La. Admin. Code tit. 50 § XV-20301

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

Section XV-20301 - "638" Facilities

A. In order to participate in the Medicaid Program as a "638" facility, the facility must provide health services and be operated by:

1. a federally recognized tribe that meets the definition as set forth in 25 U.S.C. § 1603 (d); or

2. a tribal organization as that term is defined in 25 U.S.C. § 450 b(l); or

3. an inter-tribal consortium as that term is defined in 25 U.S.C. § 458 aaa(a)(5).

B. A "638" facility must:

1. comply with all provider enrollment requirements for the Louisiana Medicaid Program, including an attestation stating they will only seek reimbursement for services rendered to Medicaid eligible tribe members and Medicaid eligible individuals who are statutorily eligible under 25 U.S.C. § 1680 c (a) to receive treatment at an IHS facility;

2. employ or have a contractual agreement with the licensed health professionals who will perform the required services included in the encounter rate. These health care professionals must meet the participation standards required for Medicaid enrollment of their respective provider type;

3. comply with the Medicaid rules and regulations governing those services included in the facility's encounter rate;

4. assure that services will be provided on-site; and

5. have a physician affiliated with the clinic that must spend as much time in the facility as is necessary to ensure that patients are receiving services in a safe and efficient manner in accordance with accepted standards of medical, dental, and behavioral health practice, and other health care professionals available as needed.

La. Admin. Code tit. 50, § XV-20301

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:2029 (August 2005), Amended by the Department of Health, Bureau of Health Services Financing, LR 491726 (10/1/2023).

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