Current through Register Vol. 50, No. 9, September 20, 2024
A. Reimbursement
for outpatient hospital services to qualifying high Medicaid academic hospitals
who meet all of the criteria in §7701 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.
These rates are conditional on the hospital continuing to meet all qualifying
criteria included in §7701. If the hospital no longer qualifies, payments
will revert back to appropriate non-rural, non-state hospital assigned rates
effective on the date that the qualification(s) in §7701 are no longer
met.
C. 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.
