La. Admin. Code tit. 50 § IX-15155

Current through Register Vol. 50, No. 12, December 20, 2024

Section IX-15155 - Qualifying Criteria-Professional Services of Practitioners Affiliated with Tulane School of Medicine

A. Effective for dates of service on or after July 1, 2012, physicians and other eligible professional service practitioners who are employed by a physician group affiliated with Tulane University School of Medicine located in the city of New Orleans may qualify for supplemental payments for services rendered to Medicaid recipients. To qualify for the supplemental payment, the physician or professional service practitioner must be:

1. licensed by the state of Louisiana;

2. enrolled as a Louisiana Medicaid provider; and

3. identified by Tulane University School of Medicine as a physician or other professional service practitioner that is employed by, or under contract to provide services for that entity.

B. The following professional services practitioners shall quality to receive supplemental payments:

1. physicians;

2. physician assistants;

3. certified registered nurse practitioners; and

4. certified registered nurse anesthetists.

C. The supplemental payment shall be calculated in a manner that will bring payments for these services up to the community rate level.

1. For purposes of these provisions, the community rate shall be defined as the rates paid by commercial payers for the same service.

D. The private physician group shall periodically furnish satisfactory data for calculating the community rate as requested by the department.

E. The supplemental payment amount shall be determined by establishing a Medicare to community rate conversion factor for the private physician group. At the end of each quarter, for each Medicaid claim paid during the quarter, a Medicare payment amount will be calculated and the Medicare to community rate conversion factor will be applied to the result. Medicaid payments made for the claims paid during the quarter will then be subtracted from this amount to establish the supplemental payment amount for that quarter.

F. The supplemental payments shall be made on a quarterly basis and the Medicare to community rate conversion factor shall be recalculated at least every three years.

La. Admin. Code tit. 50, § IX-15155

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:1964 (August 2012).

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