La. Admin. Code tit. 50 § XV-9307

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

Section XV-9307 - Reimbursement Methodology

A. The Medicaid Program shall provide reimbursement to the Office of Behavioral Health for substance abuse services rendered to EPSDT recipients. Under the provisions of this Rule, payments to OBH for these services shall sunset as of February 29, 2012.

B. Reimbursement for these services shall be based on the most recent actual cost to OBH. Cost data shall be derived from the department's ISIS reporting of costs for the period. The cost period shall be consistent with the state fiscal year. Costs are determined by selecting the expenditures paid from state and local funds for the state fiscal year.

C. OBH encounter data from their database shall be used to identify allowable services. Encounter data for recipients under the age of 21 shall be extracted and used in calculations to determine actual cost to OBH.

D. Costs shall be calculated by using the cost-weighted amount and include Medicaid eligibles under 21 database costs divided by total database costs times OBH's expenditures for the program which were derived from the state's ISIS data.

La. Admin. Code tit. 50, § XV-9307

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 38:2372 (September 2012).

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