News & Insights

New Hospital Licensure Requirement: “Primarily Engaged” and Sanitary Code Changes

December 12, 2019

Joseph T. D. Tran, Attorney at Law


New Hospital Licensure Requirement: “Primarily Engaged” and Sanitary Code Changes

The Louisiana Department of Health (LDH) has promulgated rules that modify hospital licensure requirements that may affect certain hospitals. This rule went into effect October 20, 2019.

What Are the Changes?

One key change is the requirement that hospitals be “primarily engaged” in providing inpatient hospital services to inpatients, by or under the supervision of licensed physicians. Important sanitary and dietary requirements have also been added.

What Are Inpatient Hospital Services?

Inpatient hospital services include those services provided to inpatients of hospitals as diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.1  

What is “Primarily Engaged”?

In reaching a determination as to whether or not an entity is primarily engaged in providing inpatient hospital services to inpatients of a hospital, the LDH will evaluate the total facility operations and consider multiple factors.2 In evaluating the total facility operations, LDH will review the actual provision of care and services to two or more inpatients, and the effects of that care, to assess whether the care provided meets the needs of individual patients by way of patient outcomes.

The factors that the department will consider include, but are not limited to:

  • Average daily census (ADC) of the main hospital and/or any off-site campus(es)

  • Average length of stay (ALOS) of patients at the main hospital and/or any off-site campus(es)

  • Number of off-site campus outpatient locations operated by the entity

  • Number of provider-based emergency departments for the entity

  • Number of inpatient beds related to the size of the entity and the scope of the services offered

  • Volume of outpatient surgical procedures compared to the inpatient surgical procedures (if surgical services are provided)

  • Staffing patterns

  • Patterns of ADC by day of the week

What is the Minimum ADC and ALOS Required?

An entity is not considered primarily engaged in providing inpatient hospital services to inpatients of a hospital if a main hospital or a main hospital’s off-site campus(es) has an ADC or ALOS of less than two. For purposes of determining whether a main hospital and its off-site campus(es) are primarily engaged, the ADC and the ALOS shall be determined independently for each entity.

The ADC is calculated by adding the midnight daily census of the main hospital or its off-site campus(es), independent of one another, for each day of the 12-month period and dividing the total number by the number of days in the year.3  

The ALOS is the average of the number of inpatient days a person is in the main hospital or its off-site campus(es). ALOS is calculated by dividing the total inpatient days by the total discharges during a specified period, which results in an average number of days in the main hospital or its off-site campus(es) for each person admitted. In calculating ALOS, LDH may utilize a period of between three months and 12 months. For purposes of calculating the ALOS of the main hospital or its off-site campus(es), each facility shall be considered an independent entity.4 

What About Inpatient to Outpatient Bed Ratios?

Hospitals are not required to have a specific inpatient bed to outpatient bed ratio in order to meet the definition of primarily engaged. If the hospital has an emergency department (ED), the number of hospital inpatient beds shall be greater than the number of ED beds, with a ratio of not less than 2:1. 5

Do These Requirements Apply to My Hospital?

Likely, if your hospital meets the definition of a hospital and doesn’t fall into some exception.6 LDH excludes urgent care clinics and infirmaries or clinics maintained solely by any college or university for treatment of faculty, students and employees from the definition of hospitals.7 Conversely, licensed hospitals designated as psychiatric hospitals and critical access hospitals8, and licensed hospitals designated as rural hospitals9 are not subject to the primarily engaged requirements. 

If you have a concern about the licensing or relicensing of your hospitals, contact the Louisiana Department of Health.

Food and Sanitation

LDH requires hospitals to have an organized dietary service that provides nutritional and therapeutic dietetic services to patients. These services shall be under the supervision of a registered dietitian, licensed to practice in Louisiana. If the registered dietitian is not full-time, there shall be a full-time dietary manager qualified according to the Rule.10 

The registered dietitian shall be responsible for assuring that quality nutritional and therapeutic dietetic services are provided to patients. 

All hospital contracts or arrangements for off-site food preparation shall be with a provider who is licensed by LDH's healthcare division or operating under the authority of the federal government. Hospitals that contract with a provider licensed by the LDH’s Health Standards Section or through an outside food management company also have additional requirements according to La. Admin. Code tit. 48, pt. I § 9377.B.

The hospital shall employ sufficient support personnel, competent in their respective duties, to carry out the function of the dietary service adequate to meet the nutritional and therapeutic dietetic needs of the patients in accordance with the prescribed plan of care.

The new Rules also specify certain sanitary conditions such as the proper storage, transportation, preparation, distributing and serving of food to prevent foodborne illness.11 

For a copy of the Rule, visit the LDH website at LDH.LA.gov or click here

 

1  A non-exclusive list can be found in La. Admin. Code tit. 48, pt. I § 9303.A.
2  La. Admin. Code tit. 48, pt. I § 9301.C.
3  La. Admin. Code tit. 48, pt. I § 9303.A. Average Daily Census (ADC).
4  La. Admin. Code tit. 48, pt. I § 9303.A. Average Length of Stay (ALOS).
5  La. Admin. Code tit. 48. pt. I § 9301.C.5.
6  La. Admin. Code tit. 48. pt. I § 9303.A. Hospital.
7  La. Admin. Code tit. 48. pt. I § 9303.A. Hospital.
As defined by the Code of Federal Regulations
9  As defined by La. Rev. Stat. § 40:1189.3
10  La. Admin. Code tit. 48. pt. I §§ 9379.A. and 9379.B.
11  La Admin. Code tit. 48, pt. I §9383.

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