Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part IX - Professional Services Program
Subpart 15 - Reimbursement
Chapter 151 - Reimbursement Methodology
Subchapter F - Supplemental Payments
Section IX-15155 - Qualifying Criteria-Professional Services of Practitioners Affiliated with Tulane School of Medicine

A. Effective for dates of service on or after July 1, 2012, physicians and other eligible professional service practitioners who are employed by a physician group affiliated with Tulane University School of Medicine located in the city of New Orleans may qualify for supplemental payments for services rendered to Medicaid recipients. To qualify for the supplemental payment, the physician or professional service practitioner must be:

B. The following professional services practitioners shall quality to receive supplemental payments:

C. The supplemental payment shall be calculated in a manner that will bring payments for these services up to the community rate level.

D. The private physician group shall periodically furnish satisfactory data for calculating the community rate as requested by the department.

E. The supplemental payment amount shall be determined by establishing a Medicare to community rate conversion factor for the private physician group. At the end of each quarter, for each Medicaid claim paid during the quarter, a Medicare payment amount will be calculated and the Medicare to community rate conversion factor will be applied to the result. Medicaid payments made for the claims paid during the quarter will then be subtracted from this amount to establish the supplemental payment amount for that quarter.

F. The supplemental payments shall be made on a quarterly basis and the Medicare to community rate conversion factor shall be recalculated at least every three years.