Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part V - Hospital Services
Subpart 5 - Outpatient Hospital Services
Chapter 69 - Out-of-State Hospitals
Subchapter B - Reimbursement
Section V-6915 - Reimbursement Methodology
Universal Citation: LA Admin Code V-6915
Current through Register Vol. 50, No. 9, September 20, 2024
A. Reimbursement for all Louisiana Medicaid recipients who receive outpatient services in an out-of-state hospital, including those recipients up to the age of 21, shall be calculated as follows:
1.
Outpatient services provided in out-of-state hospitals that are subject to a
fee schedule in-state shall be paid at the fee schedule amounts utilized for
in-state non-rural, non-state hospitals.
2. Outpatient services provided in
out-of-state hospitals that are not subject to a fee schedule in-state shall be
paid at the annual average cost to charge ratio calculated from the filed
Medicaid cost reports for in-state non-rural, non-state hospitals multiplied by
the percent of allowable cost as specified in
§6115 that is in effect for the applicable
time period for in-state non-rural, non-state hospitals. This ratio shall be
applied to the billed charges for covered claims submitted by out-of-state
hospitals to determine payment for non-fee schedule services.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
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