Louisiana Administrative Code › Title 46 - PROFESSIONAL AND OCCUPATIONAL STANDARDS › Part XLV - Medical Professions › Subpart 3 - Practice › Chapter 42 - Illegal Payments; Required Disclosures of Financial Interests ; Prohibition on Rural Physician Self-Referral › Subchapter C - Prohibition on Rural Physician Self Referral › Section XLV-4233 - Definitions and Construction

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definitions. As used in this Chapter the following
						terms shall have the following meanings unless the context requires otherwise.
Board
- the Louisiana State Board of
						Medical Examiners.
Commercially Reasonable Terms and
C
onditions
- those terms and conditions that would be
						reasonable to a prudent individual operating a business of similar type and
						size as a rural hospital even in the absence of referrals to the rural hospital
						or healthcare facility by a physician who owns, or whose immediate family
						member owns, an interest in the healthcare facility in which the rural hospital
						has been offered the opportunity to participate as an owner. The provisions of
						42 U.S.C.
						1395 nn, and the regulations and regulatory
						guidance promulgated and issued by the Centers for Medicare and Medicaid
						Services and its predecessor or successor, shall be considered in determining
						whether terms and conditions are commercially reasonable.
Department
- the Louisiana Department of
						Health and Hospitals.
Healthcare Facility
- an independent
						diagnostic testing facility, magnetic resonance imaging equipment or facility,
						computerized tomography equipment or facility, Positron Emission Tomography
						scanner or facility, an ambulatory surgical center licensed by the department,
						or any outpatient surgical facility required to be licensed by the department
						as an ambulatory surgical center in order to obtain certification by Medicare
						as an ambulatory surgical center. However, the term
healthcare
						facility
shall not mean:
a. a rural hospital that existed on April 1, 2006, or
						that replaces a rural hospital that existed on April 1, 2006;
b. a rural hospital that is a replacement facility of a
						rural hospital that was damaged by Hurricane Rita or Hurricane Katrina;
c. an entity owned or operated by the state of Louisiana
						or the United States;
d. a physician's practice or a physician group practice,
						when such practice is owned and operated exclusively by physicians for the
						purpose of providing healthcare services and is not licensed or
						Medicare-certified as a rural health clinic;
e. any facility under development, including services
						provided by a mobile unit that is part of an existing facility as of April 1,
						2006, or operating as of April 1, 2006. A facility shall be considered under
						development if:
i. a representative of the facility has, prior to April
						1, 2006, filed a license application with the department for the establishment
						of the proposed healthcare facility;
ii. the facility can demonstrate that a minimum of
						$25,000 in architectural or engineering expenses have been incurred in
						connection with the proposed facility prior to April 1, 2006; or
iii. the facility has received a certificate of
						occupancy; or
f. any community health care clinic or rural health
						clinic.
Healthcare Services
- magnetic resonance
						imaging services, computerized tomography services, Positron Emission
						Tomography scanner services, ultrasound services, any other imaging services
						that have become generally accepted methods of providing imaging services after
						April 17, 2006, as determined by the department, any services rendered by an
						ambulatory surgical center licensed by the department, or any services rendered
						by an outpatient surgical facility required to be licensed by the department as
						an ambulatory surgical center in order to obtain certification by Medicare as
						an ambulatory surgical center.
Immediate Family Member
- husband or
						wife, birth or adoptive parent, child, or sibling, stepparent, stepchild,
						stepbrother or stepsister, father-in-law, mother-in-law, son-in-law,
						daughter-in-law, brother-in-law, or sister-in-law, grandparent or grandchild,
						and spouse of grandparent or grandchild.
Primary Service Area
- the smaller of
						either a radius of twenty-five miles from a rural hospital's main campus or the
						area represented by the number of postal zip codes, commencing with the rural
						hospital's zip code, in which seventy-five percent of a rural hospital's
						patients reside, as determined by using data derived from the hospital's most
						recent twelve month Medicare cost reporting period. In determining the primary
						service area, each outpatient encounter and each inpatient stay shall be viewed
						as a separate patient, and the zip code attributable to the patient shall be
						the zip code of the patient at the time of the inpatient stay or outpatient
						encounter. Primary service area descriptions published by the department in the
Louisiana Register
shall be utilized in determining primary
						service areas. However, the term
primary service area
shall
						not include the cities of Alexandria, Baton Rouge, Bossier City, Covington,
						Hammond, Houma, Kenner, Lafayette, Lake Charles, Mandeville, Monroe, New
						Iberia, New Orleans, Opelousas, Ponchatoula, Ruston, Shreveport, Slidell,
						Thibodaux, or West Monroe.
Proposing Party
- a person or entity that
						offers to enter into a joint venture with a rural hospital as well as any
						person or entity related to the proposing party by common ownership or control
						as such terms are defined for purposes of
						42 C.F.R.
						413.17, or its successor provision.
Rural Hospital
- shall be defined as
						provided for in
						R.S.
						40:1300.143, as such law existed on April 1,
						2006.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						37:1270, R.S.
						37:1306-1310.