Current through Register Vol. 50, No. 3, March 20, 2024
A.
Effective for dates of service on or after June 30, 2018, hospitals qualifying
for payments as major medical centers located in the southwestern area of the
state shall meet the following criteria:
1.
be a private, non-rural hospital located in Department of Health administrative
region 4;
2. have at least 175
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, 2017. For
qualification purposes, inpatient beds shall exclude nursery and
Medicare-designated distinct part psychiatric unit beds;
3. have a burn intensive care unit that is
reported on the Medicare/Medicaid cost report, Worksheet S-3, line 10, columns
1-8, for the state fiscal year ending June 30, 2017;
4. does not qualify as a Louisiana low-income
academic hospital under the provisions of §3101; and
5. does not qualify as a party to a low
income and needy care collaboration agreement with the Department of Health
under the provisions of §2713
B. Payment Methodology. Effective for dates
of service on or after June 30, 2018, 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.
b. Payments shall be limited
to the aggregate amount recouped from the qualifying hospitals described in
this Section, based on the reported DSH audit results.
c. 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.
