Current through Register Vol. 50, No. 3, March 20, 2024
A. Effective for
dates of service on or after January 1, 2020, hospitals qualifying for payments
as major medical centers located in the southeastern area of the state shall
meet the following criteria:
1. be a private,
non-rural hospital located in Department of Health administrative region
1;
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, 2018. For qualification
purposes, inpatient beds shall exclude nursery and Medicare-designated distinct
part psychiatric unit beds;
3. is
certified as an advanced comprehensive stroke center by the Joint Commission as
of June 30, 2018;
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 January 1, 2020, 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.
Reported uncompensated care costs shall be reviewed by the department to ensure
compliance with the reasonable costs definition in the Medicare Provider
Reimbursement Manual, Part l, Chapter 21, Section 2102.1, Revision 454.
Allowable uncompensated care costs must be calculated using the
Medicare/Medicaid cost report methodology.
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. If
additional payments or recoupments are required based on the results of the
mandated DSH audit report, they shall may be made within one year after the
final report for the state fiscal year is submitted to the Centers for Medicare
and Medicaid Services (CMS).
b.
Additional payments shall be limited to the aggregate amount recouped from the
qualifying hospitals described in this section, based on the reported DSH audit
results.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
