Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part V - Hospital Services › Subpart 3 - Disproportionate Share Hospital Payments › Chapter 25 - Disproportionate Share Hospital Payment Methodologies › Section V-2501 - General Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				  reimbursement methodology for inpatient hospital services incorporates a
				  provision for an additional payment adjustment for hospitals serving a
				  disproportionate share of low income patients.
B. The following provisions govern the
				  disproportionate share hospital (DSH) payment methodologies for qualifying
				  hospitals.
1. Total cumulative
				  disproportionate share payments under any and all disproportionate share
				  hospital payment methodologies shall not exceed the federal disproportionate
				  share state allotment for Louisiana for each federal fiscal year or the state
				  appropriation for disproportionate share payments for each state fiscal year.
				  The Department shall make necessary downward adjustments to hospital's
				  disproportionate share payments to remain within the federal disproportionate
				  share allotment and the state disproportionate share appropriated
				  amount.
2. Appropriate action
				  including, but not limited to, deductions from DSH, Medicaid payments and cost
				  report settlements shall be taken to recover any overpayments resulting from
				  the use of erroneous data, or if it is determined upon audit that a hospital
				  did not qualify.
3. DSH payments to
				  a hospital determined under any of the methodologies described in this Subpart
				  3 shall not exceed the hospital's net uncompensated cost as defined in Chapter
				  27 or the disproportionate share limits as defined in Section 1923(g)(1)(A) of
				  the Social Security Act for the state fiscal year to which the payment is
				  applicable. Any Medicaid profit shall be used to offset the cost of treating
				  the uninsured in determining the hospital specific DHH limits.
4. Qualification is based on the hospital's
				  latest filed cost report and related uncompensated cost data as required by the
				  Department. Qualification for small rural hospitals is based on the latest
				  filed cost report. Hospitals must file cost reports in accordance with Medicare
				  deadlines, including extensions. Hospitals that fail to timely file Medicare
				  cost reports and related uncompensated cost data will be assumed to be
				  ineligible for disproportionate share payments. Only hospitals that return
				  timely disproportionate share qualification documentation will be considered
				  for disproportionate share payments. After the final payment during the state
				  fiscal year has been issued, no adjustment will be given on DSH payments with
				  the exception of public state-operated hospitals, even if subsequently
				  submitted documentation demonstrates an increase in uncompensated care costs
				  for the qualifying hospital. After completion of a Center for Medicare and
				  Medicaid Services' (CMS) mandated independent audit for the state fiscal year,
				  additional payments may occur subject to the conditions specified in
				  §2705. D.2 and
				  §2707. B For hospitals
				  with distinct part psychiatric units, qualification is based on the entire
				  hospital's utilization.
5.
				  Hospitals shall be notified by letter at least 60 days in advance of
				  calculation of DSH payment to submit documentation required to establish DSH
				  qualification. Only hospitals that timely return DSH qualification
				  documentation will be considered for DSH payments. The required documents are:
a. obstetrical qualification
				  criteria;
b. low income utilization
				  revenue calculation;
c. Medicaid
				  cost report; and
d. uncompensated
				  cost calculation.
6.
				  Hospitals and/or units which close or withdraw from the Medicaid Program shall
				  become ineligible for further DSH pool payments for the remainder of the
				  current DSH pool payment cycle and thereafter.