Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 25 - Disproportionate Share Hospital Payment Methodologies › Section V-2503 - Disproportionate Share Hospital Qualifications

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to qualify as a disproportionate
				  share hospital, a hospital must:
1. have at
				  least two obstetricians who have staff privileges and who have agreed to
				  provide obstetric services to individuals who are Medicaid eligible. In the
				  case of a hospital located in a rural area (i.e., an area outside of a
				  metropolitan statistical area), the term
obstetrician
includes
				  any physician who has staff privileges at the hospital to perform nonemergency
				  obstetric procedures; or
2. treat
				  inpatients who are predominantly individuals under 18 years of age;
				  or
3. be a hospital which did not
				  offer nonemergency obstetric services to the general population as of December
				  22, 1987; and
4. have a utilization
				  rate in excess of one or more of the following specified minimum utilization
				  rates:
a. Medicaid utilization rate is a
				  fraction (expressed as a percentage). The numerator is the hospital's number of
				  Medicaid (Title XIX) inpatient days. The denominator is the total number of the
				  hospital's inpatient days for a cost reporting period. Inpatient days include
				  newborn and psychiatric days and exclude swing bed and skilled nursing days.
				  Hospitals shall be deemed disproportionate share providers if their Medicaid
				  utilization rates are in excess of the mean, plus one standard deviation of the
				  Medicaid utilization rates for all hospitals in the state receiving payments;
				  or
b. hospitals shall be deemed
				  disproportionate share providers if their low-income utilization rates are in
				  excess of 25 percent. Low-income utilization rate is the sum of:
i. the fraction (expressed as a percentage).
				  The numerator is the sum (for the period) of the total Medicaid patient
				  revenues plus the amount of the cash subsidies for patient services received
				  directly from state and local governments. The denominator is the total amount
				  of revenues of the hospital for patient services (including the amount of such
				  cash subsidies) in the cost reporting period from the financial statements;
				  and
ii. the fraction (expressed as
				  a percentage). The numerator is the total amount of the hospital's charges for
				  inpatient services which are attributable to charity (free) care in a period,
				  less the portion of any cash subsidies as described in
				  §2503. A.4.b.i in the
				  period which are reasonably attributable to inpatient hospital services. The
				  denominator is the total amount of the hospital's charges for inpatient
				  hospital services in the period. For public providers furnishing inpatient
				  services free of charge or at a nominal charge, this percentage shall not be
				  less than zero. This numerator shall not include contractual allowances and
				  discounts (other than for indigent patients ineligible for Medicaid), i.e.,
				  reductions in charges given to other third-party payers, such as HMOs,
				  Medicare, or BlueCross; nor charges attributable to Hill-Burton obligations. A
				  hospital providing "free care" must submit its criteria and procedures for
				  identifying patients who qualify for free care to the Bureau of Health Services
				  Financing for approval. The policy for free care must be posted prominently and
				  all patients must be advised of the availability of free care and the
				  procedures for applying. Hospitals not in compliance with free care criteria
				  will be subject to recoupment of DSH and Medicaid payments; or
5. effective November
				  3, 1997, be a
small rural hospital
as defined in
				  §2705. A.2 a-m;
				  or
6. effective September 15, 2006,
				  be a non-rural community hospital as defined in
				  §2701 A;
7. effective January 20, 2010, be a hospital
				  participating in the low-income and needy care collaboration as defined in
				  §2713 A;
8. effective January 1, 2013, be a
				  public-private partnership hospital as defined in
				  §2901 A;
9. effective May 24, 2014, be a Louisiana
				  low-income academic hospital as defined in
				  §3101 A-B;
10. effective June 29, 2016, be a major
				  medical center located in the central and northern areas of the state as
				  defined in
				  §2715 A;
11. be a major medical center with a
				  specialized care unit located in the southwestern area of the state as defined
				  in §2717 A;
12. be a major medical center located in the
				  southeastern area of the state as defined in
				  §2719 A;
13. be a psychiatric hospital located in the
				  northern area of the state as defined in
				  §2721 A; and
14. effective July 1, 1994, must also have a
				  Medicaid inpatient utilization rate of at least 1 percent.