Current through Register Vol. 50, No. 3, March 20, 2024
A. Effective for
dates of service on or after June 30, 2016, hospitals qualifying for payments
as major medical centers located in the central and northern areas of the state
shall meet the following criteria:
1. be a
private, non-rural hospital located in Department of Health administrative
regions 6, 7, or 8;
2. have at
least 200 inpatient beds as reported on the Medicare/Medicaid cost report,
Worksheet S-3, column 2, lines 1-18, for the state fiscal year ending June 30,
2015. For qualification purposes, inpatient beds shall exclude nursery and
Medicare-designated distinct part psychiatric unit beds;
3. does not qualify as a Louisiana low-income
academic hospital under the provisions of §3101; and
4. such qualifying hospital (or its
affiliate) does have a memorandum of understanding executed on or after June
30, 2016 with Louisiana State University, School of Medicine, the purpose of
which is to maintain and improve access to quality care for Medicaid patients
in connection with the expansion of Medicaid in the state through the
promotion, expansion, and support of graduate medical education and
training.
B. Payment
Methodology Effective for dates of service on or after June 30, 2016, each
qualifying hospital shall be paid a DSH adjustment payment which is the pro
rata amount calculated by dividing their hospital specific allowable
uncompensated care costs by the total allowable uncompensated care costs for
all hospitals qualifying under this category and multiplying by the funding
appropriated by the Louisiana Legislature in the applicable state fiscal year
for this category of hospitals.
1. Costs,
patient specific data and documentation that qualifying criteria is met shall
be submitted in a format specified by the department.
2. Costs and lengths of stay shall be
reviewed by the department for reasonableness before payments are
made.
3. Aggregate DSH payments for
hospitals that receive payment from this category, and any other DSH category,
shall not exceed the hospitals specific DSH limit. If payments calculated under
this methodology would cause a hospitals aggregate DSH payment to exceed the
limit, the payment from this category shall be capped at the hospitals specific
DSH limit.
4. A pro rata decrease,
necessitated by conditions specified in §2501. B.1 above for hospitals
described in this Section, will be calculated based on the ratio determined by
dividing the hospital's uncompensated costs by the uncompensated costs for all
of the qualifying hospitals described in this Section, then multiplying by the
amount of disproportionate share payments calculated in excess of the federal
DSH allotment.
a. Additional payments shall
only be made after finalization of the Centers for Medicare and Medicaid
Services' (CMS) mandated DSH audit for the state fiscal year. Payments shall be
limited to the aggregate amount recouped from the qualifying hospitals
described in this Section, based on these reported audit results. If the
hospitals' aggregate amount of underpayments reported per the audit results
exceeds the aggregate amount overpaid, the payment redistribution to underpaid
hospitals shall be paid on a pro rata basis calculated using each hospitals
amount underpaid, divided by the sum of underpayments for all of the hospitals
described in this Section.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
