Louisiana Revised Statutes 46:2625 – Fees on healthcare providers; disposition of fees
Terms Used In Louisiana Revised Statutes 46:2625
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:2622
- Dispensing physician: means any physician in the state of Louisiana who has registered as a dispensing physician with the Louisiana State Board of Medical Examiners and who dispenses to his patients any drug, chemical, or medication, except a bona fide medication sample. See Louisiana Revised Statutes 46:2622
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Fund: means the Louisiana Medical Assistance Trust Fund. See Louisiana Revised Statutes 46:2622
- Intermediate care facility for people with developmental disabilities: means a facility which is licensed as an intermediate care facility for people with developmental disabilities in accordance with La. See Louisiana Revised Statutes 46:2622
- Medicaid program: means the medical assistance program as established in Title XIX of the Social Security Act and as administered in the state of Louisiana by the Louisiana Department of Health. See Louisiana Revised Statutes 46:2622
- Nursing facility: means a facility which is licensed as a nursing home in accordance with Louisiana Revised Statutes 46:2622
- Out-of-state pharmacy: means any natural person, firm, corporation, partnership, or other juridical person, that is permitted as a pharmacy by a state other than Louisiana, and that, through or by out-of-state pharmacists, sells at retail, fills, dispenses, or furnishes out-of-state prescriptions. See Louisiana Revised Statutes 46:2622
- Out-of-state prescription: means a physician's order, written or oral, for a drug, chemical, medicine, device, or a combination thereof, that is filled, compounded or dispensed by an out-of-state pharmacist at a location outside the state of Louisiana, provided that the person for whom the physician issued the order is a resident of and domiciled in the state of Louisiana. See Louisiana Revised Statutes 46:2622
- Out-patient prescription: means a prescription dispensed to an individual who is not an in-patient of a facility licensed by the Louisiana Department of Health as a hospital. See Louisiana Revised Statutes 46:2622
- Pharmacist: means any natural person who is licensed or registered as a pharmacist by the state of Louisiana, who is a resident of and domiciled in the state of Louisiana, and who fills, compounds, or dispenses prescriptions. See Louisiana Revised Statutes 46:2622
- Pharmacy: means any natural person, firm, corporation, partnership, or other juridical person that is permitted as a pharmacy by the state of Louisiana, that is located within the state of Louisiana, and that through or by pharmacists, sells at retail, fills, dispenses, or furnishes prescriptions. See Louisiana Revised Statutes 46:2622
- Prescription: means a physician's order, written, oral, or electronically transmitted for a drug, chemical, medicine, device, or a combination thereof, that is filled, compounded, or dispensed by a licensed or registered pharmacist or dispensing physician. See Louisiana Revised Statutes 46:2622
A.(1) The Louisiana Department of Health is hereby authorized to adopt and impose fees for healthcare services provided by the Medicaid program on every nursing facility, every intermediate care facility for people with developmental disabilities, every pharmacy in the state of Louisiana and certain out-of-state pharmacies, dispensing physicians, and medical transportation providers. The amount of any fee shall not exceed the total cost to the state of providing the healthcare service subject to such fee. In addition, the amount of the fees imposed under the rules and regulations adopted shall not exceed the following:
(a) For nursing facilities, the percentage of net patient service revenues permitted by federal regulation pursuant to 42 C.F.R. § 433.68 as determined by the department on a per occupied bed per day basis.
(b) Thirty dollars per occupied bed per day for intermediate care facilities for people with developmental disabilities.
(c) Ten cents per out-patient prescription.
(d) Ten cents per out-patient out-of-state prescription.
(e) Ten cents per out-patient prescription dispensed by dispensing physicians.
(f) Seven dollars and fifty cents per medical service trip for medical transportation providers.
(2)(a) Any fee authorized by and imposed pursuant to this Section shall be considered an allowable cost for purposes of insurance or other third party reimbursements and shall be included in the establishment of reimbursement rates.
(b) Every contract between a pharmacy or pharmacist or his agent and a health insurance issuer or its agent shall include provisions requiring the health insurance issuer or its agent to reimburse the pharmacy or pharmacist or his agent for payment of the fee authorized by Subparagraph (A)(1)(c) of this Section, provided that the pharmacy or pharmacist or his agent makes a claim for reimbursement of the fee. Reimbursement, in accordance with La. Rev. Stat. 22:1854, shall be made not later than the fifteenth day after the date on which the claim was electronically adjudicated in the manner by which the pharmacy or pharmacist or his agent routinely receives reimbursement and accompanied by a remittance advice generated by a health insurance issuer or its agent which shall clearly identify the fee for each claim. Any contract that does not include such provisions shall nonetheless be interpreted and enforced to comply with this Section.
(c) In the event any provision of Subparagraph (b) of this Paragraph prevents any sums otherwise certifiable by the state as a component of its share of expenditures in the medical assistance program from being used in such manner, the provision shall be ineffective to the extent it prevents the certification.
(3) Subject to the exceptions contained in La. Const. Art. VII, § 9(A) , all fees collected pursuant to the authority granted in this Section shall be paid into the state treasury and shall be credited to the Bond Security and Redemption Fund. Out of the funds remaining in the Bond Security and Redemption Fund after a sufficient amount is allocated from that fund to pay all obligations secured by the full faith and credit of the state which become due and payable within any fiscal year, the treasurer shall, prior to placing such remaining funds in the state general fund, pay into the Louisiana Medical Assistance Trust Fund an amount equal to the total amount of such fees collected.
B. Repealed by Acts 2016, No. 675, §2.
C.(1) The department is hereby authorized and directed to adopt and promulgate, pursuant to the Administrative Procedure Act, such rules and regulations as are necessary to administer the fees imposed herein, including but not limited to rules and regulations regarding the collection and payment of the fees and the records necessary to be maintained and made available by the providers on whom the fees are imposed. Any such information, other than the amount of fees collected from each provider and the total amount of revenues generated by the fees authorized herein, which is received by any department or agency of the state pursuant to this Chapter shall be held confidential.
(2) The department is authorized and directed to adopt and promulgate, pursuant to the Administrative Procedure Act, rules and regulations governing the rights and obligations of those on whom said fees will be imposed. Such rules and regulations shall include the administrative appeal rights and procedures governing disputes arising out of the collection or administration of the fees authorized herein, subject to the provisions of Subsection E of this Section.
D. The governor, by executive order, may designate any agency, department, or division of state government to collect the fees authorized herein.
E.(1) All disputes arising from submission of reports and fees due from a pharmacy which are deemed untimely as described herein or disputes regarding the amount of fees due from a pharmacy pursuant to Paragraph (A)(1) of this Section shall be handled as provided in this Subsection. All other disputes regarding pharmacy fees pursuant to this Section which are not related to timeliness and accuracy of reports or fees due the department, or which involve fees due from a dispensing physician under this Section, shall be handled as provided for in rules promulgated pursuant to Paragraph (C)(2) of this Section.
(2) Beginning January 1, 2000, the Louisiana Board of Pharmacy, hereinafter “the board”, shall take necessary action to suspend the registration and permit of any registered in-state or out-of-state pharmacy which fails to timely submit a quarterly statement with the Louisiana Department of Health containing the number of prescriptions filled, compounded, or dispensed, and delivered in or into the state of Louisiana during the previous three-month period, or for failure to timely submit the appropriate prescription fees due pursuant to this Section. A report or fee shall be considered untimely if it is received by the department thirty days after the close of the most recent quarter. Each report of the quarterly statement shall be signed and verified as to accuracy of information contained therein by the preparer of the statement on a form provided by the department.
(3) The board in consultation with the department shall promulgate rules, in accordance with the Administrative Procedure Act, as necessary to comply with the requirements of the board herein, including rules to strictly define criteria for exceptions to the suspension requirements herein, and to provide rules for reinstatement procedures. Any revocation action taken pursuant to this Subsection shall proceed in accordance with laws and rules applicable to suspension of pharmacy permits in general, including the hearing and appeal rights provided pursuant to La. Rev. Stat. 37:1200 and 1201.
(4) The department shall promptly notify the board by certified mail of any reports or fees as described herein which are untimely as described herein, or fees in which the department considers the amount due from the pharmacy to be in dispute thirty calendar days after the date such fees are due to be received by the department. A copy of such notification shall also be sent by certified mail to the pharmacy which is the subject of the untimely reports or fees. The department shall promulgate rules, in accordance with the Administrative Procedure Act, as necessary to comply with the requirements of this Subsection, including rules to continuously apprise the board of fees and reports received by the department from any pharmacy which has been referred to the board for suspension proceedings.
(5) Nothing in this Subsection shall be construed to prevent the department from enforcing existing rules which assess monetary penalties against a pharmacy for late filing of reports or fees, which are not otherwise in conflict with the provisions herein.
Acts 1992, No. 260, §1, eff. June 10, 1992 (La. Rev. Stat. 46:2625(B) eff. April 1, 1992); Acts 1999, No. 1192, §1; Acts 2006, No. 163, §3; Acts 2015, No. 399, §2; Acts 2016, No. 675, §§1, 2; Acts 2019, No. 404, §1, eff. July 1, 2020.