Current through Register Vol. 50, No. 9, September 20, 2024
A. Effective for dates of service on or after
July 1, 2008, the reimbursement methodology for services rendered by a rural
health clinic that was licensed as part of a small rural hospital as of July 1,
2007 shall be as follows:
1. Hospital-based
rural health clinics shall be reimbursed in the aggregate at 110 percent of
reasonable costs.
2. The interim
payment for claims shall be the Medicaid Benefits Improvement and Protection
Act of 2000 (BIPA) Prospective Payment System (PPS) per visit rate currently in
effect for each provider. Final reimbursement shall be the greater of BIPA PPS
payments or the alternative payment methodology of 110 percent of allowable
costs as calculated through the cost settlement process.
3. The payment received under this
methodology will be compared each year to the BIPA PPS rate to assure the
clinic that their payment under this alternative payment methodology (APM) is
at least equal to the BIPA PPS rate. If the payment calculation at 110 percent
of allowable cost is less than the BIPA PPS payments, the clinic will be paid
the difference.
B.
Effective for dates of service on or after July 1, 2023, the reimbursement
methodology for services rendered by a rural health clinic licensed as part of
a small rural hospital and included as a hospital outpatient department on the
hospital's fiscal year end cost report prior to July 1, 2023 shall be eligible
for the APM at 110 percent of allowable costs as calculated through cost
settlement. Reimbursement shall be as follows:
1. The reimbursement methodology will be in
accordance with
§16705.A 1-3 as
indicated above.
2. Future
qualifications for the 110 percent alternative payment methodology
reimbursement shall be determined on an annual basis for hospital-based rural
health clinics enrolling and licensing as hospital outpatient departments
during the hospital's fiscal year end cost reporting periods subsequent to June
30, 2023. Payments shall begin effective for dates of service beginning on July
1 after qualification.
3.
Hospital-based rural health clinics that terminate their licensing as hospital
outpatient departments will no longer be eligible for the alternative payment
methodology at 110 percent of allowable costs upon
termination.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
