La. Admin. Code tit. 40 § I-2505

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-2505 - Hospital Inpatient Reimbursement

A. Reimbursement for inpatient hospital services will be limited to the lesser of covered billed charges or the per diem amount. The per diem rate assigned to the Standard Metropolitan Statistical Area in which the services are rendered will be applied to inpatient days by type of service, either medical or surgical.* The reimbursement amount will be reduced by charges for noncovered items and services.

NOTE: *The diagnosis/procedure code requiring the greatest resource consumption (severity) should be used to assign the correct category.

B. Using the following Per Diem Rate Schedule, the formula for calculating payment amount is:

Per Diem Rate x Inpatient Days = per Diem Amount

1. If billed charges per diem amount, pay per diem amount less noncovered charges.

2. If billed charges < per diem amount, pay billed charges less noncovered charges.

Per Diem Rate Schedule
SMSA*	Medical per Diem	Surgical per Diem
Alexandria	$1212	$1628
Baton Rouge	$1125	$2015
Houma-Thibodaux	$ 908	$1697
Lafayette	$1009	$1655
Lake Charles	$ 946	$1645
Monroe	$1050	$1654
New Orleans	$1186	$2059
Nonmetropolitan	$ 771	$1570
Shreveport	$1198	$1629
*Please refer to Exhibit I for listing of hospitals within each SMSA.

C. A provider formally approved by Medicare as a rural referral center will be recognized as such under these rules, and will be reimbursed under the same per diem rate as that of the SMSA assigned to the provider by the Medicare Geographic Classification Review Board.

D. Exhibit 1

Hospitals by Area
Alexandria Bayou Rapides Byrd Memorial Rapides General St. Frances Cabrini Baton Rouge Ascension Hospital Baton Rouge General Medical Lane Memorial Medical Center of Baton Rouge Our Lady of the Lake Prevost Memorial Hospital Riverview Medical Center River West Medical Center Seventh Ward Community Westpark Community Hospital Womans Hospital Houma-Thibodaux Lady of the Sea General St. Anne General Terrebonne General Thibodaux Hospital Lafayette Doctors Hospital of Opelousas Gary Memorial Hospital Hamilton Medical Center Lafayette General Hospital Opelousas General Hospital Our Lady of Lourdes Womens and Childrens Hospital	Monroe Glenwood Regional Medical Center HCA North Monroe Hospital Lincoln General St. Francis Medical Center St. Erlington Hospital Lake Charles Beauregard Memorial Dequincy Memorial Humana Hospital-Lake Charles Lake Charles Memorial St. Patrick Hospital West Calcasieu-Cameron Shreveport Bossier Medical Center Doctors Hospital Highland Hospital Humana Hospital-Springhill LSU Medical Center Minden Medical Hospital North Caddo Memorial Physicians and Surgeons Riverside Community Schumpert Hospital Willis Knighton Medical	New Orleans Childrens Hospital De La Ronde Hospital Doctors Hospital of Jefferson East Jefferson General Elmwood Medical Center Eye, Ear, Nose and Throat Highland Park Hospital Hotel Dieu Hospital Humana Hospital-New Orleans Jo Ellen Smith/F. Edward Hebert Lakeside Hospital Meadowcrest Hospital Mercy Hospital of New Orleans New Orleans General Northshore Regional Medical Ochsner Foundation Pendleton Memorial Methodist River Parishes Hospital Slidell Memorial Southern Baptist Hospital St. Charles Hospital St. Charles Hospital/Luling St. Jude Medical Center St. Tammany Parish Touro Infirmary Tulane Medical Center United Medical Center West Jefferson Medical Center	Nonmetropolitan Abbeville General Abrom Kaplan Memorial Acadia Saint Landry Allen Parish American Legion Hospital Assumption General Bienville General Bogalusa Community Bunkie General Caldwell Memorial Citizens Medical Center Dauterive Hospital Desoto General East Carroll Parish Franklin Foundation Franklin Parish Hardtner Medical Center Homer Memorial Hood Memorial Humana Hospital-Marksville Humana Hospital-Oakdale Humana Hospital-Ville Platte Humana Hospital-Winn Parish Iberia General Jackson Parish Jennings American Legion L.S. Huckabay Medical Memorial Lakewood Hospital Lasalle General Madison Parish Merryville General Moosa Memorial Hospital Morehouse General Natchitoches Parish Pointe Coupee General Richland Parish- Delhi Richland Parish-Rayville Riverland Medical Center Riverside Medical Center Sabine Medical Center Savoy Memorial Hospital South Cameron Memorial St. Helena Parish St. James Parish Tri Ward General Union General West Carroll Memorial West Feliciana Parish

La. Admin. Code tit. 40, § I-2505

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.