reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2701 - Non-Rural Community Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Definitions
Non-Rural
Community
					 Hospital-
a non-state, non-rural hospital that may be either publicly
					 or privately owned. Psychiatric, rehabilitation and long term hospitals may
					 also qualify for this category.
B. DSH payments to a public, non-rural
				  community hospital shall be calculated as follows.
1. Each qualifying public, non-rural
				  community hospital shall certify to the Department of Health and Hospitals its
				  uncompensated care costs. The basis of the certification shall be 100 percent
				  of the hospital's allowable costs for these services, as determined by the most
				  recently filed Medicare/Medicaid cost report. The certification shall be
				  submitted in a form satisfactory to the department no later than October 1 of
				  each fiscal year. The department will claim the federal share for these
				  certified public expenditures. The department's subsequent reimbursement to the
				  hospital shall be in accordance with the qualifying criteria and payment
				  methodology for non-rural community hospitals included in Act 18 and may be
				  more or less than the federal share so claimed. Qualifying public, non-rural
				  community hospitals that fail to make such certifications by October 1 may not
				  receive Title XIX claim payments or any disproportionate share payments until
				  the department receives the required certifications.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2703 - Federally Mandated Statutory Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definition
Federally Mandated Statutory Hospital-
a
					 hospital that meets the federal DSH statutory utilization requirements in
					 §2503. A.4 a-b.ii.
B. DSH payments to individual federally
				  mandated statutory hospitals shall be based on actual paid Medicaid days for a
				  six-month period ending on the last day of the last month of that period, but
				  reported at least 30 days preceding the date of payment. Annualization of days
				  for the purposes of the Medicaid days pool is not permitted. The amount will be
				  obtained by DHH from a report of paid Medicaid days by service date.
C. Disproportionate share payments for
				  individual hospitals in this group shall be calculated based on the product of
				  the ratio determined by:
1. dividing each
				  qualifying hospital's actual paid Medicaid inpatient days for a six-month
				  period ending on the last day of the month preceding the date of payment (which
				  will be obtained by the department from a report of paid Medicaid days by
				  service date) by the total Medicaid inpatient days obtained from the same
				  report of all qualified hospitals included in this group. Total Medicaid
				  inpatient days include Medicaid nursery days but do not include skilled nursing
				  facility or swing-bed days; then
2.
				  multiplying by the state disproportionate share appropriated amount for this
				  pool of hospitals.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2707 - Public State-Operated Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definitions
Net Uncompensated Cost
-the cost of
					 furnishing inpatient and outpatient hospital services, net of Medicare costs,
					 Medicaid payments (excluding disproportionate share payments), costs associated
					 with patients who have insurance for services provided, private payer payments,
					 and all other inpatient and outpatient payments received from patients.
Public State-Operated Hospital
-a hospital
					 that is owned or operated by the state of Louisiana.
B. DSH payments to individual public
				  state-owned or operated hospitals shall be up to 100 percent of the hospital's
				  net uncompensated costs. Final payment shall be made in accordance with final
				  uncompensated care costs as calculated per the CMS mandated audit for the state
				  fiscal year.
C. In the event that
				  it is necessary to reduce the amount of disproportionate share payments to
				  remain within the federal disproportionate share allotment, the department
				  shall calculate a pro rata decrease for each public state-owned or operated
				  hospital based on the ratio determined by:
1.
				  dividing that hospital's uncompensated cost by the total uncompensated cost for
				  all qualifying public state-owned or operated hospitals during the state fiscal
				  year; then
2. multiplying by the
				  amount of disproportionate share payments calculated in excess of the federal
				  disproportionate allotment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2709 - Distinct Part Psychiatric Units

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after February 10, 2012, a
				  Medicaid-enrolled non-state acute care hospital that enters into a cooperative
				  endeavor agreement (CEA) with the Department of Health and Hospitals, Office of
				  Behavioral Health to provide inpatient psychiatric hospital services to
				  Medicaid and uninsured patients, and which also assumes the operation and
				  management of a state-owned and formerly state-operated hospital distinct part
				  psychiatric unit, shall be paid a per diem rate of $581.11 per day for each
				  uninsured inpatient.
B. Qualifying
				  hospitals must submit costs and patient specific data in a format specified by
				  the department.
1. Cost and lengths of stay
				  will be reviewed for reasonableness before payments are made.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2711 - Mental Health Emergency Room Extensions (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2715 - Major Medical Centers Located in Central and Northern Areas of the State

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for
				  dates of service on or after June 30, 2016, hospitals qualifying for payments
				  as major medical centers located in the central and northern areas of the state
				  shall meet the following criteria:
1. be a
				  private, non-rural hospital located in Department of Health administrative
				  regions 6, 7, or 8;
2. have at
				  least 200 inpatient beds as reported on the Medicare/Medicaid cost report,
				  Worksheet S-3, column 2, lines 1-18, for the state fiscal year ending June 30,
				  2015. For qualification purposes, inpatient beds shall exclude nursery and
				  Medicare-designated distinct part psychiatric unit beds;
3. does not qualify as a Louisiana low-income
				  academic hospital under the provisions of §3101; and
4. such qualifying hospital (or its
				  affiliate) does have a memorandum of understanding executed on or after June
				  30, 2016 with Louisiana State University, School of Medicine, the purpose of
				  which is to maintain and improve access to quality care for Medicaid patients
				  in connection with the expansion of Medicaid in the state through the
				  promotion, expansion, and support of graduate medical education and
				  training.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2717 - Major Medical Centers with Specialized Burn Care Units Located in the Southwestern Area of the State

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after June 30, 2018, hospitals qualifying
				  for payments as major medical centers located in the southwestern area of the
				  state shall meet the following criteria:
1.
				  be a private, non-rural hospital located in Department of Health administrative
				  region 4;
2. have at least 175
				  inpatient beds as reported on the Medicare/Medicaid cost report, Worksheet S-3,
				  column 2, lines 1-18, for the state fiscal year ending June 30, 2017. For
				  qualification purposes, inpatient beds shall exclude nursery and
				  Medicare-designated distinct part psychiatric unit beds;
3. have a burn intensive care unit that is
				  reported on the Medicare/Medicaid cost report, Worksheet S-3, line 10, columns
				  1-8, for the state fiscal year ending June 30, 2017;
4. does not qualify as a Louisiana low-income
				  academic hospital under the provisions of §3101; and
5. does not qualify as a party to a low
				  income and needy care collaboration agreement with the Department of Health
				  under the provisions of §2713
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2719 - Major Medical Centers Located in the Southeastern Area of the State

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for
				  dates of service on or after January 1, 2020, hospitals qualifying for payments
				  as major medical centers located in the southeastern area of the state shall
				  meet the following criteria:
1. be a private,
				  non-rural hospital located in Department of Health administrative region
				  1;
2. have at least 175 inpatient
				  beds as reported on the Medicare/Medicaid cost report, Worksheet S-3, column 2,
				  lines 1-18, for the state fiscal year ending June 30, 2018. For qualification
				  purposes, inpatient beds shall exclude nursery and Medicare-designated distinct
				  part psychiatric unit beds;
3. is
				  certified as an advanced comprehensive stroke center by the Joint Commission as
				  of June 30, 2018;
4. does not
				  qualify as a Louisiana low-income academic hospital under the provisions of
				  §3101; and
5. does not qualify as a
				  party to a low income and needy care collaboration agreement with the
				  Department of Health under the provisions of §2713
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 27 - Qualifying Hospitals › Section V-2721 - Psychiatric Hospitals Located in the Northern Area of the State

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for
				  dates of service on or after February 20, 2024, hospitals qualifying for
				  payments as psychiatric hospitals located in the northern area of the state
				  shall meet the following criteria:
1. be a
				  private, non-rural freestanding psychiatric hospital located in Department of
				  Health administrative regions 7 or 8; and
2. have a current executed academic
				  affiliation agreement for purposes of providing graduate medical education and
				  training to at least five documented intern and resident full time equivalents
				  (FTEs) annually.
a. the affiliation agreement
				  must be with a medical school located in Louisiana;
b. the intern and resident FTE count must be
				  included on the Medicare Medicaid cost report annually on worksheet S-3, column
				  9; and
c. the hospital must be
				  listed as a graduate medical education program training site on the
				  Accreditation Council for Graduate Medical Education
				  website.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 29 - Public-Private Partnerships › Section V-2901 - Qualifying Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Free-Standing Psychiatric Hospitals. Effective for dates of service on or after
				  January 1, 2013, a free-standing psychiatric hospital may qualify for this
				  category by being:
1. a Medicaid enrolled
				  non-state privately owned and operated hospital that enters into a cooperative
				  endeavor agreement with the Department of Health to increase its provision of
				  inpatient Medicaid and uninsured hospital services by:
a. assuming the management and operation of
				  services at a facility where such services were previously provided by a state
				  owned and operated facility; or
b.
				  providing services that were previously delivered and terminated or reduced by
				  a state owned and operated facility; or
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 29 - Public-Private Partnerships › Section V-2903 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Free-Standing Psychiatric Hospitals. Effective for dates of service on or after
				  October 1, 2015, the per diem rate paid to free-standing psychiatric hospitals
				  shall be reduced by 5 percent of the rate in effect on September 30, 2015. The
				  new per diem rate shall be $552.05 per day.
1. Cost and lengths of stay will be reviewed
				  for reasonableness before payments are made. Payments shall be made on a
				  monthly basis.
2. Aggregate DSH
				  payments for hospitals that receive payment from this category, and any other
				  DSH category, shall not exceed the hospitals specific DSH limit. If payments
				  calculated under this methodology would cause a hospitals aggregate DSH payment
				  to exceed the limit, the payment from this category shall be capped at the
				  hospitals specific DSH limit.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 31 - Louisiana Low-Income Academic Hospitals › Section V-3101 - Qualifying Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. Hospitals
				  Located Outside of the Baton Rouge and New Orleans Metropolitan Statistical
				  Area
1. Effective for dates of service on or
				  after July 1, 2016, a hospital may qualify for this category by:
a. being a private acute care general
				  hospital that is located outside of the Baton Rouge and New Orleans
				  metropolitan statistical area (MSA) which:
i.
				  entered into a cooperative endeavor agreement with the State of Louisiana to
				  increase its provision of inpatient Medicaid and uninsured services by
				  providing services that were previously delivered and terminated or reduced by
				  a state owned and operated facility; or
ii. is formerly a state owned and operated
				  hospital whose ownership change to non-state privately owned and operated prior
				  to July 1, 2014;
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 31 - Louisiana Low-Income Academic Hospitals › Section V-3103 - Payment Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each
				  qualifying hospital shall be paid DSH adjustment payments equal to 100 percent
				  of allowable hospital specific uncompensated care costs.
1. Costs, patient specific data and
				  documentation that qualifying criteria is met shall be submitted in a format
				  specified by the department.
2. The
				  department shall review cost data, charge data, lengths of stay and Medicaid
				  claims data per the Medicaid management and information systems for
				  reasonableness before payments are made.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 51 - General Provisions › Section V-5107 - Duration of Outpatient Status (Repealed)

Current through Register Vol. 50, No. 6, June 20, 2024
AUTHORITY NOTE:
					 Promulgated in accordance with
					 R.S.
					 36:254 and Title XIX of the Social Security
					 Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 51 - General Provisions › Section V-5109 - Children's Specialty Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  In order to receive Medicaid reimbursement for outpatient services as a
				  children's specialty hospital, the acute care hospital must meet the following
				  criteria:
1. be recognized by Medicare as a
				  prospective payment system (PPS) exempt children's specialty
				  hospital;
2. does not qualify for
				  Medicare disproportionate share hospital payments; and
3. has a Medicaid inpatient days utilization
				  rate greater than the mean plus two standard deviations of the Medicaid
				  utilization rates for all hospitals in the state receiving Medicaid
				  payments.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 51 - General Provisions › Section V-5111 - Hospital Provider-Based Outpatient Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to receive Medicaid reimbursement
				  as a hospital provider-based outpatient facility, an off-site campus of a
				  hospital which provides outpatient services shall meet the provider-based
				  requirements for Medicare as established in
				  42
				  CFR 413.65, except when the provisions in
				  §5111. B are applicable.
B. Closure
				  of a State-Owned and/or Operated Hospital. If a state-owned and/or operated
				  hospital ceases to do business and surrenders its license, the off-site campus
				  of that closed hospital may be deemed to be "provider-based" for purposes of
				  Medicaid reimbursement only when all of the following criteria are met.
1. The off-site campus shall comply with the
				  provider-based requirements in
				  42
				  CFR 413.65 except that:
a. the off-site campus shall be deemed in
				  compliance with
				  42
				  CFR 413.65(d)(2)(vi) if the
				  off-site campus refers patients requiring inpatient hospital services to either
				  its main hospital provider campus or to the nearest available inpatient
				  services; and
b. the off-site
				  campus shall be deemed in compliance with
				  42
				  CFR 413.65(e)(3)(i) if they
				  are licensed as an off-site campus of another state-owned and/or operated
				  hospital that is within 100 miles of the off-site campus.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 51 - General Provisions › Section V-5113 - Never Events

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
				  for dates of service on or after July 1, 2012, the Medicaid Program will not
				  provide reimbursement for outpatient hospital services for "never events" or
				  medical procedures performed in error which are preventable and have a serious,
				  adverse impact to the health of the Medicaid recipient. Reimbursement will not
				  be provided when the following "never events" occur:
1. the wrong surgical procedure is performed
				  on a patient;
2. surgical or
				  invasive procedures are performed on the wrong body part; or
3. surgical or invasive procedures are
				  performed on the wrong patient.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 51 - General Provisions › Section V-5117 - Service Limits

Current through Register Vol. 50, No. 6, June 20, 2024
A. Outpatient
				  hospital services shall be limited to the following:
1. rehabilitation services-number of visits
				  in accordance with a rehabilitation plan prior authorized by the department or
				  its designee;
2. clinic
				  services-physician services provided in a clinic in an outpatient hospital
				  setting shall be considered physician services, not outpatient services, and
				  there shall be no limits placed on the number of physician visits payable by
				  the Medicaid program for eligible recipients; and
3. all other outpatient services, including
				  therapeutic and diagnostic radiology services, shall have no limit imposed
				  other than the medical necessity for the services.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter A - General Provisions › Section V-5301 - Payment for Outpatient Surgery Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payment for outpatient surgery services is
					 a flat rate in accordance with the published fee schedule. The flat rate
					 payment covers all services provided during the outpatient surgical admission.
					 There shall be no cost settlement for outpatient surgery services except for
					 the specific hospital types identified in Subchapter B of this Chapter.
1. Effective for dates of service on or after
					 February 10, 2022, the Medicaid Program shall provide reimbursement for
					 Coronavirus Disease 2019 laboratory testing in addition to the outpatient
					 surgery fee schedule flat fee reimbursement amount.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter B - Reimbursement Methodology › Section V-5311 - Small Rural Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after July 1, 2008, the reimbursement amount paid to
					 small rural hospitals for outpatient hospital surgery services shall be as
					 follows.
1. Small rural hospitals shall
					 receive an interim payment for claims which shall be the Medicaid fee schedule
					 payment on file for each service as of July 1, 2008.
2. A quarterly interim cost settlement
					 payment shall be made to each small rural hospital to estimate a payment of 110
					 percent of allowable cost for fee schedule services.
a. The interim cost settlement payment shall
					 be calculated by subtracting the actual quarterly payments for the applicable
					 dates of services from 110 percent of the allowable costs of the quarterly
					 claims. The cost to charge ratio from the latest filed cost report shall be
					 applied to quarterly charges for the outpatient claims paid by fee schedule and
					 multiplied by 110 percent of the allowable costs as calculated through the cost
					 report settlement process.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter B - Reimbursement Methodology › Section V-5313 - Non-Rural, Non-State Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after February 20, 2009, the reimbursement
					 paid to non-rural, non-state hospitals for outpatient surgery shall be reduced
					 by 3.5 percent of the fee schedule on file as of February 19, 2009.
B. Effective for dates of service on or after
					 August 4, 2009, the reimbursement paid to non-rural, non-state hospitals for
					 outpatient surgery shall be reduced by 5.65 percent of the fee schedule on file
					 as of August 3, 2009.
C. Low Income
					 and Needy Care Collaboration. Effective for dates of service on or after
					 January 1, 2010, quarterly supplemental payments will be issued to qualifying
					 non-rural, non-state hospitals for outpatient surgery services rendered during
					 the quarter. Maximum aggregate payments to all qualifying hospitals in this
					 group shall not exceed the available upper payment limit per state fiscal year.
1. Qualifying Criteria. In order to qualify
					 for the supplemental payment, the non-rural, non-state hospital must be
					 affiliated with a state or local governmental entity through a Low Income and
					 Needy Care Collaboration Agreement
a. A
					 non-state hospital is defined as a hospital which is owned or operated by a
					 private entity.
b. A Low Income and
					 Needy Care Collaboration Agreement is defined as an agreement between a
					 hospital and a state or local governmental entity to collaborate for purposes
					 of providing healthcare services to low income and needy patients.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter B - Reimbursement Methodology › Section V-5315 - Non-Rural, Non-State Public Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
					 July 1, 2013, quarterly supplemental payments may be issued to qualifying
					 non-rural, non-state public hospitals for outpatient surgical services rendered
					 during the quarter. Payment amounts may be reimbursed up to the Medicare
					 outpatient upper payment limits as determined in accordance with
					 42 CFR §
												447.321
1.
					 Qualifying Criteria. In order to qualify for the quarterly supplemental
					 payment, the non-rural, non-state public acute care hospital must be designated
					 as a non-teaching hospital by the department and must:
a. be located in a Medicare metropolitan
					 statistical area (MSA) per
					 42 CFR
					 413.231(b)(1);
b. provide inpatient obstetrical and neonatal
					 intensive care unit services; and
c. per the cost report period ending in SFY
					 2012, have a Medicaid inpatient day utilization percentage in excess of 21
					 percent and a Medicaid newborn day utilization percentage in excess of 65
					 percent as documented on the as filed cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter B - Reimbursement Methodology › Section V-5317 - Childrens Specialty Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after September 1, 2009, the reimbursement
					 amount paid to children's specialty hospitals for outpatient hospital surgery
					 services shall be as follows.
1. Qualifying
					 hospitals shall receive an interim payment equal to the Medicaid fee schedule
					 amount on file for each service.
2.
					 Final reimbursement shall be 97 percent of allowable cost as calculated through
					 the cost report settlement process.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 53 - Outpatient Surgery › Subchapter B - Reimbursement Methodology › Section V-5319 - State-Owned Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after February 10, 2012, medical education payments
					 for outpatient surgery services which are reimbursed by a prepaid risk-bearing
					 managed care organization (MCO) shall be reimbursed by Medicaid annually
					 through the Medicaid cost report settlement process.
1. For purposes of these provisions,
					 qualifying medical education programs are defined as graduate medical
					 education, paramedical education, and nursing schools.
2. Final payment shall be determined based on
					 the actual MCO covered outpatient surgery services and Medicaid medical
					 education costs for the cost reporting period per the Medicaid cost
					 report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter A - General Provisions › Section V-5501 - Payment for Outpatient Hospital Clinic Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payment for outpatient hospital clinic
					 services is a flat rate in accordance with the published fee schedule. There
					 shall be no cost settlement for outpatient clinic services except for the
					 specific hospital types identified in Subchapter B of this Chapter.
AUTHORITY
						NOTE: Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter B - Reimbursement Methodology › Section V-5511 - Small Rural Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after July 1, 2008, the reimbursement amount paid to
					 small rural hospitals for outpatient hospital clinic services shall be as
					 follows.
1. Small rural hospitals shall
					 receive an interim payment for claims which shall be the Medicaid fee schedule
					 payment on file for each service as of July 1, 2008.
2. A quarterly interim cost settlement
					 payment shall be made to each small rural hospital to estimate a payment of 110
					 percent of allowable cost for fee schedule services.
a. The interim cost settlement payment shall
					 be calculated by subtracting the actual quarterly payments for the applicable
					 dates of services from 110 percent of the allowable costs of the quarterly
					 claims. The cost to charge ratio from the latest filed cost report shall be
					 applied to quarterly charges for the outpatient claims paid by fee schedule and
					 multiplied by 110 percent of the allowable costs as calculated through the cost
					 report settlement process.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter B - Reimbursement Methodology › Section V-5513 - Non-Rural, Non-State Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after February 20, 2009, the reimbursement
					 paid to non-rural, non-state hospitals for outpatient clinic services shall be
					 reduced by 3.5 percent of the fee schedule on file as of February 19,
					 2009.
B. Effective for dates of
					 service on or after August 4, 2009, the reimbursement paid to non-rural,
					 non-state hospitals for outpatient clinic services shall be reduced by 5.65
					 percent of the fee schedule on file as of August 3, 2009.
C. Low Income and Needy Care Collaboration.
					 Effective for dates of service on or after January 1, 2010, quarterly
					 supplemental payments will be issued to qualifying non-rural, non-state
					 hospitals for clinic services rendered during the quarter. Maximum aggregate
					 payments to all qualifying hospitals in this group shall not exceed the
					 available upper payment limit per state fiscal year.
1. Qualifying Criteria. In order to qualify
					 for the supplemental payment, the non-rural, non-state hospital must be
					 affiliated with a state or local governmental entity through a Low Income and
					 Needy Care Collaboration Agreement.
a. A
					 non-state hospital is defined as a hospital which is owned or operated by a
					 private entity.
b. A Low Income and
					 Needy Care Collaboration Agreement is defined as an agreement between a
					 hospital and a state or local governmental entity to collaborate for purposes
					 of providing healthcare services to low income and needy patients.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter B - Reimbursement Methodology › Section V-5515 - Non-Rural, Non-State Public Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
					 July 1, 2013, quarterly supplemental payments may be issued to qualifying
					 non-rural, non-state public hospitals for clinic services rendered during the
					 quarter. Payment amounts may be reimbursed up to the Medicare outpatient upper
					 payment limits as determined in accordance with
					 42 CFR §
												447.321
1.
					 Qualifying Criteria. In order to qualify for the quarterly supplemental
					 payment, the non-rural, non-state public acute care hospital must be designated
					 as a non-teaching hospital by the department and must:
a. be located in a MSA per
					 42 CFR
					 413.231(b)(1);
b. provide inpatient obstetrical and neonatal
					 intensive care unit services; and
c. per the cost report period ending in SFY
					 2012, have a Medicaid inpatient day utilization percentage in excess of 21
					 percent and a Medicaid newborn day utilization percentage in excess of 65
					 percent as documented on the as filed cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter B - Reimbursement Methodology › Section V-5517 - Childrens Specialty Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after September 1, 2009, the reimbursement
					 amount paid to children's specialty hospitals for outpatient hospital clinic
					 services shall be the Medicaid fee schedule amount on file for each
					 service.
B. Effective for dates of
					 service on or after February 3, 2010, the reimbursement paid to children's
					 specialty hospitals for outpatient hospital clinic services shall be reduced by
					 five percent of the fee schedule on file as of February 2, 2010.
C. Effective for dates of service on or after
					 August 1, 2010, the reimbursement paid to children's specialty hospitals for
					 outpatient hospital clinic services shall be reduced by 4.6 percent of the fee
					 schedule on file as of July 31, 2010.
D. Effective for dates of service on or after
					 January 1, 2011, the reimbursement paid to children's specialty hospitals for
					 outpatient hospital clinic services shall be reduced by 2 percent of the fee
					 schedule on file as of December 31, 2010.
E. Effective for dates of service on or after
					 August 1, 2012, the reimbursement rates paid to children's specialty hospitals
					 for outpatient hospital clinic services shall be reduced by 3.7 percent of the
					 fee schedule on file as of July 31, 2012.
F. Effective for dates of service on or after
					 February 1, 2013, the reimbursement rates paid to children's specialty
					 hospitals for outpatient hospital clinic services shall be reduced by 1 percent
					 of the fee schedule on file as of January 31, 2013.
G. Effective for dates of service on or after
					 January 1, 2017, the reimbursement rates paid to childrens specialty hospitals
					 for outpatient hospital clinic services shall be increased by 7.03 percent of
					 the rates on file as of December 31, 2016.
H. Effective for dates of service on or after
					 January 1, 2018, the reimbursement rates paid to children's specialty hospitals
					 for outpatient hospital clinic services shall be increased by 4.82 percent of
					 the rates on file as of December 31, 2017.
I. Effective for dates of service on or after
					 January 1, 2019, the reimbursement rates paid to childrens specialty hospitals
					 for outpatient hospital clinic services shall be increased by 5.26 percent of
					 the rates on file as of December 31, 2018.
J. Effective for dates of service on or after
					 January 1, 2020, the reimbursement rates paid to childrens specialty hospitals
					 for outpatient hospital clinic services shall be increased by 3.2 percent of
					 the rates on file as of December 31, 2019.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 55 - Clinic Services › Subchapter B - Reimbursement Methodology › Section V-5519 - State-Owned Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after February 10, 2012, medical education payments
					 for outpatient clinic services which are reimbursed by a prepaid risk-bearing
					 managed care organization (MCO) shall be reimbursed by Medicaid annually
					 through the Medicaid cost report settlement process.
1. Qualifying medical education programs are
					 defined as graduate medical education, paramedical education, and nursing
					 schools.
2. Final payment shall be
					 determined based on the actual MCO covered outpatient clinic services and
					 Medicaid medical education costs for the cost reporting period per the Medicaid
					 cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 57 - Laboratory Services › Subchapter A - General Provisions › Section V-5701 - Payment for Outpatient Hospital Laboratory Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payment for outpatient hospital laboratory
					 services is a flat rate in accordance with the published fee schedule. There
					 shall be no cost settlement for outpatient laboratory services.
AUTHORITY
						NOTE: Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 57 - Laboratory Services › Subchapter B - Reimbursement Methodology › Section V-5711 - Small Rural Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after July 1, 2008, the reimbursement amount paid to
					 small rural hospitals for outpatient clinical diagnostic laboratory services
					 shall be a fee schedule amount equal to the Medicare Fee Schedule amount on
					 file as of July 1, 2008.
B.
					 Effective for dates of service on or after August 1, 2010, small rural
					 hospitals shall be reimbursed for outpatient clinical diagnostic laboratory
					 services up to the Medicare outpatient upper payment limits.
C . Low Income and Needy Care Collaboration.
					 Effective for dates of service on or after October 20, 2011, quarterly
					 supplemental payments will be issued to qualifying non-state hospitals for
					 outpatient laboratory services rendered during the quarter. Maximum aggregate
					 payments to all qualifying hospitals in this group shall not exceed the
					 available upper payment limit per state fiscal year.
1. Qualifying Criteria. In order to qualify
					 for the supplemental payment, the non-state hospital must be affiliated with a
					 state or local governmental entity through a low income and needy care
					 collaboration agreement.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 57 - Laboratory Services › Subchapter B - Reimbursement Methodology › Section V-5713 - Non-Rural, Non-State Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Effective for dates of service on or after February 20, 2009, the reimbursement
					 paid to non-rural, non-state hospitals for outpatient laboratory services shall
					 be reduced by 3.5 percent of the fee schedule on file as of February 19,
					 2009.
B. Effective for dates of
					 service on or after August 4, 2009, the reimbursement paid to non-rural,
					 non-state hospitals for outpatient laboratory services shall be reduced by 5.65
					 percent of the fee schedule on file as of August 3, 2009.
C. Low Income and Needy Care Collaboration.
					 Effective for dates of service on or after January 1, 2010, quarterly
					 supplemental payments will be issued to qualifying non-rural, non-state
					 hospitals for laboratory services rendered during the quarter. Maximum
					 aggregate payments to all qualifying hospitals in this group shall not exceed
					 the available upper payment limit per state fiscal year.
1. Qualifying Criteria. In order to qualify
					 for the supplemental payment, the non-rural, non-state hospital must be
					 affiliated with a state or local governmental entity through a Low Income and
					 needy care collaboration agreement.
a. A
					 non-state hospital is defined as a hospital which is owned or operated by a
					 private entity.
b. A Low Income and
					 needy care collaboration Agreement is defined as an agreement between a
					 hospital and a state or local governmental entity to collaborate for purposes
					 of providing healthcare services to low income and needy patients.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 57 - Laboratory Services › Subchapter B - Reimbursement Methodology › Section V-5715 - State-Owned Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. For dates of
					 service on or after July 1, 2008, state-owned hospitals shall be reimbursed for
					 outpatient clinical laboratory services at 100 per cent of the current Medicare
					 clinical laboratory fee schedule.
B. Effective for dates of service on or after
					 August 1, 2012, the reimbursement rates paid to state-owned hospitals for
					 outpatient laboratory services shall be reduced by 10 percent of the fee
					 schedule on file as of July 31, 2012.
C. Effective for dates of service on or after
					 January 1, 2021, the reimbursement rates paid to state-owned hospitals for
					 outpatient laboratory services shall be reimbursed at 100 per cent of the
					 current Medicare clinical laboratory fee schedule.
AUTHORITY NOTE:
						Promulgated in accordance with
						R.S.
						46:153 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 57 - Laboratory Services › Subchapter B - Reimbursement Methodology › Section V-5717 - Non-Rural, Non-State Public Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
					 July 1, 2013, quarterly supplemental payments may be issued to qualifying
					 non-rural, non-state public hospitals for laboratory services rendered during
					 the quarter. Payment amounts may be reimbursed up to the Medicare outpatient
					 upper payment limits as determined in accordance with
					 42
					 CFR §447.321.
1. Qualifying Criteria. In order to qualify
					 for the quarterly supplemental payment, the non-rural, non-state public acute
					 care hospital must be designated as a non-teaching hospital by the department
					 and must:
a. be located in a MSA per
					 42 CFR
					 413.231(b)(1);
b. provide inpatient obstetrical and neonatal
					 intensive care unit services; and
c. per the cost report period ending in SFY
					 2012, have a Medicaid inpatient day utilization percentage in excess of 21
					 percent and a Medicaid newborn day utilization percentage in excess of 65
					 percent as documented on the as filed cost report.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 59 - Rehabilitation Services › Subchapter A - General Provisions › Section V-5901 - Payment for Outpatient Hospital Rehabilitation Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Payment for outpatient hospital
					 rehabilitation services is a flat rate in accordance with the published fee
					 schedule. There shall be no cost settlement for outpatient rehabilitation
					 services except for the specific hospital types identified in Subchapter B of
					 this Chapter.
AUTHORITY
						NOTE: Promulgated in accordance with
						R.S.
						36:254 and Title XIX of the Social Security
						Act.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 5 - Outpatient Hospital Services › Chapter 59 - Rehabilitation Services › Subchapter B - Reimbursement Methodology › Section V-5911 - Small Rural Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after July 1, 2008, the reimbursement amount paid to
					 small rural hospitals for rehabilitation services shall be as follows.
1. Small rural hospitals shall receive an
					 interim payment for claims which shall be the Medicaid fee schedule payment on
					 file for each service as of July 1, 2008.
2. A quarterly interim cost settlement
					 payment shall be made to each small rural hospital to estimate a payment of 110
					 percent of allowable cost for fee schedule services.
a. The interim cost settlement payment shall
					 be calculated by subtracting the actual quarterly payments for the applicable
					 dates of services from 110 percent of the allowable costs of the quarterly
					 claims. The cost to charge ratio from the latest filed cost report shall be
					 applied to quarterly charges for the outpatient claims paid by fee schedule and
					 multiplied by 110 percent of the allowable costs as calculated through the cost
					 report settlement process.