reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-117 - Laboratory Testing for Coronavirus Disease 2019 (COVID-19)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
				  September 20, 2021, the Medicaid Program shall provide reimbursement to acute
				  care hospitals for COVID-19 laboratory testing provided to
				  inpatients.
B. Reimbursement.
				  Hospitals shall be reimbursed for such testing in addition to the hospital per
				  diem payment for the inpatient hospital stay.
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 1 - Inpatient Hospitals Services › Chapter 1 - General Provisions › Section V-119 - Coverage of Genetic Testing of Critically Ill Infants

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to Act 501 of the 2022 Regular
				  Session of the Louisiana Legislature, effective for dates of service on or
				  after January 1, 2023, the Medicaid Program shall provide reimbursement to
				  inpatient hospitals for rapid whole genome sequencing testing of a Medicaid
				  enrolled infant who meets all of the following criteria:
1. is one year of age or younger;
2. has a complex illness of unknown etiology;
				  and
3. is receiving inpatient
				  hospital services in an intensive care unit or in a pediatric care
				  unit.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 3 - Pre-Admission Certification › Section V-301 - General Provisions (Repealed)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 1 - Inpatient Hospitals Services › Chapter 5 - State Hospitals › Subchapter B - Reimbursement Methodology › Section V-551 - Acute Care Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Inpatient
					 hospital services rendered by state-owned acute care hospitals shall be
					 reimbursed at allowable costs and shall not be subject to per discharge or per
					 diem limits.
B. Effective for dates
					 of service on or after October 16, 2010, a quarterly supplemental payment up to
					 the Medicare upper payment limits will be issued to qualifying state-owned
					 hospitals for inpatient acute care services rendered.
C. Qualifying Criteria for Supplemental
					 Payment. The state-owned acute care hospitals must be located in DHH
					 Administrative Region 8 (Monroe).
D. Effective for dates of service on or after
					 October 16, 2010, Medicaid rates paid to state-owned acute care hospitals that
					 do not meet the qualifying criteria for the supplemental payment shall be
					 adjusted to 60 percent of allowable Medicaid costs.
E. Effective for dates of service on or after
					 February 1, 2012, medical education payments for inpatient services which are
					 reimbursed by a prepaid risk-bearing managed care organization (MCO) shall be
					 paid monthly by Medicaid as interim lump sum payments.
1. Hospitals with qualifying medical
					 education programs shall submit a listing of inpatient claims paid each month
					 by each MCO.
a.
Qualifying Medical
					 Education Programs
-graduate medical education, paramedical education,
					 and nursing schools.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 5 - State Hospitals › Subchapter B - Reimbursement Methodology › Section V-553 - Inpatient Psychiatric Services for State Owned Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for
					 dates of service on or after January 1, 2020, the prospective per diem rate
					 paid to state owned freestanding psychiatric hospitals, and distinct part
					 psychiatric units within state owned acute care hospitals, shall be increased
					 by indexing to 32 percent of the small rural hospital prospective per diem rate
					 in effect on January 1, 2019.
1. Psychiatric
					 hospitals and units whose per diem rates as of January 1, 2019, excluding the
					 graduate medical education portion of the per diem, are greater than 32 percent
					 of the January 1, 2019 small rural hospital rate shall not be
					 increased.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 7 - Prospective Reimbursement › Subchapter A - Appeals Procedure › Section V-701 - Request for Administrative Review

Current through Register Vol. 50, No. 6, June 20, 2024
A. Any hospital seeking an adjustment to its
					 rate, shall submit a written request for administrative review to the Medicaid
					 director (hereafter referred to as director) within 30 days after receipt of
					 the letter notifying the hospital of its rates.
1. The receipt of the letter notifying the
					 hospital of its rates shall be deemed to be five days from the date of the
					 letter.
2. The time period for
					 requesting an administrative review may be extended upon written agreement
					 between the department and the hospital.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 7 - Prospective Reimbursement › Subchapter A - Appeals Procedure › Section V-703 - Administrative Appeal and Judicial Review

Current through Register Vol. 50, No. 6, June 20, 2024
A. If the director's decision is adverse to
					 the hospital, the hospital may appeal the director's decision to the Bureau of
					 Appeals or its successor. The appeal must be lodged within 30 days of receipt
					 of the written decision of the director. The receipt of the decision of the
					 director shall be deemed to be five days from the date of the decision. The
					 administrative appeal shall be conducted in accordance with the Louisiana
					 Administrative Procedure Act (APA). The Bureau of Appeals shall submit a
					 recommended decision to the secretary of the department. The secretary will
					 issue the final decision of the department.
B. Judicial review of the secretary's
					 decision shall be in accordance with the APA and shall be filed in the
					 Nineteenth Judicial District Court.
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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter A - General Provisions › Section V-901 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Non-Rural, Non-State Hospital
-a hospital
						which is either owned and operated by a private entity, a hospital service
						district or a parish and does not meet the definition of a rural hospital as
						set forth in
						R.S.
						40:1300.143(3)(a).
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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter A - General Provisions › Section V-907 - Well Baby Care

Current through Register Vol. 50, No. 6, June 20, 2024
A. A separate
					 prospective per diem rate shall be paid to qualifying hospitals for well baby
					 care rendered to infants who are discharged at the same time that the mother is
					 discharged.
B. Qualifying Criteria.
					 Non-state, non-rural hospitals that perform more than 1,500 Medicaid deliveries
					 per year shall be eligible for this payment. The department will verify that
					 qualifying hospitals meet the 1,500 Medicaid delivery threshold each state
					 fiscal year. Well baby payments shall be discontinued should a hospital no
					 longer qualify.
C. Reimbursement
					 Methodology. The per diem rate for well baby care shall be the same prospective
					 rate that is paid for nursery boarder baby service.
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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter A - General Provisions › Section V-909 - Children's Specialty Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 In order to receive Medicaid reimbursement for inpatient 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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter A - General Provisions › Section V-911 - Children's Specialty Hospitals Psychiatric Units

Current through Register Vol. 50, No. 6, June 20, 2024
A. A psychiatric sub-provider unit in a
					 Medicare Prospective Payment System (PPS) exempt children's specialty hospital
					 may enroll in the Medicaid Program. The hospital must submit an attestation to
					 the department that the unit meets the PPS exempt criteria outlined in
					 42
					 CFR 412.25 [except 412.25(a)(1)(ii)].
					 Enrollment of the new unit will be effective upon verification of the
					 hospital's attestation by the department.
B. Changes in the number of beds in existing
					 units may only be made at the start of the hospital's cost reporting period.
					 The hospital must notify the department of changes in bed size at least 90 days
					 prior to the end of the hospital's cost reporting period. Qualifying Medicaid
					 services provided in these approved units shall be subjected to the existing
					 pre-admission certification requirements for children and adolescents in
					 distinct part psychiatric/substance abuse units in acute care general
					 hospitals.
C. Reimbursement for
					 services will be the inpatient psychiatric prospective per diem rate.
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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter A - General Provisions › Section V-915 - Distinct Part Psychiatric Units

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Changes in the Size of Distinct Part Psychiatric Units. For the purposes of
					 Medicaid reimbursement, the number of beds and square footage of each distinct
					 part psychiatric unit will remain the same throughout the cost reporting
					 period. Any changes in the number of beds or square footage considered to be a
					 part of a distinct part psychiatric unit may be made only at the start of a
					 cost reporting period. Verification of these changes will be completed during
					 the Medicaid agency's on-site survey at least 60 days prior, but no more than
					 90 days prior, to the end of the hospital's current cost reporting period with
					 other information necessary for determining recognition as a distinct part
					 psychiatric unit.
B. 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, may make a
					 one-time increase in its number of beds with a one-time opening of a new
					 distinct part psychiatric unit.
1. This
					 expansion or opening of a new unit will not be recognized, for Medicare
					 purposes, until the beginning of the next cost reporting period. At the next
					 cost reporting period, the hospital must meet the Medicare Prospective Payment
					 System (PPS) exemption criteria and enroll as a Medicare PPS excluded distinct
					 part psychiatric unit.
2. At the
					 time of any expansion or opening of a new distinct part psychiatric unit, the
					 provider must provide a written attestation that they meet all Medicare PPS
					 rate exemption criteria.
3.
					 Admissions to this expanded or new distinct part psychiatric unit may not be
					 based on payer source.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-953 - Acute Care Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. For dates of
					 service on or after September 1, 2007, the prospective per diem rate paid to
					 non-rural, non-state acute care hospitals for inpatient services shall be
					 increased by 4.75 percent of the rate on file for August 31, 2007.
B. Effective for dates of services on or
					 after October 1, 2007, a quarterly supplemental payment will be issued to
					 non-rural, non-state acute care hospitals that qualify as a high Medicaid
					 hospital.
1. Qualifying Criteria. A hospital
					 is considered to be a "high Medicaid hospital" if it has a Medicaid inpatient
					 utilization percentage greater than 30 percent based on the 12 month cost
					 report period ending in SFY 2006. For the purposes of calculating the Medicaid
					 inpatient utilization percentage, Medicaid days shall include nursery and
					 distinct part psychiatric unit days, but shall not include Medicare crossover
					 days.
2. Each eligible hospital
					 will receive a quarterly supplemental payment which shall be calculated based
					 on the pro rata share of each qualifying hospital's paid Medicaid days
					 (including covered nursery and distinct part psychiatric unit days) for dates
					 of service in SFY 2007 to the total Medicaid days of all eligible hospitals
					 multiplied by $5,000,000 which is the amount appropriated for these
					 supplemental payments.
3.
					 Rehabilitation hospitals, long term acute care hospitals and free-standing
					 psychiatric hospitals are not eligible for this supplemental payment.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-954 - Outlier Payments

Current through Register Vol. 50, No. 6, June 20, 2024
A. Pursuant to
					 §1902(s)(1) of title XIX of the Social Security Act, additional payments called
					 outlier payments shall be made to hospitals for catastrophic costs associated
					 with inpatient services provided to:
1.
					 children less than six years of age who receive services in a disproportionate
					 share hospital setting; and
2.
					 infants less than one year of age who receive services in any acute care
					 hospital setting.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-955 - Long-Term Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. For dates of
					 service on or after September 1, 2007, the prospective per diem rate paid to
					 long term hospitals for inpatient services shall be increased by 4.75 percent
					 of the rate on file for August 31, 2007.
B. For dates of service on or after February
					 20, 2009, the prospective per diem rate paid to long term hospitals for
					 inpatient services shall be reduced by 3.5 percent of the rate on file as of
					 February 19, 2009.
1. Payments for inpatient
					 hospital services to high Medicaid hospitals classified as long term hospitals
					 shall be exempted from these reductions.
2. For the purposes of qualifying for the
					 exemption to the reimbursement reduction as a high Medicaid hospital, the
					 following conditions must be met.
a. The
					 inpatient Medicaid days utilization rate for high Medicaid hospitals shall be
					 calculated based on the cost report filed for the period ending in state fiscal
					 year 2007 and received by the department prior to April 20, 2008.
b. Only Medicaid covered days for inpatient
					 hospital services, which include newborn and distinct part psychiatric unit
					 days, are included in this calculation.
c. Inpatient stays covered by Medicare Part A
					 cannot be included in the determination of the Medicaid inpatient utilization
					 days rate.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-957 - Hospital Intensive Neurological Rehabilitation Units (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 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-959 - Inpatient Psychiatric Hospital Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. For dates of service on or after September
					 1, 2007, the prospective per diem rate paid to private free-standing
					 psychiatric hospitals and distinct part psychiatric units shall be increased by
					 4.75 percent of the rate on file for August 31, 2007.
B. Effective for dates of service on or after
					 February 20, 2009, the prospective per diem rate paid to non-rural, non-state
					 free-standing psychiatric hospitals and distinct part psychiatric units shall
					 be reduced by 3.5 percent of the rate on file as of February 19, 2009.
1. Distinct part psychiatric units that
					 operate within an acute care hospital that qualifies as a high Medicaid
					 hospital, as defined in
					 §953. C 2, are exempt from
					 the rate reduction.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-961 - Inpatient Rehabilitation Hospital Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Definitions
Free-Standing Rehabilitation Hospital-
a
						non-rural, non-state hospital that is designated as a rehabilitation specialty
						hospital by Medicare.
B.
					 Reimbursement Methodology
1. Effective for
					 dates of service on or after January 1, 2018, the prospective per diem rate
					 paid to non-rural, non-state free-standing rehabilitation hospitals shall be
					 indexed to 36 percent of the small rural hospital prospective per diem rate in
					 effect on January 1, 2017.
2.
					 Rehabilitation hospitals whose per diem rates as of January 1, 2017, excluding
					 the graduate medical education portion of the per diem, are greater than 36
					 percent of the January 1, 2017 small rural hospital rate shall not be
					 increased.
3. Effective for dates
					 of service on or after January 1, 2020, the prospective per diem rate paid to
					 non-rural, non-state free-standing rehabilitation hospitals shall be indexed to
					 37 percent of the small rural hospital prospective per diem rate in effect on
					 January 1, 2019.
4. Rehabilitation
					 hospitals whose per diem rates as of January 1, 2019, excluding the graduate
					 medical education portion of the per diem, are greater than 37 percent of the
					 January 1, 2019 small rural hospital rate shall not be increased.
5. Effective for dates of service on or after
					 January 1, 2021, the inpatient per diem rate paid to non-rural, non-state
					 free-standing rehabilitation hospitals shall be increased by 3.2 percent of the
					 per diem rate on file as of December 31, 2020.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-963 - Public Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after May 15, 2011, non-rural, non-state public
					 hospitals shall be reimbursed up to the Medicare inpatient upper payment limits
					 as determined in accordance with
					 42 CFR §
												447.272
B. Effective for dates of service on or after
					 August 1, 2012, quarterly supplemental payments will be issued to qualifying
					 non-rural, non-state public hospitals for inpatient services rendered during
					 the quarter. Payment amounts shall be reimbursed up to the Medicare inpatient
					 upper payment limits as determined in accordance with
					 42 CFR §
												447.272
1.
					 Qualifying Criteria. In order to qualify for the quarterly supplemental
					 payment, the non-rural, non-state public acute care hospital must:
a. be designated as a major teaching hospital
					 by the department as of July 1, 2015 and have at least 300 licensed acute
					 hospital beds; or
b. effective for
					 dates of service on or after August 1, 2012, be located in a city with a
					 population of over 300,000 as of the 2010 U.S. Census.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-965 - Hemophilia Blood Products

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after July 1, 2015, the Department of Health and
					 Hospitals shall provide additional reimbursements to certain non-rural,
					 non-state acute care hospitals for the extraordinary costs incurred in
					 purchasing blood products for certain Medicaid recipients diagnosed with, and
					 receiving inpatient treatment for hemophilia.
B. Hospital Qualifications. To qualify for
					 the additional reimbursement, the hospital must:
1. be classified as a major teaching hospital
					 and contractually affiliated with a university located in Louisiana that is
					 recognized by the Centers for Disease Control and Prevention and the Health
					 Resource and Services Administration, Maternal and Child Health Bureau as
					 maintaining a comprehensive hemophilia care center;
2. have provided clotting factors to a
					 Medicaid recipient who:
a. has been diagnosed
					 with hemophilia or other rare bleeding disorders for which the use of one or
					 more clotting factors is Food and Drug Administration (FDA) approved;
					 and
b. has been hospitalized at the
					 qualifying hospital for a period exceeding six days; and
3. have actual cost exceeding $50,000 for
					 acquiring the blood products used in the provision of clotting factors during
					 the hospitalization;
a. actual cost is the
					 hospital's cost of acquiring blood products for the approved inpatient hospital
					 dates of service as contained on the hospital's original invoices, less all
					 discount and rebate programs applicable to the invoiced products.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-967 - Childrens Specialty Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Routine Pediatric Inpatient Services. For dates of service on or after October
					 4, 2014, payment shall be made per a prospective per diem rate that is 81.1
					 percent of the routine pediatric inpatient cost per day as calculated per the
					 "as filed" fiscal year end cost report ending during SFY 2014. The "as filed"
					 cost report will be reviewed by the department for accuracy prior to
					 determination of the final per diem rate.
1.
					 Repealed.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 9 - Non-Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-969 - Transplant Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Qualifying
					 Criteria. The hospital must be a Medicare approved transplant center for each
					 type of organ transplant to qualify for reimbursement of Medicaid transplant
					 services. Bone marrow transplant, stem cell transplant, and certain autologous
					 immunotherapies (such as CAR T-cell therapy) services shall only be allowable
					 for payment to hospitals that are accredited by the Foundation for the
					 Accreditation of Cellular Therapy (FACT).
B. Reimbursement Methodology. Reimbursement
					 shall be limited to the lesser of allowable cost, net of capital and medical
					 education cost, or the hospital-specific per diem limitation calculated for
					 each type of transplant.
1. Allowable cost is
					 defined as the ratio of cost to charges from the annual filed cost report
					 multiplied by the covered charges, net of capital and medical education cost,
					 for the specific transplant type.
2. The per diem limitation is calculated by
					 deriving the hospital's per diem for the transplant type from the hospital's
					 base period trended forward using the annual Medicare target rate inflation
					 percentage for prospective payment system (PPS)-exempt hospitals.
3. The base period is the cost report period
					 for the hospital's fiscal year ending September 30, 1983 through August 31,
					 1984. The base period for types of transplants that were not performed in the
					 base period shall be the first cost report filed subsequently that includes
					 costs for that type of transplant.
4. Reasonable capital and medical education
					 costs as calculated per the annual filed cost report shall be paid as a pass
					 through cost and included in cost report settlement amounts.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 11 - Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-1125 - 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 prospective per diem rate
					 paid to small rural hospitals for inpatient acute care services shall be the
					 median cost amount plus 10 percent.
1. The per
					 diem rate calculation shall be based on each hospital's year-end cost report
					 period ending in calendar year 2006. If the cost reporting period is not a full
					 period (12 months), the latest filed full period cost report shall be
					 used.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 11 - Rural, Non-State Hospitals › Subchapter B - Reimbursement Methodology › Section V-1127 - Inpatient Psychiatric Hospital Services

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective for dates of service on or after
					 July 1, 2008, the prospective per diem rate paid to small rural hospitals for
					 psychiatric services rendered in distinct part psychiatric units shall be the
					 median cost amount per inpatient day plus 10 percent.
1. The per diem rate calculation shall be
					 based on each hospital's year-end cost report period ending in calendar year
					 2006. If the cost reporting period is not a full period (12 months), the latest
					 filed full period cost report shall be used.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 13 - Teaching Hospitals › Subchapter A - General Provisions › Section V-1301 - Major Teaching Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A.The Louisiana
					 Medical Assistance Program's recognition of a major teaching hospital is
					 limited to facilities having a documented affiliation agreement for the purpose
					 of providing graduate medical education training with a Louisiana medical
					 school accredited by the Liaison Committee on Medical Education (LCME) or by
					 the Commission on Osteopathic College Accreditation (COCA). A major teaching
					 hospital shall meet one of the following criteria:
1. be a major participant in at least four
					 approved medical residency programs and maintain at least 15 intern and
					 resident un-weighted full-time equivalent positions. For purposes of this Rule,
					 full-time equivalent positions will be calculated as defined in
					 42
					 CFR 413.78. At least two of the programs must
					 be in medicine, surgery, obstetrics/gynecology, pediatrics, family practice,
					 emergency medicine or psychiatry; or
2. maintain at least 20 intern and resident
					 un-weighted full-time equivalent positions, with an approved medical residency
					 program in family practice located more than 150 miles from the medical school
					 accredited by the LCME or the COCA. For purposes of this Rule, full-time
					 equivalent positions will be calculated as defined in
					 42 CFR
					 413.78.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 13 - Teaching Hospitals › Subchapter A - General Provisions › Section V-1303 - Minor Teaching Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
					 Louisiana Medical Assistance Program's recognition of a minor teaching hospital
					 is limited to facilities having a documented affiliation agreement for the
					 purposes of providing graduate medical education training with a Louisiana
					 medical school accredited by the LCME or by the COCA. A minor teaching hospital
					 shall meet the following criteria:
1. must
					 participate significantly in at least one approved medical residency program in
					 either medicine, surgery, obstetrics/gynecology, pediatrics, family practice,
					 emergency medicine or psychiatry; and
2. maintain at least six intern and resident
					 un-weighted full-time equivalent positions. For purposes of this Rule,
					 full-time equivalent positions will be calculated as defined in
					 42
					 CFR 413.78.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 13 - Teaching Hospitals › Subchapter A - General Provisions › Section V-1305 - Approved Medical Residency Program

Current through Register Vol. 50, No. 6, June 20, 2024
A. An approved medical residency program is
					 one that meets one of the following criteria:
1. is approved by one of the national
					 organizations listed in
					 42
					 CFR 415.152;
2. may count towards certification of the
					 participant in a specialty or subspecialty listed in the current edition of
					 either of the following publications:
a.
The Directory of Graduate Medical Education Programs
published
					 by the American Medical Association, and available from American Medical
					 Association, Department of Directories and Publications; or
b.
The Annual Report and Reference
					 Handbook
published by the American Board of Medical Specialties, and
					 available from American Board of Medical Specialties;
3. is approved by the Accreditation Council
					 for Graduate Medical Education (ACGME) as a fellowship program in geriatric
					 medicine; or
4. is a program that
					 would be accredited except for the accrediting agency's reliance upon an
					 accreditation standard that requires an entity to perform an induced abortion
					 or require, provide, or refer for training in the performance of induced
					 abortions, or make arrangements for such training, regardless of whether the
					 standard provides exceptions or exemptions.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 13 - Teaching Hospitals › Subchapter A - General Provisions › Section V-1309 - Requirements for Reimbursement

Current through Register Vol. 50, No. 6, June 20, 2024
A.
					 Qualification for teaching hospital status shall be re-established at the
					 beginning of each fiscal year.
B.
					 To be reimbursed as a teaching hospital, a facility shall submit a signed
					 "certification for teaching hospital recognition" form to the Bureau of Health
					 Services, Rate Setting and Audit Section at least 30 days prior to the
					 beginning of each state fiscal year or at least 30 days prior to the effective
					 date of the conversion of a state owned and operated teaching hospital to
					 private ownership in accordance with a public/private partnership cooperative
					 endeavor agreement that was instituted to preserve graduate medical education
					 training and access to healthcare services for indigent patients.
C. Each hospital which is reimbursed as a
					 teaching hospital shall submit the following documentation with their Medicaid
					 cost report filing:
D. Copies of
					 all affiliation agreements, contracts, payroll records and time allocations
					 related to graduate medical education must be maintained by the hospital and
					 available for review by the state and federal agencies or their agents upon
					 request.
E. If it is subsequently
					 discovered that a hospital has been reimbursed as a major or minor teaching
					 hospital and did not qualify for that peer group for any reimbursement period,
					 retroactive adjustment shall be made to reflect the correct peer group to which
					 the facility should have been assigned. The resulting overpayment will be
					 recovered through either immediate repayment by the hospital or recoupment from
					 any funds due to the hospital from the department.
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 1 - Inpatient Hospitals Services › Chapter 13 - Teaching Hospitals › Subchapter B - Reimbursement Methodology › Section V-1331 - Acute Care Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Effective
					 for dates of service on or after February 1, 2012, medical education payments
					 for inpatient services which are reimbursed by a prepaid risk-bearing managed
					 care organization (MCO) shall be paid monthly by Medicaid as interim lump sum
					 payments.
1. Hospitals with qualifying medical
					 education programs shall submit a listing of inpatient claims paid each month
					 by each MCO.
a. Qualifying medical education
					 programs are defined as graduate medical education, paramedical education, and
					 nursing schools.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 17 - Public-Private Partnerships › Section V-1701 - Baton Rouge Area Hospitals

Current through Register Vol. 50, No. 6, June 20, 2024
A. Qualifying
				  Criteria. Effective for dates of service on or after April 15, 2013, the
				  department shall provide supplemental Medicaid payments for inpatient hospital
				  services rendered by non-state privately owned hospitals in the Baton Rouge
				  Area that meet the following conditions.
1.
				  The hospital must be a non-state privately owned and operated hospital that
				  enters into a cooperative endeavor agreement with the Department of Health and
				  Hospitals 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.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 17 - Public-Private Partnerships › Section V-1703 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Reserved.
B. Effective for dates of
				  service on or after April 15, 2013, a major teaching hospital that enters into
				  a cooperative endeavor agreement with the Department of Health and Hospitals to
				  provide acute care hospital services to Medicaid and uninsured patients and
				  which assumes providing services that were previously delivered and terminated
				  or reduced by a state-owned and operated facility shall be reimbursed as
				  follows.
1. The inpatient reimbursement shall
				  be reimbursed at 95 percent of allowable Medicaid costs. The interim per diem
				  reimbursement may be adjusted not to exceed the final reimbursement of 95
				  percent of allowable Medicaid costs.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 19 - Urban Metropolitan Statistical Area (MSA) Facility › Section V-1901 - Qualifying Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to
				  qualify as an urban metropolitan statistical area (MSA) facility, the hospital:
1. has a facility type code of acute and
				  opened subsequent to the March 12, 2020 presidential declaration of a national
				  emergency due to COVID-19 to provide availability of additional beds and
				  services for COVID-19 patients;
2.
				  must have been licensed and certified no later than June 30, 2020, and located
				  in zip code 70806, east of I-110, north of I-10, and south of Business Highway
				  190;
3. is located in an urban
				  metropolitan statistical area (MSA) as defined by the United States Office of
				  Management and Budget;
4. has an
				  operational emergency room and is located greater than five miles in distance
				  from the closest hospital emergency room; and
5. is located on a single site.
a. The addition of any off-site campus
				  location to the license of this hospital will invalidate the provisions of this
				  reimbursement methodology.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 19 - Urban Metropolitan Statistical Area (MSA) Facility › Section V-1903 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective July 1, 2022, the inpatient hospital per diem rate paid to an urban
				  MSA facility for acute care services shall be increased by indexing annually to
				  95 percent of the small rural hospital acute per diem rate in effect.
B. Effective July 1, 2022, the inpatient
				  hospital per diem rate paid to an urban MSA facility for psychiatric services
				  shall be increased by indexing annually to 95 percent of the small rural
				  hospital psychiatric per diem rate in effect.
C. These rates are conditional on the
				  hospital continuing to meet all qualifying criteria included in
				  §1901 If the hospital no longer qualifies,
				  payments will revert back to appropriate non-rural, non-state hospital assigned
				  rates effective on the date that the qualification(s) in
				  §1901 are no longer met.
D. The department may review all above
				  provisions every three years, at a minimum, to evaluate continuation of these
				  enhanced reimbursements.
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 1 - Inpatient Hospitals Services › Chapter 21 - Urban Metropolitan Statistical Area (MSA) Facility-New Orleans Area › Section V-2101 - Qualifying Criteria

Current through Register Vol. 50, No. 6, June 20, 2024
A. In order to
				  qualify as an urban metropolitan statistical area (MSA) facility-New Orleans
				  area, effective as of October 5, 2022, the hospital must:
1. be designated a non-rural hospital service
				  district located in LDH region 1, with a facility type code of acute, Medicaid
				  enrolled, with an original hospital license date before July 13, 2014, but
				  after July 1, 2014, located in zip code 70127;
2. be a hospital that is located an urban MSA
				  as defined by United States Office of Management and Budget;
3. have an operational emergency room;
				  and
4. not add additional locations
				  under this license, without prior written approval of the department.
a. The addition of any off-site campus,
				  beyond an outpatient primary care clinic, to the license of this hospital will
				  invalidate the provisions of this reimbursement methodology.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 21 - Urban Metropolitan Statistical Area (MSA) Facility-New Orleans Area › Section V-2103 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  inpatient hospital per diem rate paid for acute care services to qualifying
				  urban MSA hospitals-New Orleans area who meet all of the criteria in
				  §2101 shall be increased by indexing
				  annually to 95 percent of the small rural hospital acute per diem rate in
				  effect.
B. The inpatient hospital
				  per diem rate paid for psychiatric services to qualifying urban MSA
				  hospitals-New Orleans area who meet all of the criteria in
				  §2101 shall be increased by indexing
				  annually to 95 percent of the small rural hospital psychiatric per diem rate in
				  effect.
C. These rates are
				  conditional on the hospital continuing to meet all qualifying criterial
				  included in
				  §2101 If the hospital no longer qualifies,
				  payments will revert back to appropriate non-rural, non-state hospital assigned
				  rates effective on the date that the qualification(s) in
				  §2101 are no longer met.
D. The department may review all above
				  provisions every three years, at a minimum to evaluate continuation of these
				  enhanced reimbursements.
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 1 - Inpatient Hospitals Services › Chapter 23 - Medicare Part A Claims for Medicaid Eligible Beneficiaries › Section V-2301 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A. To
				  determine the amount that Medicaid will reimburse on a claim for a Medicaid
				  beneficiary who is also eligible for Medicare Part A, the Medicare claim
				  payment is compared to the Medicaid payment rate on file for the inpatient
				  service multiplied by the inpatient covered days. If the Medicare payment
				  exceeds the Medicaid rate that would have been paid, the claim is adjudicated
				  as a paid claim with a zero payment. If the Medicaid rate that would have been
				  paid exceeds the Medicare payment, the claim is reimbursed at the lesser of the
				  co-insurance and deductible or up to the Medicaid maximum payment. If the
				  Medicaid payment is reduced or eliminated as a result of the Medicare/Medicaid
				  payment comparison, the amount of the Medicare payment plus the amount of the
				  Medicaid payment, if any, shall be considered to be payment in full for the
				  service.
B. Medicare Part A claims
				  for small rural hospitals, as defined in
				  R.S.
				  40:1300, are exempt from the Medicaid maximum
				  payment limitation.
C. The
				  beneficiary does not have any legal liability to make payment for the
				  service.
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 1 - Inpatient Hospitals Services › Chapter 24 - Out-of-State Hospitals › Section V-2401 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after September 20, 2023, payment will be
				  made to out-of-state hospitals for provision of inpatient services which meet
				  at least one of the following conditions:
1.
				  medical services are needed because of a medical emergency;
2. medical services are needed and the
				  beneficiaries' health would be endangered if they were required to travel to
				  their state of residence;
3. the
				  state determines, on the basis of medical advice, that the needed medical
				  services, or necessary supplementary resources, are more readily available in
				  the other state; or
4. it is
				  general practice for beneficiaries in a particular locality to use medical
				  resources in another state.
Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 1 - Inpatient Hospitals Services › Chapter 24 - Out-of-State Hospitals › Section V-2403 - Reimbursement Methodology

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Effective for dates of service on or after September 20, 2023, payment for all
				  out-of-state inpatient services, other than organ transplants, shall be made at
				  the Louisiana in-state prospective peer group rate in effect for the
				  corresponding type of non-teaching hospital or specialty carve out service.
1. Separate prospective per diem rates will
				  be paid for out-of-state inpatient services provided in acute care general
				  hospitals, psychiatric hospitals and services, rehabilitation hospitals, long
				  term acute care hospitals, children's hospitals, nursery services, neonatal
				  intensive care services, pediatric intensive care services, and burn unit
				  intensive care services.