Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part V - Hospital Services
Subpart 5 - Outpatient Hospital Services
Chapter 77 - High Medicaid Utilization Academic Hospitals
Section V-7701 - Qualifying Criteria
Universal Citation: LA Admin Code V-7701
Current through Register Vol. 50, No. 9, September 20, 2024
A. In order to qualify as a high Medicaid utilization academic hospital effective for dates of service on or after July 1, 2024, the hospital shall meet the following criteria per the Medicare/Medicaid as filed cost report for their fiscal year ended in SFY 2023:
1. have a Medicaid
inpatient utilization percent of at least 39 percent; and
2. have an approved graduate medical
education program with at least 400 intern and resident full time equivalents
(FTEs). The intern and resident FTE count must be included on the
Medicare/Medicaid cost report on worksheet E-4, line 6 plus worksheet E-3, Part
II, line 6.
NOTE: Payments will not be processed and claims will not be recycled until the Rule is final.
B. Qualifying hospitals shall not add additional locations under their license, without prior written approval of the department.
1. The addition of any off-site
campus, beyond an outpatient primary care clinic, to the license of this
hospital will invalidate the provisions of this reimbursement
methodology.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
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