence/$3,000,000 per annual aggregate; and e.the LDH-HSS shall specifically be identified as the certificate holder on any policies and any certificates of insurance issued as proof of insurance by the insurer or producer (agent). C.The department may perform an on-site survey and inspection of the center upon renewal. D.Failure to submit a completed license renewal application packet prior to the expiration of the current license will result in the voluntary non-renewal of the CRC license upon the license's expiration. E.The renewal of a license does not in any manner affect any sanction, civil monetary penalty, or other action imposed by the department against the center. F.If a licensed CRC has been issued a notice of license revocation or suspension, and the center's license is due for annual renewal, the department shall deny the license renewal application and shall not issue a renewal license. G.Voluntary Non-Renewal of a License 1.If a center fails to timely renew its license, the license: a.expires on the license's expiration date; and b.is considered a non-renewal and voluntarily surrendered. 2.There is no right to an administrative reconsideration or appeal from a voluntary surrender or non-renewal of the license. 3.If a center fails to timely renew its license, the center shall immediately cease providing services, unless the center is actively treating clients, in which case the center shall: a.within two days of the untimely renewal, provide written notice to HSS of the number of clients receiving treatment at the center; b.within two days of the untimely renewal, provide written notice to each active client's prescribing physician and to every client, or, if applicable, the client's parent or legal guardian, of the following: i.voluntary non-renewal of license; ii.date of closure; and iii.plans for the transition of the client; c.discharge and transition each client in accordance with this Chapter within 15 days of the license's expiration date; and d.within 30 days of the license's expiration date, notify HSS of the location where records will be stored in compliance with federal and state laws and the name, address, and phone number of the person responsible for the records. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:106 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:473 (April 2021). §5321.Licensing Surveys A.The department may conduct periodic licensing surveys and other surveys as deemed necessary to ensure compliance with all laws, rules and regulations governing crisis receiving centers and to ensure client health, safety and welfare. These surveys may be conducted on-site or by administrative review and shall be unannounced. B.If deficiencies are cited, the department may require the center to submit an acceptable plan of correction. C.The department may conduct a follow-up survey following any survey in which deficiencies were cited to ensure correction of the deficiencies. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:107 (January 2015). §5323.Complaint Surveys A.Pursuant to R.S. 40:2009.13 et seq., the department has the authority to conduct unannounced complaint surveys on crisis receiving centers. B.The department shall issue a statement of deficiency to the center if it finds a deficiency during the complaint survey. C.Plan of Correction 1.Once the department issues a statement of deficiencies, the department may require the center to submit an acceptable plan of correction. 2.If the department determines that other action, such as license revocation, is appropriate, the center: a.may not be required to submit a plan of correction; and b.will be notified of such action. D.Follow-up Surveys 1.The department may conduct a follow-up survey following a complaint survey in which deficiencies were cited to ensure correction of the deficient practices. 2.If the department determines that other action, such as license revocation, is appropriate: a.a follow-up survey is not necessary; and b.the center will be notified of such action. E.Informal Reconsiderations of Complaint Surveys 1.A center that is cited with deficiencies found during a complaint survey has the right to request an informal reconsideration of the deficiencies. The center's written request for an informal reconsideration must be received by HSS within 10 calendar days of the center's receipt of the statement of deficiencies. 2.An informal reconsideration for a complaint survey or investigation shall be conducted by the department as a desk review. 3.Correction of the violation or deficiency shall not be the basis for the reconsideration. 4.The center shall be notified in writing of the results of the informal reconsideration. 5.Except for the right to an administrative appeal provided in R.S. 40:2009.16, the informal reconsideration shall constitute final action by the department regarding the complaint survey, and there shall be no further right to an administrative appeal. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:107 (January 2015). §5325.Statement of Deficiencies A.The CRC shall make any statement of deficiencies available to the public upon request after the center submits a plan of correction that is accepted by the department or 90 days after the statement of deficiencies is issued to the center, whichever occurs first. B.Informal Reconsiderations 1.Unless otherwise provided in statute or in this Chapter, a CRC has the right to an informal reconsideration of any deficiencies cited as a result of a survey. 2.Correction of the violation, noncompliance or deficiency shall not be the basis for the reconsideration. 3.The center's written request for informal reconsideration must be received by HSS within 10 calendar days of the center's receipt of the statement of deficiencies. 4.If a timely request for an informal reconsideration is received, the department shall schedule and conduct the informal reconsideration. 5.HSS shall notify the center in writing of the results of the informal reconsideration. 6.Except as provided pursuant to R.S. 40:2009.13 et seq., and as provided in this Chapter: a.the informal reconsideration decision is the final administrative decision regarding the deficiencies; and b.there is no right to an administrative appeal of such deficiencies. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:107 (January 2015). §5327.Cessation of Business A.Except as provided in §5407 and §5409 of these licensing regulations, a license shall be immediately null and void if a provider ceases to operate. B.A cessation of business is deemed to be effective the date on which the provider stopped offering or providing services to the community. C.Upon the cessation of business, the provider shall immediately return the original license to the department. D.Cessation of business is deemed to be a voluntary action on the part of the provider. The provider does not have a right to appeal a cessation of business. E.A CRC that intends to cease operations shall: 1.provide 30 days advance written notice to HSS and the active client, or if applicable, the client's parent(s), legal guardian, or designated representative; and 2.discharge and transition all clients in accordance with this Chapter. F.The provider shall notify the department in writing 30 days prior to the effective date of the closure or cessation. In addition to the notice, the provider shall submit a written plan for the disposition of patient medical records for approval by the department. The plan shall include the following: 1.the effective date of the closure; 2.provisions that comply with federal and state laws on storage, maintenance, access, and confidentiality of the closed provider's patients medical records; 3.an appointed custodian(s) who shall provide the following: a.access to records and copies of records to the patient or authorized representative, upon presentation of proper authorization(s); and b.physical and environmental security that protects the records against fire, water, intrusion, unauthorized access, loss and destruction; 4.public notice regarding access to records, in the newspaper with the largest circulation in close proximity to the closing provider, at least 15 days prior to the effective date of closure. G.If a CRC fails to follow these procedures, the department may prohibit the owners, managers, officers, directors, and/or administrators from opening, managing, directing, operating, or owning a CRC for a period of two years. H.Once the provider has ceased doing business, the provider shall not provide services until the provider has obtained a new initial license. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:108 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). §5329.Sanctions A.The department may issue sanctions for deficiencies and violations of law, rules and regulations that may include, but are not limited to: 1.civil fines; 2.directed plans of correction; 3.provisional licensure; and/or 4.license revocation or denial of license renewal. B.The department may deny an application for an initial license or a license renewal, or may revoke a license in accordance with the Administrative Procedure Act. C.The department may deny an initial license, revoke a license or deny a license renewal for any of the following reasons, including but not limited to: 1.failure to be in compliance with the CRC licensing laws, rules and regulations; 2.failure to be in compliance with other required statutes, laws, ordinances, rules or regulations; 3.failure to comply with the terms and provisions of a settlement agreement or education letter; 4.cruelty or indifference to the welfare of the clients; 5.misappropriation or conversion of the property of the clients; 6.permitting, aiding or abetting the unlawful, illicit or unauthorized use of drugs or alcohol within the center of a program; 7.documented information of past or present conduct or practices of an employee or other staff which are detrimental to the welfare of the clients, including but not limited to: a.illegal activities; or b.coercion or falsification of records; 8.failure to protect a client from a harmful act of an employee or other client including, but not limited to: a.mental or physical abuse, neglect, exploitation or extortion; b.any action posing a threat to a client's health and safety; c.coercion; d.threat or intimidation; e.harassment; or f.criminal activity; 9.failure to notify the proper authorities, as required by federal or state law or regulations, of all suspected cases of the acts outlined in Paragraph D.8 above; 10.knowingly making a false statement in any of the following areas, including but not limited to: a.application for initial license or renewal of license; b.data forms; c.clinical records, client records or center records; d.matters under investigation by the department or the Office of the Attorney General; or e.information submitted for reimbursement from any payment source; 11.knowingly making a false statement or providing false, forged or altered information or documentation to DHH employees or to law enforcement agencies; 12.the use of false, fraudulent or misleading advertising; or 13.the CRC, an owner, officer, member, manager, administrator, medical director, managing employee, or clinical supervisor has pled guilty or nolo contendere to a felony, or is convicted of a felony, as documented by a certified copy of the record of the court; 14.failure to comply with all reporting requirements in a timely manner, as required by the department; 15.failure to allow or refusal to allow the department to conduct an investigation or survey or to interview center staff or clients; 16.interference with the survey process, including but not limited to, harassment, intimidation, or threats against the survey staff; 17.failure to allow or refusal to allow access to center or client records by authorized departmental personnel; 18.bribery, harassment, intimidation or solicitation of any client designed to cause that client to use or retain the services of any particular CRC; 19.failure to repay an identified overpayment to the department or failure to enter into a payment agreement to repay such overpayment; 20.failure to timely pay outstanding fees, fines, sanctions or other debts owed to the department; or 21.failure to uphold client rights that may have resulted or may result in harm, injury or death of a client. D.If the department determines that the health and safety of a client or the community may be at risk, the imposition of the license revocation or license non-renewal may be immediate and may be enforced during the pendency of the administrative appeal. The department will provide written notification to the center if the imposition of the action will be immediate. E.Any owner, officer, member, manager, director or administrator of such CRC is prohibited from owning, managing, directing or operating another CRC for a period of two years from the date of the final disposition of any of the following: 1.license revocation; 2.denial of license renewal; or 3.the license is surrendered in lieu of adverse action. AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:108 (January 2015). §5331.Notice and Appeal of License Denial, License Revocation and Denial of License Renewal A.The department shall provide written notice to the CRC of the following: 1.license denial; 2.license revocation; or 3.denial of license renewal. B.The CRC has the right to an administrative reconsideration of the license denial, license revocation or denial of license renewal. 1.If the CRC chooses to request an administrative reconsideration, the request must: a.be in writing addressed to HSS; b.be received by HSS within 15 calendar days of the center's receipt of the notice of the license denial, license revocation or denial of license renewal; and c.include any documentation that demonstrates that the determination was made in error. 2.If a timely request for an administrative reconsideration is received, HSS shall provide the center with written notification of the date of the administrative reconsideration. 3.The center may appear in person at the administrative reconsideration and may be represented by counsel. 4.HSS shall not consider correction of a deficiency or violation as a basis for the reconsideration. 5.The center will be notified in writing of the results of the administrative reconsideration. C.The administrative reconsideration process is not in lieu of the administrative appeals process. D.The CRC has a right to an administrative appeal of the license denial, license revocation or denial of license renewal. 1.If the CRC chooses to request an administrative appeal, the request must: a.be received by the DAL within 30 days of: i.the receipt of the results of the administrative reconsideration; or ii.the receipt of the notice of the license denial, revocation or denial of license renewal, if the CRC chose to forego its rights to an administrative reconsideration; b.be in writing; c.include any documentation that demonstrates that the determination was made in error; and d.include the basis and specific reasons for the appeal. 2.The DAL shall not consider correction of a violation or a deficiency as a basis for the administrative appeal. E.Administrative Appeals of License Revocations and Denial of License Renewals 1.If a timely request for an administrative appeal is received by the DAL, the center will be allowed to continue to operate and provide services until the DAL issues a final administrative decision. F.Administrative Appeals of Immediate License Revocations or Denial of License Renewals 1.If DHH imposes an immediate license revocation or denial of license renewal, DHH may enforce the revocation or denial of license renewal during the appeal process. 2.If DHH chooses to enforce the revocation or denial of license renewal during the appeal process, the center will not be allowed to operate and/or provide services during the appeal process. G.If a licensed CRC has a pending license revocation, and the center's license is due for annual renewal, the department shall deny the license renewal application. The denial of the license renewal application does not affect, in any manner, the license revocation. H.Administrative Hearings of License Denials, Denial of License Renewals and License Revocations 1.If a timely administrative appeal is submitted by the center, the DAL shall conduct the hearing in accordance with the Administrative Procedure Act. 2.If the final DAL decision is to reverse the license denial, denial of license renewal or license revocation, the center's license will be re-instated upon the payment of any outstanding fees or sanctions fees due to the department. 3.If the final DAL decision is to affirm the denial of license renewal or license revocation, the center shall: a.discharge and transition any and all clients receiving services according to the provisions of this Chapter; b.comply with the requirements governing cessation of business in this Chapter; and c.notify HSS within 10 days of closure of the location where the records will be stored and the name, address and phone number of the person responsible for the records. I.There is no right to an administrative reconsideration or an administrative appeal of the issuance of a provisional initial license to a new CRC, or the issuance of a provisional license to a licensed CRC. J.Administrative Reconsiderations and Administrative Appeals of the Expiration of a Provisional Initial License or Provisional License 1.A CRC with a provisional initial license, or a provisional license that expires due to deficiencies cited at the follow-up survey, has the right to request an administrative reconsideration and/or an administrative appeal of the deficiencies cited at the follow-up survey. 2.The center's request for an administrative reconsideration must: a.be in writing; b.be received by the HSS within five calendar days of receipt of the notice of the results of the follow-up survey from the department; and c.include the basis and specific reasons for the administrative reconsideration. 3.Correction of a violation or deficiency after the follow-up survey will not be considered as the basis for the administrative reconsideration or for the administrative appeal. 4.The issue to be decided in the administrative reconsideration and the administrative appeal is whether the deficiencies were properly cited at the follow-up survey. 5.The CRC's request for an administrative appeal must: a.be in writing; b.be submitted to the DAL within 15 calendar days of receipt of the notice of the results of the follow-up survey from the department; and c.include the basis and specific reasons for the appeal. 6.A center with a provisional initial license or a provisional license that expires under the provisions of this Chapter shall cease providing services and discharge or transition clients unless the DAL or successor entity issues a stay of the expiration. a.To request a stay, the center must submit its written application to the DAL at the time the administrative appeal is filed. b.The DAL shall hold a contradictory hearing on the stay application. If the center shows that there is no potential harm to the center's clients, then the DAL shall grant the stay. 7.Administrative Hearing a.If the CRC submits a timely request for an administrative hearing, the DAL shall conduct the hearing in accordance with the Administrative Procedure Act. b.If the final DAL decision is to remove all deficiencies, the department will reinstate the center's license upon the payment of any outstanding fees and settlement of any outstanding sanctions due to the department. c.If the final DAL decision is to uphold the deficiencies, thereby affirming the expiration of the provisional license, the center shall discharge any and all clients receiving services in accordance with the provisions of this Chapter. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14 HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:109 (January 2015). Subchapter C.Organization and Administration §5337.General Provisions A.Purpose and Organizational Structure. The CRC shall develop and implement a statement maintained by the center that clearly defines the purpose of the CRC. The statement shall include: 1.the program philosophy; 2.the program goals and objectives; 3.the ages, sex and characteristics of clients accepted for care; 4.the geographic area served; 5.the types of services provided; 6.the admission criteria; 7.the needs, problems, situations or patterns addressed by the provider's program; and 8.an organizational chart of the provider which clearly delineates the lines of authority. B.The CRC shall provide supervision and services that: 1.conform to the department's rules and regulations; 2.meet the needs of the client as identified and addressed in the client's treatment plan; 3.protect each client's rights; and 4.promote the social, physical and mental well-being of clients. C.The CRC shall maintain any information or documentation related to compliance with this Chapter and shall make such information or documentation available to the department. D.Required Reporting. The center shall report the following incidents in writing to HSS within 24 hours of discovery: 1.any disaster or emergency or other unexpected event that causes significant disruption to program operations; 2.any death or serious injury of a client: a.that may potentially be related to program activities; or b.who at the time of his/her death or serious injury was an active client of the center; and 3.allegations of client abuse, neglect, exploitation and misappropriation of client funds. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:110 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). §5339.Governing Body A.A crisis receiving center shall have the following: 1.an identifiable governing body with responsibility for and authority over the policies and operations of the center; 2.documents identifying the governing body's: a.members; b.contact information for each member; c.terms of membership; d.officers; and e.terms of office for each officer. B.The governing body of a CRC shall: 1.be comprised of one or more persons; 2.hold formal meetings at least twice a year; 3.maintain written minutes of all formal meetings of the governing body; and 4.maintain by-laws specifying frequency of meetings and quorum requirements. C.The responsibilities of a CRC's governing body include, but are not limited to: 1.ensuring the center's compliance with all federal, state, local and municipal laws and regulations as applicable; 2.maintaining funding and fiscal resources to ensure the provision of services and compliance with this Chapter; 3.reviewing and approving the center's annual budget; 4.designating qualified persons to act as CRC manager, clinical director and nurse manager, and delegating these persons the authority to manage the center; 5.at least once a year, formulating and reviewing, in consultation with the CRC manager, clinical director and nurse manager, written policies concerning: a.the provider's philosophy and goals; b.current services; c.personnel practices and job descriptions; and d.fiscal management; 6.evaluating the performances of the CRC manager, clinical director and nurse manager at least once a year; 7.meeting with designated representatives of the department whenever required to do so; 8.informing the department, or its designee, prior to initiating any substantial changes in the services provided by the center; 9.ensuring statewide criminal background checks are conducted as required in this Chapter and state law; and 10.ensuring verification of the Louisiana Adverse Action website and the nurse aide registry for direct care staff as required in this Chapter and state law. D.A governing body shall ensure that the CRC maintains the following documents: 1.minutes of formal meetings and by-laws of the governing body; 2.documentation of the center's authority to operate under state law; 3.all leases, contracts and purchases-of-service agreements to which the center is a party; 4.insurance policies; 5.annual operating budgets; 6.a master list of all the community resources used by the center; 7.documentation of ownership of the center; 8.documentation of all accidents, incidents, abuse/neglect allegations; and 9.a daily census log of clients receiving services. E.The governing body of a CRC shall ensure the following with regards to contract agreements to provide services for the center. 1.The agreement for services is in writing. 2.Every written agreement is reviewed at least once a year. 3.The deliverables are being provided as per the agreement. 4.The center retains full responsibility for all services provided by the agreement. 5.All services provided by the agreement shall: a.meet the requirements of all laws, rules and regulations applicable to a CRC; and b.be provided only by qualified providers and personnel in accordance with this Chapter. 6.If the agreement is for the provision of direct care services, the written agreement specifies the party responsible for screening, orientation, ongoing training and development of and supervision of the personnel providing services pursuant to the agreement. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:111 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). §5341.Policies and Procedures A.Each CRC shall develop, implement and comply with center-specific written policies and procedures governing all requirements of this chapter, including, but not limited to the following areas: 1.protection of the health, safety, and wellbeing of each client; 2.providing treatment in order for clients to achieve optimal stabilization; 3.access to care that is medically necessary; 4.uniform screening for patient placement and quality assessment, diagnosis, evaluation, and referral to appropriate level of care; 5.operational capability and compliance; 6.delivery of services that are cost-effective and in conformity with current standards of practice; 7.confidentiality and security of all client information, records and files; 8.prohibition of illegal or coercive inducement, solicitation and kickbacks; 9.client rights; 10.grievance process; 11.emergency preparedness; 12.abuse and neglect; 13.incidents and accidents, including medical emergencies; 14.universal precautions; 15.documentation of services; 16.admission, including descriptions of screening and assessment procedures; 17.transfer and discharge procedures; 18.behavior management; 19.infection control practices that meets current state and federal infection control guidelines; 20.transportation; 21.quality assurance; 22.medical and nursing services; 23.emergency care; 24.photography and video of clients; and 25.contraband. B.A center shall develop, implement and comply with written personnel policies in the following areas: 1.recruitment, screening, orientation, ongoing training, development, supervision and performance evaluation of staff including volunteers; 2.written job descriptions for each staff position, including volunteers; 3.conducting staff health assessments that are consistent with OPH guidelines and indicate whether, when and how staff have a health assessment; 4.an employee grievance procedure; 5.abuse reporting procedures that require: a.staff to report any allegations of abuse or mistreatment of clients pursuant to state and federal law; and b.staff to report any allegations of abuse, neglect, exploitation or misappropriation of a client to DHH; 6.a non-discrimination policy; 7.a policy that requires all employees to report any signs or symptoms of a communicable disease or personal illness to their supervisor, CRC manager or clinical director as soon as possible to prevent the spread of disease or illness to other individuals; 8.procedures to ensure that only qualified personnel are providing care within the scope of the center's services; 9.policies governing staff conduct and procedures for reporting violations of laws, rules, and professional and ethical codes of conduct; 10.policies governing staff organization that pertain to the center's purpose, setting and location; 11.procedures to ensure that the staff's credentials are verified, legal and from accredited institutions; and 12.obtaining criminal background checks, adverse action, and registry checks. C.A CRC shall comply with all federal and state laws, rules and regulations in the implementation of its policies and procedures. D.Center Rules 1.A CRC shall: a.have a clearly written list of rules governing client conduct in the center; b.provide a copy of the center's rules to all clients and, where appropriate, the client's parent(s) or legal guardian(s) upon admission; and c.post the rules in an accessible location in the center. E.The facility shall develop, implement and comply with policies and procedures that: 1.give consideration to the client's chronological and developmental age, diagnosis, and severity of illness when assigning a sleeping area or bedroom; 2.ensure that each client has his/her own bed; and 3.prohibit mobile homes from being used as client sleeping areas. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:111 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). Subchapter D.Provider Operations §5347.Client Records A.The CRC shall ensure: 1.a single client record is maintained for each client according to current professional standards; 2.policies and procedures regarding confidentiality of records, maintenance, safeguarding and storage of records are developed, implemented and followed; 3.safeguards are in place to prevent unauthorized access, loss, and destruction of client records; 4.when electronic health records are used, the most up to date technologies and practices are used to prevent unauthorized access; 5.records are kept confidential according to federal and state laws and regulations; 6.records are maintained at the center where the client is currently active and for six months after discharge; 7.six months post-discharge, records may be transferred to a centralized location for maintenance; 8.client records are directly and readily accessible to the clinical staff caring for the client; 9.a system of identification and filing is maintained to facilitate the prompt location of the client's record; 10.all record entries are dated, legible and authenticated by the staff person providing the treatment, as appropriate to the media; 11.records are disposed of in a manner that protects client confidentiality; 12.a procedure for modifying a client record in accordance with accepted standards of practice is developed, implemented and followed; 13.an employee is designated as responsible for the client records; 14.disclosures are made in accordance with applicable state and federal laws and regulations; and 15.client records are maintained at least 6 years from discharge. B.Record Contents. The center shall ensure that client records, at a minimum, contain the following: 1.the treatment provided to the client; 2.the client's response to the treatment; 3.other information, including: a.all screenings and assessments; b.provisional diagnoses; c.referral information; d.client information/data such as name, race, sex, birth date, address, telephone number, social security number, school/employer, and next of kin/emergency contact; e.documentation of incidents that occurred; f.attendance/participation in services/activities; g.treatment plan that includes the initial treatment plan plus any updates or revisions; h.lab work (diagnostic laboratory and other pertinent information, when indicated); i.documentation of the services received prior to admission to the CRC as available; j.consent forms; k.physicians' orders; l.records of all medicines administered, including medication types, dosages, frequency of administration, the individual who administered each dose and response to medication given on an as needed basis; m.discharge summary; n.other pertinent information related to client as appropriate; and 4.legible progress notes that are documented in accordance with professional standards of practice and: a.document implementation of the treatment plan and results; b.document the client's level of participation; and c.are completed upon delivery of services by the direct care staff to document progress toward stated treatment plan goals. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:112 (January 2015). §5349.Client Funds and Possessions A.The CRC shall: 1.maintain and safeguard all possessions, including money, brought to the center by clients; 2.maintain an inventory of each client's possessions from the date of admission; and 3.return all possessions to the client upon the client's discharge. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:113 (January 2015). §5351.Quality Improvement Plan A.A CRC shall have a quality improvement (QI) plan that: 1.assures that the overall function of the center is in compliance with federal, state, and local laws; 2.is meeting the needs of the citizens of the area; 3.is attaining the goals and objectives established in the center's mission statement; 4.maintains systems to effectively identify issues that require quality monitoring, remediation and improvement activities; 5.improves individual outcomes and individual satisfaction; 6.includes plans of action to correct identified issues that: a.monitor the effects of implemented changes; and b.result in revisions to the action plan; 7.is updated on an ongoing basis to reflect changes, corrections and other modifications. B.The QI plan shall include: 1.a sample review of client case records on a quarterly basis to ensure that: a.individual treatment plans are up to date; b.records are accurate, complete and current; and c.the treatment plans have been developed and implemented as ordered; 2.a process for identifying on a quarterly basis the risk factors that affect or may affect the health, safety and/or welfare of the clients that includes, but is not limited to: a.review and resolution of grievances; b.incidents resulting in harm to client or elopement; c.allegations of abuse, neglect and exploitation; and d.seclusion and restraint; 3.a process to correct problems identified and track improvements; and 4.a process of improvement to identify or trigger further opportunities for improvement. C.The QI plan shall establish and implement an internal evaluation procedure to: 1.collect necessary data to formulate a plan; and 2.hold quarterly staff committee meetings comprised of at least three staff members, one of whom is the CRC manager, nurse manager or clinical director, who evaluate the QI process and activities on an ongoing basis. D.The CRC shall maintain documentation of the most recent 12 months of the QI activity. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:113 (January 2015). Subchapter E.Personnel §5357.General Requirements A.The CRC shall maintain an organized professional staff who is accountable to the governing body for the overall responsibility of: 1.the quality of all clinical care provided to clients; 2.the ethical conduct and professional practices of its members; 3.compliance with policies and procedures approved by the governing body; and 4.the documented staff organization that pertains to the center's setting and location. B.The direct care staff of a CRC shall: 1.have the appropriate qualifications to provide the services required by its clients' treatment plans; and 2.not practice beyond the scope of his/her license, certification or training. C.The CRC shall ensure that: 1.qualified direct care staff members are present with the clients as necessary to ensure the health, safety and well-being of clients; 2.staff coverage is maintained in consideration of: a.acuity of the clients being serviced; b.the time of day; c.the size, location, physical environment and nature of the center; d.the ages and needs of the clients; and e.ensuring the continual safety, protection, direct care and supervision of clients; 3.all direct care staff have current certification in cardiopulmonary resuscitation; and 4.applicable staffing requirements in this Chapter are maintained. D.Criminal Background Checks 1.For any CRC that is treating minors, the center shall obtain a criminal background check on all staff. The background check must be conducted within 90 days prior to hire or employment in the manner required by R.S. 15:587.1. 2.For any CRC that is treating adults, the center shall obtain a statewide criminal background check on all unlicensed direct care staff by an agency authorized by the Office of State Police to conduct criminal background checks. The background check must be conducted within 90 days prior to hire or employment. 3.A CRC that hires a contractor to perform work which does not involve any contact with clients is not required to conduct a criminal background check on the contractor if accompanied at all times by a staff person when clients are present in the center. E.The CRC shall review the Louisiana state nurse aide registry and the Louisiana direct service worker registry included in the Louisiana Adverse Action website, or its successor, to ensure that each unlicensed direct care staff member prior to hire or employment and at least annually thereafter, does not have a negative finding on either registry. F.Prohibitions 1.The center providing services to minors is prohibited from knowingly employing or contracting with, or retaining the employment of or contract with, a person who supervises minors or provides direct care to minors who: a.has entered a plea of guilty or nolo contendere, no contest, or has been convicted of a felony involving: i.violence, abuse or neglect against a person; ii.possession, sale, or distribution of illegal drugs; iii.sexual misconduct and/or any crimes that requires the person to register pursuant to the Sex Offenders Registration Act; iv.misappropriation of property belonging to another person; or v.a crime of violence; b.has a finding placed on the Louisiana state nurse aide registry or the Louisiana direct service worker registry. 2.The center providing services to adults is prohibited from knowingly employing or contracting with, or retaining the employment of or contract with, a member of the direct care staff who: a.has entered a plea of guilty or nolo contendere, no contest, or has been convicted of a felony involving: i.abuse or neglect of a person; ii.possession, sale, or distribution of a controlled dangerous substance (a).within the last five years; or (b).when the employee/contractor is under the supervision of the Louisiana Department of Public Safety and Corrections, the U.S. Department of Probation and Parole or the U.S. Department of Justice; iii.sexual misconduct and/or any crimes that requires the person to register pursuant to the Sex Offenders Registration Act; iv.misappropriation of property belonging to another person; (a).within the last five years; or (b).when the employee is under the supervision of the Louisiana Department of Public Safety and Corrections, the U.S. Department of Probation and Parole or the U.S. Department of Justice; or v.a crime of violence; b.has a finding placed on the Louisiana state nurse aide registry or the Louisiana direct service worker registry on the Louisiana Adverse Action website, or its successor. G.Orientation and In-Service Training 1.All staff shall receive orientation prior to providing services and/or working in the center. 2.All direct care staff shall receive orientation, at least 40 hours of which is in crisis services and intervention training. 3.All direct care staff and other appropriate personnel shall receive in-service training at least once a year, at least twelve hours of which is in crisis services and intervention training. 4.All staff shall receive in-service training according to center policy at least once a year and as deemed necessary depending on the needs of the clients. 5.The content of the orientation and in-service training shall include the following: a.confidentiality; b.grievance process; c.fire and disaster plans; d.emergency medical procedures; e.organizational structure and reporting relationships; f.program philosophy; g.personnel policies and procedures; h.detecting and mandatory reporting of client abuse, neglect or misappropriation; i.an overview of mental health and substance abuse, including an overview of behavioral health settings and levels of care; j.detecting signs of illness or dysfunction that warrant medical or nursing intervention; k.side effects and adverse reactions commonly caused by psychotropic medications; l.basic skills required to meet the health needs and challenges of the client; m.components of a crisis cycle; n.recognizing the signs of anxiety and escalating behavior; o.crisis intervention and the use of non-physical intervention skills, such as de-escalation, mediation conflict resolution, active listening and verbal and observational methods to prevent emergency safety situations; p.therapeutic communication; q.client's rights; r.duties and responsibilities of each employee; s.standards of conduct required by the center including professional boundaries; t.information on the disease process and expected behaviors of clients; u.levels of observation; v.maintaining a clean, healthy and safe environment and a safe and therapeutic milieu; w.infectious diseases and universal precautions; x.overview of the Louisiana licensing standards for crisis receiving centers; y.basic emergency care for accidents and emergencies until emergency medical personnel can arrive at center; and z.regulations, standards and policies related to seclusion and restraint, including the safe application of physical and mechanical restraints and physical assessment of the restrained client. 6.The in-services shall serve as a refresher for subjects covered in orientation. 7.The orientation and in-service training shall: a.be provided only by staff who are qualified by education, training, and experience; b.include training exercises in which direct care staff members successfully demonstrate in practice the techniques they have learned for managing the delivery of patient care services; and c.require the direct care staff member to demonstrate competency before providing services to clients. I.Staff Evaluation 1.The center shall complete an annual performance evaluation of all employees. 2.The center's performance evaluation procedures for employees who provide direct care to clients shall address the quality and nature of the employee's relationships with clients. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:113 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). §5359.Personnel Qualifications and Responsibilities A.A CRC shall have the following minimum staff: 1.a CRC manager who: a.has a minimum of a master's degree in a human services field or is a licensed registered nurse; b.has at least one year of qualifying experience in the field of behavioral health; c.is a full time employee; and d.has the following assigned responsibilities: i.supervise and manage the day to day operation of the CRC; ii.review reports of all accidents/incidents occurring on the premises and identify hazards to the clinical director; iii.participate in the development of new programs and modifications; iv.perform programmatic duties and/or make clinical decisions only within the scope of his/her licensure; and v.shall not have other job responsibilities that impede the ability to maintain the administration and operation of the CRC; 2.a clinical director who is: a.a physician licensed in the state of Louisiana with expertise in managing psychiatric and medical conditions in accordance with the LSBME; or b.a psychiatric and mental health nurse practitioner who has an unrestricted APRN license with prescriptive authority, and who is in collaborative practice with a Louisiana licensed physician for consultation in accordance with the Louisiana State Board of Nursing (LSBN) requirements; c.responsible for developing and implementing policies and procedures and oversees clinical services and treatment; d.on duty as needed and on call and available at all times; 3.a nurse manager who: a.holds a current unrestricted license as a registered nurse (RN) in the state of Louisiana; b.shall be a full time employee; c.has been a RN for a minimum of five years; d.has three years of qualifying experience providing direct care to patients with behavioral health diagnoses and at least one year qualifying experience providing direct care to medical/surgical inpatients; e.has the following responsibilities: i.develop and ensure implementation of nursing policies and procedures; ii.provide oversight of nursing staff and the services they provide; iii.ensure that any other job responsibilities will not impede the ability to provide oversight of nursing services; 4.authorized licensed prescriber who: a.shall be either: i.a physician licensed in the state of Louisiana with expertise in managing psychiatric and medical conditions in accordance with the LSBME; or ii.a psychiatric and mental health nurse practitioner who has an unrestricted license and prescriptive authority and a licensed physician on call at all times to be available for consultation; b.is on call at all times; c.is responsible for managing the psychiatric and medical care of the clients; 5.licensed mental health professionals (LMHPs): a.the center shall maintain a sufficient number of LMHPs to meet the needs of its clients; b.there shall be at least one LMHP on duty during hours of operation; c.the LMHP shall have one year of qualifying experience in direct care to clients with behavioral health diagnoses and shall have the following responsibilities: i.provide direct care to clients and may serve as primary counselor to specified caseload; ii.serve as a resource person for other professionals and unlicensed personnel in their specific area of expertise; iii.attend and participate in individual care conferences, treatment planning activities, and discharge planning; and iv.function as the client's advocate in all treatment decisions; 6.nurses: a.the center shall maintain licensed nursing staff to meet the needs of its clients; b.all nurses shall have: i.a current nursing license from the state of Louisiana; ii.at least one year qualifying experience in providing direct care to clients with a behavioral health diagnosis; and iii.at least one year qualifying experience providing direct care to medical/surgical inpatients. c.the nursing staff has the following responsibilities: i.provide nursing services in accordance with accepted standards of practice, the CRC policies and the individual treatment plans of the clients; ii.supervise non-licensed clinical personnel; iii.each CRC shall have at least one RN on duty at the CRC during hours of operation; and iv.as part of orientation, all nurses shall receive 24 hours of education focusing on psychotropic medications, their side effects and possible adverse reactions. All nurses shall receive training in psychopharmacology for at least four hours per year. B.Optional Staff 1.The CRC shall maintain non-licensed clinical staff as needed who shall: a.be at least 18 years of age; b.have a high school diploma or GED; c.provide services in accordance with CRC policies, documented education, training and experience, and the individual treatment plans of the clients; and d.be supervised by the nursing staff. 2.Volunteers a.The CRC that utilizes volunteers shall ensure that each volunteer: i.meets the requirements of non-licensed clinical staff; ii.is screened and supervised to protect clients and staff; iii.is oriented to facility, job duties, and other pertinent information; iv.is trained to meet requirements of duties assigned; v.is given a written job description or written agreement; vi.is identified as a volunteer; vii.is trained in privacy measures; and viii.is required to sign a written confidentiality agreement. b.The facility shall designate a volunteer coordinator who: i.has the experience and training to supervise the volunteers and their activities; and ii.is responsible for selecting, evaluating and supervising the volunteers and their activities. 3.If a CRC utilizes student interns, it shall ensure that each student intern: a.has current registration with the appropriate Louisiana board when required or educational institution, and is in good standing at all times; b.provides direct client care utilizing the standards developed by the professional board; c.provides care only under the direct supervision of an individual authorized in accordance with acceptable standards of practice; and d.provides only those services for which the student has been properly trained and deemed competent to perform. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:115 (January 2015). §5361.Personnel Records A.A CRC shall maintain a personnel file for each employee and direct care staff member in the center. Each record shall contain: 1.the application for employment and/or resume, including contact information and employment history for the preceding five years, if applicable; 2.reference letters from former employer(s) and personal references or written documentation based on telephone contact with such references; 3.any required medical examinations or health screens; 4.evidence of current applicable professional credentials/certifications according to state law or regulations; 5.annual performance evaluations to include evidence of competency in performing assigned tasks; 6.personnel actions, other appropriate materials, reports and notes relating to the individual's employment; 7.the staff member's starting and termination dates; 8.proof of orientation, training and in-services; 9.results of criminal background checks, if required; 10.job descriptions and performance expectations; 11.a signed attestation annually by each member of the direct care staff indicating that he/she has not been convicted of or pled guilty or nolo contendere to a crime, other than traffic violations; and 12.written confidentiality agreement signed by the personnel every twelve months. B.A CRC shall retain personnel files for at least three years following termination of employment. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:116 (January 2015). Subchapter F.Admission, Transfer and Discharge §5367.Admission Requirements A.A CRC shall not refuse admission to any individual on the grounds of race, national origin, ethnicity or disability. B.A CRC shall admit only those individuals whose needs, pursuant to the screening, can be fully met by the center. C.A CRC shall expect to receive individuals who present voluntarily to the unit and/or individuals who are brought to the unit under an OPC, CEC, or PEC. D.The CRC shall develop and implement policies and procedures for diverting individuals when the CRC is at capacity, that shall include: 1.notifying emergency medical services (EMS), police and the OBH or its designee in the service area; 2.conducting a screening on each individual that presents to the center; and 3.safely transferring the presenting individual to an appropriate provider; E.Pre-Admission Requirements 1.Prior to admission, the center shall attempt to obtain documentation from the referring emergency room, agency, facility or other source, if available, that reflects the client's condition. 2.The CRC shall conduct a screening on each individual that presents for treatment that: a.is performed by a RN who may be assisted by other personnel; b.is conducted within 15 minutes of entering the center; c.determines eligibility and appropriateness for admission; d.assesses whether the client is an imminent danger to self or others; and e.includes the following: i.taking vital signs; ii.breath analysis and urine drug screen iii.brief medical history including assessment of risk for imminent withdrawal; and iv.clinical assessment of current condition to determine primary medical problem(s) and appropriateness of admission to CRC or transfer to other medical provider; F.Admission Requirements 1.The CRC shall establish the CRC's admission requirements that include: a.availability of appropriate physical accommodations; b.legal authority or voluntary admission; and c.written documentation that client and/or family if applicable, consents to treatment. 2.The CRC shall develop, implement and comply with admission criteria that, at a minimum, include the following inclusionary and exclusionary requirements: a.inclusionary: the client is experiencing a seriously acute psychological/emotional change which results in a marked increase in personal distress and exceeds the abilities and resources of those involved to effectively resolve it; b.exclusionary: the client is experiencing an exacerbation of a chronic condition that does not meet the inclusionary criteria listed in §5367.F.2.a. 3.If the client qualifies for admission into the CRC, the center shall ensure that a behavioral health assessment is conducted: a.by an LMHP; b.within four hours of being received in the unit unless extenuating or emergency circumstances preclude the delivery of this service within this time frame; and c.includes the following: i.a history of previous emotional, behavioral and substance use problems and treatment; ii.a social assessment to include a determination of the need for participation of family members or significant others in the individual's treatment; the social, peer-group, and environmental setting from which the person comes; family circumstances; current living situation; employment history; social, ethnic, cultural factors; and childhood history; current or pending legal issues including charges, pending trial, etc.; iii.an assessment of the individual's ability and willingness to cooperate with treatment; iv.an assessment for any possible abuse or neglect; and v.review of any laboratory results, results of breath analysis and urine drug screens on patients and the need for further medical testing. 4.The CRC shall ensure that a nursing assessment is conducted that is: a.begun at time of admission and completed within 24 hours; and b.conducted by a RN with the assistance of other personnel. 5.The center shall ensure that a physical assessment is conducted by an authorized licensed prescriber within 12 hours of admission that includes: a.a complete medical history; b.direct physical examination; and c.documentation of medical problems. 6.The authorized license prescriber, LMHP and/or RN shall conduct a review of the medical and psychiatric records of current and past diagnoses, laboratory results, treatments, medications and dose response, side-effects and compliance with: a.the review of data reported to clinical director; b.synthesis of data received is incorporated into treatment plan by clinical director. G.Client/Family Orientation. Upon admission or as soon as possible, each facility shall ensure that a confidential and efficient orientation is provided to the client and the client's designated representative, if applicable, concerning: 1.visitation; 2.physical layout of the center; 3.safety; 4.center rules; and 5.all other pertinent information. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:116 (January 2015). §5369.Discharge, Transfer and Referral Requirements A.The CRC shall develop, implement and comply with policies and procedures that address when and how clients will be discharged and referred or transferred to other providers in accordance with applicable state and federal laws and regulations. B.Discharge planning shall begin upon admission. C.The CRC shall ensure that a client is discharged: 1.when the client's treatment goals are achieved, as documented in the client's treatment plan; 2.when the client's issues or treatment needs are not consistent with the services the center is authorized or able to provide; or 3.according to the center's established written discharge criteria. D.Discharge Plan. Each CRC client shall have a written discharge plan to provide continuity of services that includes: 1.the client's transfer or referral to outside resources, continuing care appointments, and crisis intervention assistance; 2.documented attempts to involve the client and the family or an alternate support system in the discharge planning process; 3.the client's goals or activities to sustain recovery; 4.signature of the client or, if applicable, the client's parent or guardian, with a copy provided to the individual who signed the plan; 5.name, dosage and frequency of client's medications ordered at the time of discharge; 6.prescriptions for medications ordered at time of discharge; and 7.the disposition of the client's possessions, funds and/or medications, if applicable. E.The discharge summary shall be completed within 30 days and include: 1.the client's presenting needs and issues identified at the time of admission; 2.the services provided to the client; 3.the center's assessment of the client's progress towards goals; 4.the circumstances of discharge; and 5.the continuity of care recommended following discharge, supporting documentation and referral information. F.Transfer Process. The CRC responsible for the discharge and transfer of the client shall: 1.request and receive approval from the receiving facility prior to transfer; 2.notify the receiving facility prior to the arrival of the client of any significant medical/psychiatric conditions/complications or any other pertinent information that will be needed to care for the client prior to arrival; and 3.transfer all requested client information and documents upon request. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:117 (January 2015). Subchapter G.Program Operations §5375.Treatment Services A.A CRC shall: 1.operate 24 hours per day seven days a week; 2.operate no more than 24 licensed beds; 3.operate no more than 36 chairs/recliners for observation and crisis stabilization 4. provide services to either adults or minors but not both; and 5.provide services that include, but are not limited to: a.emergency screening; b.assessment; c.crisis intervention and stabilization; d.24-hour observation; e.medication administration; and f.referral to the most appropriate and least restrictive setting available consistent with the client's needs. B.Short Term Stay. A CRC shall admit clients for a short term stay with an estimated length of 3-7 days. If a greater length of stay is needed, the CRC shall maintain documentation of clinical justification for the extended stay. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:118 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:474 (April 2021). §5377.Laboratory Services A.The CRC shall have laboratory services available to meet the needs of its clients, including the ability to: 1.obtain STAT laboratory results as needed at all times; 2.conduct a dipstick urine drug screen; and 3.conduct a breath analysis for immediate determination of blood alcohol level. B.The CRC shall maintain a CLIA certificate for the laboratory services provided on-site. C.The CRC shall ensure that all contracted laboratory services are provided by a CLIA clinical laboratory improvement amendment (CLIA) certified laboratory. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:118 (January 2015). §5379.Pharmaceutical Services and Medication Administration A.The CRC may provide pharmaceutical services on-site at the center or off-site pursuant to a written agreement with a pharmaceutical provider. B.All compounding, packaging, and dispensing of medications shall be accomplished in accordance with Louisiana laws and Board of Pharmacy regulations and be performed by or under the direct supervision of a registered pharmacist currently licensed to practice in Louisiana. C.The CRC shall ensure that a mechanism exists to: 1.provide pharmaceutical services 24 hours per day; and 2.obtain STAT medications, as needed, within an acceptable time frame, at all times. D.CRCs that utilize off-site pharmaceutical providers pursuant to a written agreement shall have: 1.a physician who assumes the responsibility of procurement and possession of medications; and 2.an area for the secure storage of medication and medication preparation in accordance with Louisiana Board of Pharmacy rules and regulations. E.A CRC shall maintain: 1.a site-specific Louisiana controlled substance license in accordance with the Louisiana Uniform Controlled Dangerous Substance Act; and 2.a United States Drug Enforcement Administration controlled substance registration for the facility in accordance with title 21 of the United States Code. F.The CRC shall develop, implement and comply with written policies and procedures in accordance with applicable federal, state and local laws and ordinances that govern: 1.the safe administration and handling of all prescription and non-prescription medications; 2.the storage, recording and control of all medications; 3.the disposal of all discontinued and/or expired medications and containers with worn, illegible or missing labels; 4.the use of prescription medications including: a.when medication is administered, medical monitoring occurs to identify specific target symptoms; b.a procedure to inform clients, staff, and where appropriate, client's parent(s), legal guardian(s) or designated representatives, of each medication's anticipated results, the potential benefits and side-effects as well as the potential adverse reaction that could result from not taking the medication as prescribed; c.involving clients and, where appropriate, their parent(s) or legal guardian(s), and designated representatives in decisions concerning medication; and d.staff training to ensure the recognition of the potential side effects of the medication; 5.the list of abbreviations and symbols approved for use in the facility; 6.recording of medication errors and adverse drug reactions and reporting them to the client's physician or authorized prescriber, and the nurse manager; 7.the reporting of and steps to be taken to resolve discrepancies in inventory, misuse and abuse of controlled substances in accordance with federal and state law; 8.provision for emergency pharmaceutical services; 9.a unit dose system; and 10.procuring and the acceptable timeframes for procuring STAT medications when the medication needed is not available on-site. G.The CRC shall ensure that: 1.medications are administered by licensed health care personnel whose scope of practice includes administration of medications; 2.any medication is administered according to the order of an authorized licensed prescriber; 3.it maintains a list of authorized licensed prescribers that is accessible to staff at all times; 4.all medications are kept in a locked illuminated clean cabinet, closet or room at temperature controls according to the manufacturer's recommendations, accessible only to individuals authorized to administer medications; 5.medications are administered only upon receipt of written orders, electromechanical facsimile, or verbal orders from an authorized licensed prescriber; 6.all verbal orders are signed by the licensed prescriber within 72 hours; 7.medications that require refrigeration are stored in a refrigerator or refrigeration unit separate from the refrigerators or refrigeration units that store food, beverages, or laboratory specimens; 8.all prescription medication containers are labeled to identify: a.the client's full name; b.the name of the medication; c.dosage; d.quantity and date dispensed; e.directions for taking the medication; f.required accessory and cautionary statements; g.prescriber's name; and h.the expiration date; 9.medication errors, adverse drug reactions, and interactions with other medications, food or beverages taken by the client are immediately reported to the client's physician or authorized licensed prescriber, supervising pharmacist and nurse manager with an entry in the client's record; 10.all controlled substances shall be kept in a locked cabinet or compartment separate from other medications; 11.current and accurate records are maintained on the receipt and disposition of controlled substances; 12.controlled substances are reconciled: a.at least twice a day by staff authorized to administer controlled substances; or b.by an automated system that provides reconciliation; 13.discrepancies in inventory of controlled substances are reported to the nurse manager and the supervising pharmacist in accordance with federal and state laws. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:118 (January 2015). §5381.Transportation A.The CRC shall establish, implement and comply with policies and procedures to: 1.secure emergency transportation in the event of a client's medical emergency; and 2.provide non-emergent medical transportation to the clients as needed. B.The facility shall have a written agreement with a transportation service in order to provide non-emergent transport services needed by its clients that shall require all vehicles used to transport CRC clients are: 1.maintained in a safe condition; 2.properly licensed and inspected in accordance with state law; 3.operated at a temperature that does not compromise the health, safety and needs of the client; 4.operated in conformity with all applicable motor vehicle laws; 5.current liability coverage for all vehicles used to transport clients; 6.all drivers of vehicles that transport CRC clients are properly licensed to operate the class of vehicle in accordance with state law; and 7.the ability to transport non-ambulatory clients in appropriate vehicles if needed. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:119 (January 2015). §5383.Food and Diet A.The CRC shall ensure that: 1.all dietary services are provided under the direction of a Louisiana licensed and registered dietician either directly or by written agreement; 2.menus are approved by the registered dietician; 3.meals are of sufficient quantity and quality to meet the nutritional needs of clients, including religious and dietary restrictions; 4.meals are in accordance with Federal Drug Administration (FDA) dietary guidelines and the orders of the authorized licensed prescriber; 5.at least three meals plus an evening snack are provided daily with no more than 14 hours between any two meals; 6.meals are served in a manner that maintains the safety and security of the client and are free of identified contraband; 7.all food is stored, prepared, distributed, and served under safe and sanitary conditions in accordance with the Louisiana Sanitary Code; 8.all equipment and utensils used in the preparation and serving of food are properly cleaned, sanitized and stored in accordance with the Louisiana Sanitary Code; and 9.if meals are prepared on-site, they are prepared in an OPH approved kitchen. B.The CRC may provide meal service and preparation pursuant to a written agreement with an outside food management company. If provided pursuant to a written agreement, the CRC shall: 1.maintain responsibility for ensuring compliance with this Chapter; 2.provide written notice to HSS and OPH within 10 calendar days of the effective date of the contract; 3.ensure that the outside food management company possesses a valid OPH retail food permit and meets all requirements for operating a retail food establishment that serves a highly susceptible population, in accordance with the special requirements for highly susceptible populations as promulgated in the current Louisiana Sanitary Code provisions governing food display and service for retail food establishments; and 4.ensure that the food management company employs or contracts with a licensed and registered dietician who serves the center as needed to ensure that the nutritional needs of the clients are met in accordance with the authorized licensed prescriber's orders and acceptable standards of practice. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:119 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:475 (April 2021). Subchapter H.Client Rights §5389.General Provisions A.The CRC shall develop, implement and comply with policies and procedures that: 1.protect its clients' rights; 2.respond to questions and grievances pertaining to these rights; 3.ensure compliance with clients' rights enumerated in R.S. 28:171; and 4.ensure compliance with minors' rights enumerated in the Louisiana Children's Code. B.A CRC's client and, if applicable, the client's parent(s) or legal guardian or chosen designated representative, have the following rights: 1.to be informed of the client's rights and responsibilities at the time of or shortly after admission; 2.to have a family member, chosen representative and/or his or her own physician notified of admission at the client's request to the CRC; 3.to receive treatment and medical services without discrimination based on race, age, religion, national origin, gender, sexual orientation, disability, marital status, diagnosis, ability to pay or source of payment; 4.to be free from abuse, neglect, exploitation and harassment; 5.to receive care in a safe setting; 6.to receive the services of a translator or interpreter, if applicable, to facilitate communication between the client and the staff; 7.to be informed of the client's own health status and to participate in the development, implementation and updating of the client's treatment plan; 8.to make informed decisions regarding the client's care in accordance with federal and state laws and regulations; 9.to consult freely and privately with the client's legal counsel or to contact an attorney at any reasonable time; 10.to be informed, in writing, of the policies and procedures for initiation, review and resolution of grievances or client complaints; 11.to submit complaints or grievances without fear of reprisal; 12.to have the client's information and medical records, including all computerized medical information, kept confidential in accordance with federal and state statutes and rules/regulations; 13.to be provided indoor and/or outdoor recreational and leisure opportunities; 14.to be given a copy of the center's rules and regulations upon admission or shortly thereafter; 15.to receive treatment in the least restrictive environment that meets the client's needs; 16.to be subject to the use of restraint and/or seclusion only in accordance with federal and state law, rules and regulations; 17.to be informed of all estimated charges and any limitations on the length of services at the time of admission or shortly thereafter; 18.to contact DHH at any reasonable time; 19.to obtain a copy of these rights as well as the address and phone number of DHH and the Mental Health Advocacy Service at any time; and 20.to be provided with personal hygiene products, including but not limited to, shampoo, deodorant, toothbrush, toothpaste, and soap, if needed. C.A copy of the clients' right shall be posted in the facility and accessible to all clients. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:120 (January 2015). §5391.Grievances A.The facility shall develop, implement and comply with a written grievance procedure for clients designed to allow clients to submit a grievance without fear of retaliation. The procedure shall include, but not be limited to: 1.process for filing a grievance; 2.a time line for responding to the grievance; 3.a method for responding to a grievance; and 4.the staff responsibilities for addressing and resolving grievances. B.The facility shall ensure that: 1.the client and, if applicable, the client's parent(s) or legal guardian(s), is aware of and understands the grievance procedure; and 2.all grievances are addressed and resolved to the best of the center's ability. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:120 (January 2015). Subchapter I.Physical Environment §5397.Interior Space A.The CRC shall: 1.have a physical environment that protects the health, safety and security of the clients; 2.have routine maintenance and cleaning programs in all areas of the center; 3.be well-lit, clean, and ventilated; 4.conduct a risk assessment of each client and the physical environment of the facility in order to ensure the safety and well-being of all clients admitted to the facility; 5.maintain its physical environment, including, but not limited to, all equipment, fixtures, plumbing, electrical, and furnishings, in good order and safe condition in accordance with manufacturer's recommendations; 6.maintain heating, ventilation and cooling systems in good order and safe condition to ensure a comfortable environment; 7.ensure that electric receptacles in client care areas are tamper-resistant or equipped with ground fault circuit interrupters; and 8.maintain separate wings or units for voluntary and involuntary individuals to include areas for admissions, sleeping, shower and toilet areas, and sally ports or other entry areas. Further, the CRC shall provide separate areas (which may be accomplished by providing areas to voluntary individuals at different times than to involuntary individuals) for dining, recreational, educational, vocational, health care, and passageways, for voluntary and involuntary individuals. B.Common Area. The CRC shall have designated space: 1.to be used for group meetings, dining, visitation, leisure and recreational activities; 2.that is at least 25 square feet per client and no less than 150 square feet exclusive of sleeping areas, bathrooms, areas restricted to staff and office areas; and 3.that contains tables for eating meals. C.Bathrooms 1.Each bathroom to be used by clients shall contain: a.a lavatory with: i.paper towels or an automatic dryer; ii.a soap dispenser with soap for individual use; and iii.a wash basin with hot and cold running water; b.tubs and/or showers that: i.have hot and cold water; ii.have slip proof surfaces; and iii.allow for individual privacy; c.toilets: i.an adequate supply of toilet paper; ii.with seats; and iii.that allow for individual privacy; d.a sink, tub or shower and toilet for the number of clients and in accordance with the Louisiana Sanitary Code; e.shatterproof mirrors secured to the walls at convenient heights; f.plumbing, piping, ductwork, and that are recessed or enclosed in order to be inaccessible to clients; and g.other furnishings necessary to meet the clients' basic hygienic needs. 2.A CRC shall have at least one separate toilet and lavatory facility for the staff. D.Sleeping Areas and Bedroom(s) 1.A CRC that utilizes a sleeping area for multiple clients shall: a.ensure that the sleeping area has at least 60 square feet per bed of clear floor area and does not contain or utilize bunk beds; and b.shall maintain at least one separate bedroom. 2.Bedrooms. A CRC that utilizes individual bedrooms shall ensure that each bedroom: a.accommodates no more than one client; and b.has at least 80 square feet of clear floor area. 3.The CRC shall ensure that each client: a.has sufficient separate storage space for clothing, toilet articles and other personal belongings of clients; b.has sheets, pillow, bedspread, towels, washcloths and blankets that are: i.intact and in good repair; ii.systematically removed from use when no longer usable; iii.clean; iv.provided as needed or when requested unless the request is unreasonable; c.is given a bed for individual use that: i.is no less than 30 inches wide; ii.is of solid construction; iii.has a clean, comfortable, impermeable, nontoxic and fire retardant mattress; and iv.is appropriate to the size and age of the client. E.Administrative and Staff Areas 1.The CRC shall maintain a space that is distinct from the client common areas that serves as an office for administrative functions. 2.The CRC shall have a designated space for nurses and other staff to complete tasks, be accessible to clients and to observe and monitor client activity within the unit. F.Counseling and Treatment Area 1.The CRC shall have a designated space to allow for private physical examination that is exclusive of sleeping areas and common spaces. 2.The CRC shall have a designated space to allow for private and small group discussions and counseling sessions between individual clients and staff that is exclusive of sleeping areas and common space. 3.The CRC may utilize the same space for the counseling area and examination area. G.Seclusion Room 1.The CRC shall have at least one seclusion room that: a.is for no more than one client; and b.allows for continual visual observation and monitoring of the client either: i.directly; or ii.by a combination of video and audio; c.has a monolithic ceiling; d.is a minimum of 80 square feet; and e.contains a stationary restraint bed that is secure to the floor; f.flat walls that are free of any protrusions with angles; g.does not contain electrical receptacles. H.Kitchen 1.If a CRC prepares meals on-site, the CRC shall have a full service kitchen that: a.includes a cooktop, oven, refrigerator, freezer, hand washing station, storage and space for meal preparation; b.complies with OPH regulations; c.has the equipment necessary for the preparation, serving, storage and clean-up of all meals regularly served to all of the clients and staff; d.contains trash containers covered and made of metal or United Laboratories-approved plastic; and e.maintains the sanitation of dishes. 2.A CRC that does not provide a full service kitchen accessible to staff 24 hours per day shall have a nourishment station or a kitchenette, restricted to staff only, in which staff may prepare nourishments for clients, that includes: a.a kitchen sink; b.a work counter; c.a refrigerator; d.storage cabinets; e.equipment for preparing hot and cold nourishments between scheduled meals; and f.space for trays and dishes used for non-scheduled meal service. 3.A CRC may utilize ice making equipment if the ice maker: a.is self-dispensing; or b.is in an area restricted to staff only. I.Laundry 1.The CRC shall have an automatic washer and dryer for use by staff when laundering clients' clothing. 2.The CRC shall have: a.provisions to clean and launder soiled linen, other than client clothing, either on-site or off-site by written agreement; b.a separate area for holding soiled linen until it is laundered; and c.a clean linen storage area. J.Storage: 1.the CRC shall have separate and secure storage areas that are inaccessible to clients for the following: a.client possessions that may not be accessed during their stay; b.hazardous, flammable and/or combustible materials; and 2.records and other confidential information. K.Furnishings 1.The CRC shall ensure that its furnishings are: a.designed to suit the size, age and functional status of the clients; b.in good repair; c.clean; d.promptly repaired or replaced if defective, run-down or broken. L.Hardware, Fixtures and other Protrusions 1.If grab bars are used, the CRC shall ensure that the space between the bar and the wall shall be filled to prevent a cord from being tied around it. 2.All hardware as well as sprinkler heads, lighting fixtures and other protrusions shall be: a.recessed or of a design to prohibit client access; and b.tamper-resistant. 3.Towel bars, shower curtain rods, clothing rods and hooks are prohibited. M.Ceilings 1.The CRC shall ensure that the ceiling is: a.no less than 7.5 feet high and secured from access; or b.at least 9 feet in height; and c.all overhead plumbing, piping, duct work or other potentially hazardous elements shall be concealed above the ceiling. N.Doors and Windows 1.All windows shall be fabricated with laminated safety glass or protected by polycarbonate, laminate or safety screens. 2.Door hinges shall be designed to minimize points for hanging. 3.Except for specifically designed anti-ligature hardware, door handles shall point downward in the latched or unlatched position. 4.All hardware shall have tamper-resistant fasteners. 5.The center shall ensure that outside doors, windows and other features of the structure necessary for safety and comfort of individuals: a.are secured for safety; b.prohibit clients from gaining unauthorized egress; c.prohibit an outside from gaining unauthorized ingress; d.if in disrepair, not accessible to clients until repaired; and e.repaired as soon as possible. 6.The facility shall ensure that all closets, bedrooms and bathrooms for clients that are equipped with doors do not have locks and can be readily opened from both sides. O.Observation Area(s) 1.The CRC shall have one or more spaces for the placement of chair/recliners in an observation area. This space may be of a permanent configuration or may be re-arranged based on the needs of the clients in the CRC. There shall be at least three feet between each chair and at least six feet at the foot of each chair/recliner. The head of the chair/recliner may be positioned at a wall. P.Smoking 1.The CRC shall prohibit smoking in the interior of the center. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:121 (January 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 47:475 (April 2021), LR 48:302 (February 2022). §5399.Exterior Space Requirements A.The CRC shall maintain all exterior areas to prevent elopement, injury, suicide and the introduction of contraband, and shall maintain a perimeter security system designed to monitor and control visitor access and client egress. B.The facility shall maintain all exterior areas and structures of the facility in good repair and free from any reasonably foreseeable hazard to health or safety. C.The facility shall ensure the following: 1.garbage stored outside is secured in non-combustible, covered containers and are removed on a regular basis; 2.trash collection receptacles and incinerators are separate from any area accessible to clients and located as to avoid being a nuisance; 3.unsafe areas, including steep grades, open pits, swimming pools, high voltage boosters or high speed roads are fenced or have natural barriers to protect clients; 4.fences that are in place are in good repair; 5.exterior areas are well lit; and 6.the facility has appropriate signage that: a.is visible to the public; b.indicates the facility's legal or trade name; c.clearly states that the CRC provides behavioral health services only; and d.indicates the center is not a hospital or emergency room. D.A CRC with an outdoor area to be utilized by its clients shall ensure that the area is safe and secure from access and egress. AUTHORITY NOTE:Promulgated in accordance with R.S. 36:254 and R.S. 40:2180.14. HISTORICAL NOTE:Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:122 (January 2015).