La. Admin. Code tit. 50 § V-967
Current through Register Vol. 50, No. 11, November 20, 2024
Section V-967 - Childrens Specialty HospitalsA. Routine Pediatric Inpatient Services. For dates of service on or after October 4, 2014, payment shall be made per a prospective per diem rate that is 81.1 percent of the routine pediatric inpatient cost per day as calculated per the "as filed" fiscal year end cost report ending during SFY 2014. The "as filed" cost report will be reviewed by the department for accuracy prior to determination of the final per diem rate. B. Inpatient Psychiatric Services. For dates of service on or after October 4, 2014, payment shall be a prospective per diem rate that is 100 percent of the distinct part psychiatric cost per day as calculated per the as filed fiscal year end cost report ending during SFY 2014. The as filed cost report will be reviewed by the department for accuracy prior to determination of the final per diem rate. 1. Costs and per discharge/per diem limitation comparisons shall be calculated and applied separately for acute, psychiatric and each specialty service.C. Carve-Out Specialty Services. These services are rendered by neonatal intensive care units, pediatric intensive care units, burn units and include transplants. 1. Transplants. Payment shall be the lesser of costs or the per diem limitation for each type of transplant. The base period per diem limitation amounts shall be calculated using the allowable inpatient cost per day for each type of transplant per the cost reporting period which ended in SFY 2009. The target rate shall be inflated using the update factors published by the Centers for Medicare and Medicaid (CMS) beginning with the cost reporting periods starting on or after January 1, 2010. a. For dates of service on or after September 1, 2009, payment shall be the lesser of the allowable inpatient costs as determined by the cost report or the Medicaid days for the period for each type of transplant multiplied times the per diem limitation for the period. 2. Neonatal Intensive Care Units, Pediatric Intensive Care Units, and Burn Units. For dates of service on or after October 4, 2014, payment for neonatal intensive care units, pediatric intensive care units, and burn units shall be made per prospective per diem rates that are 84.5 percent of the cost per day for each service as calculated per the "as filed" fiscal year end cost report ending during SFY 2014. The "as filed" cost report will be reviewed by the department for accuracy prior to determination of the final per diem rate.D. Children's specialty hospitals shall be eligible for outlier payments for dates of service on or after October 4, 2014. E. These provisions shall not preclude childrens specialty hospitals from participation in the Medicaid Program under the high Medicaid or graduate medical education supplemental payment provisions. F. Effective for dates of service on or after February 3, 2010, the per diem rates as calculated per §967. C.1 above shall be reduced by 5 percent. Effective for dates of service on or after January 1, 2011, final payment shall be the lesser of allowable inpatient acute care costs as determined by the cost report or the Medicaid days as specified per §967. C.1 for the period, multiplied by 95 percent of the target rate per diem limitation as specified per §967. C.1 for the period.G. Effective for dates of service on or after August 1, 2010, the per diem rates as calculated per §967. C.1 above shall be reduced by 4.6 percent. Effective for dates of service on or after January 1, 2011, final payment shall be the lesser of allowable inpatient acute care costs as determined by the cost report or the Medicaid days as specified per §967. C.1 for the period, multiplied by 90.63 percent of the target rate per diem limitation as specified per §967. C.1 for the period.H. Effective for dates of service on or after January 1, 2011, the per diem rates as calculated per §967. C.1 above shall be reduced by 2 percent. Final payment shall be the lesser of allowable inpatient acute care costs as determined by the cost report or the Medicaid days as specified per §967. C.1 for the period, multiplied by 88.82 percent of the target rate per diem limitation as specified per §967. C.1 for the period.I. Effective for dates of service on or after February 1, 2012, medical education payments for inpatient services which are reimbursed by a prepaid risk-bearing managed care organization (MCO) shall be paid by Medicaid monthly as interim lump sum payments. 1. Hospitals with qualifying medical education programs shall submit a listing of inpatient claims paid each month by each MCO. a.Qualifying Medical Education Programs-graduate medical education, paramedical education, and nursing schools. 2. Monthly payments shall be calculated by multiplying the number of qualifying inpatient days times the medical education costs included in each childrens specialty hospitals interim per diem rate as calculated per the latest filed Medicaid cost report.3. Final payment shall be determined based on the actual MCO covered days and medical education costs for the cost reporting period per the Medicaid cost report. Reimbursement shall be at the same percentage that is reimbursed for fee-for-service covered Medicaid costs after application of reimbursement caps as specified in §967 A-C and reductions specified in §967 F-H.J. Effective for dates of service on or after August 1, 2012, the per diem rates as calculated per §967. C.1 above shall be reduced by 3.7 percent. Final payment shall be the lesser of allowable inpatient acute care costs as determined by the cost report or the Medicaid days as specified per §967. C.1 for the period, multiplied by 85.53 percent of the target rate per diem limitation as specified per §967. C.1 for the period.K. Effective for dates of service on or after February 1, 2013, the per diem rates as calculated per §967. C.1 above shall be reduced by 1 percent. Final payment shall be the lesser of allowable inpatient acute care costs as determined by the cost report or the Medicaid days as specified per §967. C.1 for the period, multiplied by 84.67 percent of the target rate per diem limitation as specified per §967. C.1 for the period.L. Effective for dates of service on or after January 1, 2017, the inpatient per diem rates paid to childrens specialty hospitals for acute, neonatal intensive care units, pediatric intensive care units and burn units services shall be increased by 7.03 percent of the per diem rate on file as of December 31, 2016.M. Effective for dates of service on or after January 1, 2017, the prospective per diem rate paid to distinct part psychiatric units within childrens specialty hospitals shall be increased by 2 percent of the per diem rate on file as of December 31, 2016. N. Effective for dates of service on or after January 1, 2020, the inpatient per diem rates paid to childrens specialty hospitals for acute, neonatal intensive care units, pediatric intensive care units and burn units services shall be increased by 3.2 percent of the per diem rate on file as of December 31, 2019.O. Effective for dates of service on or after January 1, 2020, the prospective per diem rate paid to distinct part psychiatric units within childrens specialty hospitals shall be increased by indexing to 32 percent of the small rural hospital prospective per diem rate in effect on January 1, 2019.P. Effective for dates of service on or after January 1, 2021, the inpatient per diem rates paid to childrens specialty hospitals for acute, neonatal intensive care units, pediatric intensive care units and burn units services shall be increased by 3.2 percent of the per diem rate on file as of December 31, 2020.Q. Effective for dates of service on or after January 1, 2021, the inpatient per diem rates paid to distinct part psychiatric units within childrens specialty hospitals shall be increased by 3.2 percent of the per diem rate on file as of December 31, 2020.La. Admin. Code tit. 50, § V-967
Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:2562 (November 2010), amended LR 37:2162, 2162 (July 2011), LR 38:2773 (November 2012), LR 39:3097 (November 2013), LR 40:312 (February 2014), repromulgated LR 40:1940 (October 2014), amended LR 40:1941 (October 2014), Amended LR 42275 (2/1/2016), Amended by the Department of Health, Bureau of Health Services Financing, LR 43964 (5/1/2017), Amended LR 451771 (12/1/2019), Amended LR 461683 (12/1/2020).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.