La. Admin. Code tit. 50 § II-10105

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

Section II-10105 - Provider Enrollment

A. In order to participate as a provider of nursing services under Medicaid, a facility must meet certification requirements and enter into a provider agreement with the Department of Health and Hospitals. A provider agreement is the basis for payments by the Bureau of Health Services Financing. The execution of provider agreement and the assignment of the provider's Medicaid vendor number is contingent upon the following criteria.

1. The facility shall request a Medicaid enrollment packet from the BHSF/HSS Provider Enrollment Unit. The information listed below shall be returned as soon as it is completed.

a. Two copies of the provider agreement form which shall bear the signature of the person legally designated to enter into the contract with DHH;

b. One copy of the provider enrollment form, PE 50, which shall be completed in accordance with accompanying instructions and bear the signature of the administrator or authorized representative;

c. An addendum to the above provider agreement shall be completed if the facility chooses to provide any of the following enhanced levels of care:

i. a skilled-infectious disease (S-ID);

ii. skilled-technology dependent care (S-TDC);

iii. skilled/neurological rehabilitation treatment program (S-NRTP).

B. Effective date of the provider enrollment agreement. The effective date of the provider agreement shall be determined as follows.

1. If all federal requirements (health and safety standards) including facility need review approval requirements specified above are met on the day of the Health Standards Section survey, then the effective date of the provider agreement is the date the on-site survey is completed.

2. If all requirements as specified in one above are not met on the day of the HSS survey, then the effective date of the provider agreement is the earlier of the following dates:

a. the date on which the provider meets all requirements; and

b. the date on which the provider submits a corrective action plan acceptable to the HSS.

3. Upon receipt of the above documentation/verification, Bureau of Health Services Financing-Health Standards Section Provider Enrollment Unit will assign a vendor number for billing purposes along with the issuance of the Provider Agreement. The Fiscal Intermediary will be notified accordingly.

C. Provider Agreement Time Periods. The provider agreement shall meet the following criteria in regard to time periods.

1. It shall not exceed 14 months;

2. It shall coincide with the certification period set by the Health Standards Section Survey Unit; and

EXCEPTION: If HSS has adequate documentation showing "good cause", it may make an agreement and certification period for less than 12 months.

3. After a provider agreement expires, payment may be made to a facility for up to 30 days.

La. Admin. Code tit. 50, § II-10105

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.