La. Admin. Code tit. 50 § I-12505

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

Section I-12505 - Qualifying Criteria for Hospitals

A. Hospitals shall qualify for Medicaid incentive payments when:

1. services are rendered to the required number of patients based on the Medicaid patient volume threshold; and

2. the meaningful use requirements are met for EHR systems, based on the participation year of the program.

B. Acute care hospitals shall be required to meet the minimum Medicaid patient volume threshold of 10 percent. There is no Medicaid patient volume threshold for children's hospitals.

C. Hospitals that meet Medicare's meaningful use requirements for certified EHR systems shall satisfy the meaningful use requirements for Medicaid incentive payments.

D. Incentive payments for eligible hospitals shall begin in SFY 2011. Hospitals participating in the Medicaid incentive program cannot initiate payments after SFY 2016 and payment years must be consecutive after SFY 2016.

E. Eligible hospitals may receive incentive payments from Medicare and Medicaid simultaneously.

F. Payments are based on Federal fiscal year and are calculated as follows.

1. The overall EHR amount is multiplied times the Medicaid share.

a. The overall EHR amount is the sum over four years of the base amount plus the discharge related amount applicable for each year multiplied times the transition factor applicable for each year.

b. The Medicaid share is the Medicaid inpatient bed days plus the Medicaid managed care inpatient bed days divided by the total inpatient bed days multiplied times the estimated total charges minus uncompensated (charity) care charges divided by the estimated total charges.

2. The resulting amount is the eligible hospital payment amount.

G. Payments to eligible hospitals are disbursed over a 3-6 year period. No annual payment may exceed 50 percent of the total calculation and no two-year payment may exceed 90 percent of the total calculation.

La. Admin. Code tit. 50, § I-12505

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:2866 (December 2010).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.