Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part V - Hospital Services
Subpart 5 - Outpatient Hospital Services
Chapter 75 - Urban Metropolitan Statistical Area (MSA) Facility-New Orleans Area
Section V-7503 - Reimbursement Methodology
Universal Citation: LA Admin Code V-7503
Current through Register Vol. 50, No. 9, September 20, 2024
A. Payments for outpatient services to qualifying urban MSA hospitals-New Orleans area who meet all of the criteria in §7501 shall be made as follows:
1. Outpatient Surgery. The reimbursement
amount for outpatient hospital surgery services shall be an interim payment
equal to the Medicaid fee schedule amount on file for each service, and a final
reimbursement amount of 95 percent of allowable Medicaid cost as calculated
through the cost report settlement process.
2. Clinic Services. The reimbursement amount
for outpatient clinic services shall be an interim payment equal to the
Medicaid fee schedule amount on file for each service, and a final
reimbursement amount of 95 percent of allowable Medicaid cost as calculated
through the cost report settlement process.
3. Laboratory Services. The reimbursement
amount for outpatient clinical diagnostic laboratory services shall be the
Medicaid fee schedule amount on file for each service.
4. Rehabilitation Services. The reimbursement
amount for outpatient rehabilitation services shall be an interim payment equal
to the Medicaid fee schedule amount on file for each service, and a final
reimbursement amount of 95 percent of allowable Medicaid cost as calculated
through the cost report settlement process.
5. Other Outpatient Hospital Services. The
reimbursement amount for outpatient hospital services other than clinical
diagnostic laboratory services, outpatient surgeries, rehabilitation services,
and outpatient hospital facility fees shall be an interim payment equal to 95
percent of allowable Medicaid cost as calculated through the cost report
settlement process.
B. The department may review all above provisions every three years, at a minimum, to evaluate continuation of these enhanced reimbursements.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
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