Current through Register Vol. 50, No. 9, September 20, 2024
A. Definitions
Emergency Ground Ambulance Service
Provider-a non-public, non-federal provider of emergency ground
ambulance services.
Net Operating Revenue-Repealed.
Quarter-for purposes of this Chapter,
quarters shall be constituted as follows.
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First Quarter
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December, January, February
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Second Quarter
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March, April, May
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Third Quarter
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June, July, August
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Fourth Quarter
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September, October, November
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a. Exception.
For purposes of hospital and emergency ground ambulance services, quarters
shall be constituted as follows.
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First Quarter
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July, August, September
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Second Quarter
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October, November, December
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Third Quarter
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January, February, March
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Fourth Quarter
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April, May, June
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B. Nursing Facility Services
1. A fee shall be paid by each facility
licensed as a nursing home in accordance with
R.S.
40:2009.3 et seq., for each occupied bed on a
per day basis. A bed shall be considered occupied, regardless of physical
occupancy, based upon payment for nursing facility services available or
provided to any individual or payer through formal or informal agreement. For
example, a bed reserved and paid for during a temporary absence from a nursing
facility shall be subject to the fee. Likewise, any bed or beds under contract
to a Hospice shall be subject to the fee for each day payment is made by the
Hospice. Contracts, agreements, or reservations, whether formal or informal,
shall be subject to the fee only where payment is made for nursing services
available or provided. Nursing facilities subject to the fee shall provide
documentation quarterly, on a form provided by the department, of occupied beds
in conjunction with payment of the fee.
2. The fee imposed for nursing facility
services shall not exceed 6 percent of the net patient revenues received by
providers of that class of services and shall not exceed $12.08 per occupied
bed per day. The fee amount shall be calculated annually in conjunction with
updating provider reimbursement rates under the Medical Assistance Program.
Notice to providers subject to fees shall be given in conjunction with the
annual rate setting notification by the Bureau of Health Services
Financing.
C.
Intermediate Care Facility for Individuals with Developmental Disabilities
(ICF/DD) Services
1. A fee shall be paid by
each facility licensed as an intermediate care facility for individuals with
developmental disabilities in accordance with
R.S.
46:2625 et seq., for each occupied bed per
day. A bed shall be considered occupied, regardless of physical occupancy,
based on payment for ICF/DD facility services available or provided to any
individual or payer through formal or informal agreement. For example, a bed
reserved and paid for during a temporary absence from a facility shall be
subject to the fee. Likewise, any bed or beds under contract to a hospice shall
be subject to the fee for each day payment is made by the hospice. Contracts,
agreements, or reservations, whether formal or informal, shall be subject to
the fee only where payment is made for ICF/DD facility services available or
provided. ICF/DD facilities subject to fees shall provide documentation
quarterly, on a form provided by the department, of occupied beds in
conjunction with payment of the fee.
2. The fees imposed for ICF/DD facility
services shall not exceed 6 percent of the net patient revenues received by
providers of that class of service and shall not exceed $30 per occupied bed
per day. The fee amount shall be calculated annually in conjunction with
updating provider reimbursement rates under the Medical Assistance Program.
Notice to providers subject to fees shall be given in conjunction with the
annual rate setting notification by the Bureau of Health Services
Financing.
D. Pharmacy
Services. A fee shall be paid by each pharmacy and dispensing physician for
each out-patient prescription dispensed. The fee shall be $0.10 per
prescription dispensed by a pharmacist or dispensing physician. Where a
prescription is filled outside of Louisiana and not shipped or delivered in any
form or manner to a patient in the state, no fee shall be imposed. However,
out-of-state pharmacies or dispensing physicians dispensing prescriptions which
are shipped, mailed or delivered in any manner inside the state of Louisiana
shall be subject to the $0.10 fee per prescription. The fee only applies to
prescriptions which are dispensed for human use. Pharmacies and dispensing
physicians subject to the fees shall provide documentation quarterly, on a form
provided by the department, in conjunction with payment of fees.
E. Emergency Ground Ambulance Services. A fee
shall be imposed on emergency ground ambulance services in accordance with
R.S.
46:2626.
1.
The assessment shall be a percentage fee, determined at the discretion of the
secretary with the express and written mutual agreement of the emergency ground
ambulance service providers subject to the assessment and which make up a
minimum of 65 percent of all emergency ground ambulance services in the state
of Louisiana.
a. the maximum fee allowable in
any year shall not exceed the percentage of net patient service revenues
permitted by federal regulation pursuant to
42 CFR
433.68 as determined by the department, as
reported by the provider and subject to audit for the previous fiscal year of
the provider. The department will arrive at net patient services revenue by
using net operating revenue as defined in
R.S.
46:2626.
b. - 3.a. Repealed.
F. Hospital Services
1. Effective July 1, 2022, a hospital
stabilization assessment fee shall be levied and collected in accordance with
article VII, section 10.13 of the Constitution of Louisiana, any legislation
setting forth the hospital stabilization formula, and departmental requirements
relative to directed payments.
a. Subject to
written approval by the Centers for Medicare and Medicaid Services (CMS) of a
directed payment arrangement pursuant to
42 C.F.R.
438.6, the Department of Health shall levy
and collect an assessment from those hospitals subject to the approved directed
payment arrangement. Each approved directed payment arrangement is effective
for one Healthy Louisiana Medicaid managed care contract rating period.
i. Prior to the levy of any assessment
pursuant to this Subsection, the Department of Health shall submit a Medicaid
assessment report to the Joint Legislative Committee on the Budget. The
Medicaid assessment report shall include a description of the proposed
assessment, the basis for the calculation of the assessment, and a listing of
each hospital included in the proposed assessment. The hospital assessment
shall be calculated in accordance with the annual hospital stabilization
formula set forth by the Legislature of Louisiana and enacted pursuant to
article VII, section 10.13 of the Constitution of Louisiana.
ii. An assessment levied pursuant to this
Subsection shall be levied only for the quarters that directed payments are
actually paid to qualified hospitals pursuant to
42 C.F.R.
438.6 directed payment arrangements approved
by CMS.
2.
Individual hospitals subject to an assessment under this Subsection shall be
obligated to pay such assessment regardless of whether a directed payment is
actually paid to the hospital for the quarter for which the assessment is
levied.
3. The assessment will be
levied and collected on a quarterly basis and at the beginning of each quarter
that the assessment is due.
4. -
5. Repealed.
AUTHORITY
NOTE: Promulgated in accordance with Chapter 45 of Title 46 as enacted in 1992,
46:2601-2605, redesignated as Chapter 47 of Title 46, containing
R.S.
46:2621 to 46:2625 and
P.L.
102-234,
R.S.
36:254, and Article VII, Section 10.13 of the
Constitution of Louisiana.
