Current through Register Vol. 50, No. 3, March 20, 2024
A. Effective for
dates of service on or after February 20, 2024, hospitals qualifying for
payments as psychiatric hospitals located in the northern area of the state
shall meet the following criteria:
1. be a
private, non-rural freestanding psychiatric hospital located in Department of
Health administrative regions 7 or 8; and
2. have a current executed academic
affiliation agreement for purposes of providing graduate medical education and
training to at least five documented intern and resident full time equivalents
(FTEs) annually.
a. the affiliation agreement
must be with a medical school located in Louisiana;
b. the intern and resident FTE count must be
included on the Medicare Medicaid cost report annually on worksheet S-3, column
9; and
c. the hospital must be
listed as a graduate medical education program training site on the
Accreditation Council for Graduate Medical Education
website.
B.
Payment Methodology. Effective for dates of service on or after February 20,
2024, 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 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.
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
hospital's 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.
