Current through Register Vol. 50, No. 3, March 20, 2024
Low Income and Needy Care Collaboration
Agreement-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.
B. In order to qualify under this DSH
category in any period, a hospital must be party to a low income and needy care
collaboration agreement with the Department of Health and Hospitals in that
period.
C. DSH payments to low
income and needy care collaborating hospitals shall be calculated as follows.
1. In each quarter, the department shall
divide hospitals qualifying under this DSH category into two pools. The first
pool shall include hospitals that, in addition to qualifying under this DSH
category, also qualify for DSH payments under any other DSH category. Hospitals
in the first pool shall be eligible to receive DSH payments under §2713. C.2
provisions. The second pool shall include all other hospitals qualifying under
this DSH category. Hospitals in the second pool shall be eligible to receive
DSH payments under §2713. C.3 provisions.
2. In each quarter, to the extent the
department appropriates funding to this DSH category, hospitals that qualify
under the provisions of §2713. C.2 shall receive 100 percent of the total
amount appropriated by the department for this DSH category.
a. If the net uncompensated care costs of
these hospitals exceed the amount appropriated for this pool, payment shall be
made based on each hospital's pro rata share of the pool.
i. The pro rata share shall be calculated by
dividing the hospital's net uncompensated care costs by the total of the net
uncompensated care costs for all hospitals qualifying under §2713. C.2 and
multiplying by the amount appropriated by the department.
b. If the amount appropriated for this DSH
category exceeds the net uncompensated care costs of all hospitals qualifying
under §2713. C.2, payment shall be made up to each hospital's net uncompensated
care costs.
c. Any amount available
after all distributions are made under §2713. C.2 provisions shall be
distributed subject to the provisions in §2713. C.3.
3. In each quarter, to the extent
distributions are available, and after all distributions are made under §2713.
C.2 provisions, distributions under §2713. C.3 provisions shall be made
according to the following terms.
a. If the
net uncompensated care costs of all hospitals qualifying for payment under
§2713. C.3 provisions exceed the amount available for this pool, payment shall
be made based on each hospital's pro rata share of the pool.
i. The pro rata share shall be calculated by
dividing its net uncompensated care costs by the total of the net uncompensated
care costs for all hospitals qualifying under §2713. C.3.
b. If the amount available for payments under
§2713. C.3 exceeds the net uncompensated care costs of all qualifying
hospitals, payments shall be made up to each hospital's net uncompensated care
costs and the remaining amount shall be used by the department to make
disproportionate share payments under this DSH category in future
quarters.
D.
In the event it is necessary to reduce the amount of disproportionate share
payments under this DSH category to remain within the federal disproportionate
share allotment in any quarter, the department shall calculate a pro rata
decrease for each hospital qualifying under the provisions of §2713. C.3.
1. The pro rata decrease shall be based on a
ratio determined by:
a. dividing that
hospital's DSH payments by the total DSH payments for all hospitals qualifying
under §2713. C.3 in that quarter; and
b. multiplying the amount of DSH payments
calculated in excess of the federal disproportionate share allotment.
2. If necessary in any quarter,
the department will reduce Medicaid DSH payments under these provisions to zero
for all applicable hospitals.
E. After the reduction in §2713. D has been
applied, if it is necessary to further reduce the amount of DSH payments under
this DSH category to remain within the federal disproportionate share allotment
in any quarter, the department shall calculate a pro rata decrease for each
hospital qualifying under §2713. C.2.
1. The
pro rata decrease shall be based on a ratio determined by:
a. dividing that hospital's DSH payments by
the total DSH payments for all hospitals qualifying under §2713. C.2 in that
quarter; and
b. multiplying the
amount of DSH payments calculated in excess of the federal disproportionate
share allotment.
2. If
necessary in any quarter, the department shall reduce Medicaid DSH payments
under these provisions to zero for all applicable hospitals.
F. Qualifying hospitals must
submit costs and patient specific data in a format specified by the department.
Costs and lengths of stay will be reviewed for reasonableness before payments
are made.
G. Payments shall be made
on a quarterly basis, however, each hospital's eligibility for DSH and net
uncompensated care costs shall be determined on an annual basis.
H. Payments to hospitals qualifying under
this DSH category shall be made subsequent to any DSH payments for which a
hospital is eligible under another DSH category.
I. Aggregate DSH payments for hospitals that
receive payment from this category, and any other DSH category, shall not
exceed the hospital's specific DSH limit. If payments calculated under this
methodology would cause a hospital's aggregate DSH payment to exceed the limit,
the payment from this category shall be capped at the hospital's specific DSH
limit. The remaining payments shall be redistributed to the other hospitals in
accordance with these provisions.
J. If the amount appropriated for this DSH
category exceeds the specific DSH limits of all qualifying hospitals, payment
will be made up to each hospital's specific DSH limit and the remaining amount
shall be used by the department to make disproportionate share payments under
this DSH category in future quarters.
K. Effective for dates of service on or after
January 1, 2011, all parties that participate in Medicaid DSH payments under
this Section, either as a qualifying hospital by receipt of Medicaid DSH
payments or as a state or local governmental entity funding Medicaid DSH
payments, must meet the following conditions during the period of their
participation:
1. Each participant must comply
with the prospective conditions of participation in the Louisiana Private
Hospital Upper Payment Limit Supplemental Reimbursement Program.
2. A participating hospital may not make a
cash or in-kind transfer to their affiliated governmental entity that has a
direct or indirect relationship to Medicaid payments and would violate federal
law.
3. A participating
governmental entity may not condition the amount it funds the Medicaid Program
on a specified or required minimum amount of low income and needy
care.
4. A participating
governmental entity may not assign any of its contractual or statutory
obligations to an affiliated hospital.
5. A participating governmental entity may
not recoup funds from an affiliated hospital that has not adequately performed
under the low income and needy care collaboration agreement.
6. A participating hospital may not return
any of the Medicaid DSH payments it receives under this Section to the
governmental entity that provides the non-federal share of the Medicaid DSH
payments.
7. A participating
governmental entity may not receive any portion of the Medicaid DSH payments
made to a participating hospital under this Section.
L. Each participant must certify that it
complies with the requirements of §2713. K by executing the appropriate
certification form designated by the department for this purpose. The completed
form must be submitted to the Department of Health and Hospitals, Bureau of
Health Services Financing.
M. Each
qualifying hospital must submit a copy of its low income and needy care
collaboration agreement to the department.
N. The Medicaid DSH payments authorized in
LAC 50:V.Subpart 3 shall not be considered as interim Medicaid inpatient
payments in the determination of cost settlement amounts for inpatient hospital
services rendered by children's specialty hospitals.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
