Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part V - Hospital Services
Subpart 3 - Disproportionate Share Hospital Payments
Chapter 31 - Louisiana Low-Income Academic Hospitals
Section V-3101 - Qualifying Criteria
Universal Citation: LA Admin Code V-3101
Current through Register Vol. 50, No. 3, March 20, 2024
A. Hospitals Located Outside of the Baton Rouge and New Orleans Metropolitan Statistical Area
1. Effective for dates of
service on or after July 1, 2016, a hospital may qualify for this category by:
a. being a private acute care general
hospital that is located outside of the Baton Rouge and New Orleans
metropolitan statistical area (MSA) which:
i.
entered into a cooperative endeavor agreement with the State of Louisiana to
increase its provision of inpatient Medicaid and uninsured services by
providing services that were previously delivered and terminated or reduced by
a state owned and operated facility; or
ii. is formerly a state owned and operated
hospital whose ownership change to non-state privately owned and operated prior
to July 1, 2014;
b. has
Medicaid inpatient days utilization greater than 18.9 percent. Qualification
shall be calculated by dividing the Medicaid inpatient days by the total
inpatient days reported on the Medicaid as filed cost report ending during
state fiscal year 2015 received by April 30, 2016, and shall include
traditional, shared, and managed care Medicaid days per the worksheet S-3 part
I, lines 1 through 18. Column 7 shall be used to determine allowable Medicaid
days and column 8 shall be used to determine total inpatient days;
and
c. has a ratio of intern and
resident full time equivalents (FTEs) to total inpatient beds that is greater
than .08. Qualification shall be based on the total inpatient beds and intern
and resident FTEs reported on the Medicare/Medicaid cost report ending during
state fiscal year 2015. The ratio of interns and resident FTEs shall be
calculated by dividing the unweighted intern and resident FTEs reported on the
Medicare Cost Report Worksheet E-4, line 6 by the total inpatient beds,
excluding nursery and Medicare designated distinct part psychiatric unit beds,
reported on worksheet S-3, column 2, lines 1 through 18.
B. Hospitals Located In the New Orleans Metropolitan Statistical Area
1.
Effective for dates of service on or after July 1, 2016, a hospital may qualify
for this category by:
a. being a private acute
care general hospital that is located in the New Orleans MSA which:
i. entered into a cooperative endeavor
agreement with the State of Louisiana to increase its provision of inpatient
Medicaid and uninsured services by providing services that were previously
delivered and terminated or reduced by a state owned and operated facility;
or
ii. is formerly a state owned
and operated hospital whose ownership changed to non-state privately owned and
operated prior to July 1, 2014;
b. has Medicaid inpatient days utilization
greater than 45 percent. Qualification shall be calculated by dividing the
Medicaid inpatient days by the total inpatient days reported on the Medicaid as
filed cost report ending during state fiscal year 2015 received by April 30,
2016, and shall include traditional, shared, and managed care Medicaid days per
the worksheet S-3 part I, lines 1 through 18. Column 7 shall be used to
determine allowable Medicaid days and column 8 shall be used to determine total
inpatient days; and
c. has a ratio
of intern and resident FTEs to total inpatient beds that is greater than 1.25.
Qualification shall be based on the total inpatient beds and intern and
resident FTEs reported on the Medicare/Medicaid cost report ending during state
fiscal year 2015. The ratio of interns and resident FTEs shall be calculated by
dividing the unweighted intern and resident FTEs reported on the Medicare Cost
Report Worksheet E-4, line 6 by the total inpatient beds, excluding nursery and
Medicare designated distinct part psychiatric unit beds, reported on worksheet
S-3, column 2, lines 1 through 18.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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