Louisiana Revised Statutes 40:1248.12 – Governmental institutional providers; enhanced reimbursement
Terms Used In Louisiana Revised Statutes 40:1248.12
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 40:1248.1
- Governmental institutional provider: means either of the following:
(a) A nonstate governmental hospital, licensed in accordance with the Hospital Licensing Law, Louisiana Revised Statutes 40:1248.1
- Institutional provider: means a nongovernmental hospital licensed in accordance with the Hospital Licensing Law, Louisiana Revised Statutes 40:1248.1
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
A. Upon request from a parish in which a governmental institutional provider is located, the department shall attempt in good faith to execute a cooperative endeavor agreement acceptable to the department. Notwithstanding any law to the contrary, by September 1, 2020, or as soon thereafter as such a cooperative endeavor agreement is effective, the department shall file a Medicaid state plan amendment with the Centers for Medicare and Medicaid Services, referred to hereafter in this Section as “CMS”, amending the Medicaid state plan provisions governing hospital reimbursement to provide that a governmental institutional provider, as defined in La. Rev. Stat. 40:1248.1, shall be reimbursed at a rate which equals or approximates one hundred ten percent, or, if a reduction is required by CMS, the maximum amount acceptable to CMS, but in no case less than one hundred percent, of the appropriate reasonable cost of providing hospital inpatient and outpatient services, including but not limited to services provided in a rural health clinic licensed as part of a governmental institutional provider. The new governmental institutional provider payment methodology shall utilize prospective rates approximating costs at the time of service for inpatient acute care and psychiatric services. To ensure that governmental institutional provider outpatient services, including those reimbursed on a cost basis and those reimbursed on a fee schedule, are reimbursed in the aggregate at one hundred ten percent of the reasonable costs or such lesser amounts as approved by CMS, but in no case less than one hundred percent of their reasonable costs, the department shall pay an interim rate for cost-based outpatient services at one hundred ten percent of reasonable cost during the year and for fee-based services paid on a claim-by-claim basis, and the department shall make quarterly estimates of Medicaid base rate payments required to bring reimbursement to the governmental institutional provider for such services up to one hundred percent of reasonable costs and immediately remit such payments to the governmental institutional provider, and at final settlement pay such amounts as are necessary to ensure that all outpatient services in the aggregate, both cost-based and fee schedule, are paid at one hundred ten percent of reasonable costs.
B. The governmental institutional provider payment methodology provided for in this Subpart shall be implemented on January 1, 2021, or as soon thereafter as is practicable after the methodology is authorized by federal law.
Acts 2020, No. 330, §1.