Bj 10-11 Property Use for Emergency Berm Project for Deepwater Horizon Oil Spill Response 1412

Subpart 3. Disproportionate Share Hospital Payments

Chapter 27. Qualifying Hospitals

§2701. Non-Rural Community Hospitals

A. …

B. DSH payments to a public, non-rural community hospital shall be calculated as follows.

1. Each qualifying public, non-rural community hospital shall certify to the Department of Health and Hospitals its uncompensated care costs. The basis of the certification shall be 100 percent of the hospital’s allowable costs for these services, as determined by the most recently filed Medicare/Medicaid cost report. The certification shall be submitted in a form satisfactory to the department no later than October 1 of each fiscal year. The department will claim the federal share for these certified public expenditures. The department’s subsequent reimbursement to the hospital shall be in accordance with the qualifying criteria and payment methodology for non-rural community

hospitals included in Act 10 of the 2009 Regular Session of the Louisiana Legislature, and may be more or less than the federal share so claimed. Qualifying public, non-rural community hospitals that fail to make such certifications by October 1 may not receive Title XIX claim payments or any disproportionate share payments until the department receives the required certifications.

C. Private, non-rural community hospitals (other than freestanding psychiatric hospitals) shall be reimbursed as follows.

1. If the hospital’s qualifying uninsured cost is less than 3.5 percent of total hospital cost, no payment shall be made.

2. If the hospital’s qualifying uninsured cost is equal to or greater than 3.5 percent of total hospital cost, but less than 6.5 percent, the payment shall be 50 percent of an amount equal to the difference between the total qualifying uninsured cost as a percent of total hospital cost and 3.5 percent of total hospital cost.

3. If the hospital’s qualifying uninsured cost is equal to or greater than 6.5 percent of total hospital cost, but less than or equal to 8 percent, the payment shall be 80 percent of an amount equal to the difference between the total qualifying uninsured cost as a percent of total hospital cost and 3.5 percent of total hospital cost.

4. If the hospital’s qualifying uninsured cost is greater than 8 percent of total hospital cost, the payment shall be 90 percent of qualifying uninsured cost for the portion in excess of 8 percent of total hospital cost and 80 percent of an amount equal to 4.5 percent of total hospital cost.

C.5. - E. …

F. In the event that the total payments calculated for all recipient hospitals are anticipated to exceed the total amount appropriated, the department shall reduce payments on a pro rata basis in order to achieve a total cost that is not in excess of the amounts appropriated for this purpose. Any funding not distributed per the methodology outlined in C.1 - C.5 above shall be reallocated to these qualifying hospitals based on their reported uninsured costs. The $35,000,000 appropriation for the non-rural community hospital pool shall be effective only for state fiscal year 2010 and distributions from the pool shall be considered nonrecurring.

G. Of the total appropriation for the non-rural community hospital pool, $12,000,000 shall be allocated to public and private non-rural community hospitals with a distinct part psychiatric unit and freestanding psychiatric hospitals.

1. To qualify for this payment hospitals must have uninsured cost as defined in §2701.C.5 equal to or greater than 3.5 percent of total hospital cost and:

a. be a public or private non-rural community hospital, as defined in §2701.A. that has a Medicaid enrolled distinct part psychiatric unit; or

b. enrolled in Medicaid as a freestanding psychiatric hospital that pursuant to 42 CFR 441.151 is accredited by the Joint Commission on the Accreditation of Healthcare Organizations.

2. Payment shall be calculated by dividing each qualifying freestanding psychiatric hospital’s or distinct part

psychiatric unit’s uninsured days by the sum of all qualifying psychiatric uninsured days and multiplying by $12,000,000.

G.2.a. - G.2.b. Repealed

H. - I. …

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

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 34:655 (April 2008), amended LR 34:2402 (November 2008), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to Don Gregory, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. He is responsible for responding to all inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.

Alan Levine

Secretary

1007#025

DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Federally Qualified Health Centers
Service Limit Reduction (LAC 50:XI.10503)

The Department of Health and Hospitals, Bureau of Health Services Financing amends LAC 50:XI.10503 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act and as directed by Act 10 of the 2009 Regular Session of the Louisiana Legislature which states: “The secretary is directed to utilize various cost containment measures to ensure expenditures remain at the level appropriated in this Schedule, including but not limited to precertification, preadmission screening, diversion, fraud control, utilization review and management, prior authorization, service limitations, drug therapy management, disease management and other measures as permitted under federal law.” This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R. S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing established provisions governing provider enrollment, and clarified the provisions governing services and the reimbursement methodology for federally qualified health centers (FQHCs)(Louisiana Register, Volume 32, Number 10).

As a result of a budgetary shortfall in state fiscal year 2010, the Department of Health and Hospitals, Bureau of

Health Services Financing promulgated an Emergency Rule which reduced the reimbursement rates paid for dental encounters and reduced the service limits for medically necessary services rendered by federally qualified health centers (Louisiana Register, Volume 36, Number 2). The department determined that it was necessary to amend the provisions of the January 22, 2010 Emergency Rule to repeal the provisions governing the rate reduction for dental encounters (Louisiana Register, Volume 36, Number 4). This Emergency Rule is being promulgated to continue the provisions of the April 20, 2010 Emergency Rule. This action is being taken to avoid a budget deficit in the medical assistance programs.

Effective August 19, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing federally qualified health centers.

Title 50

PUBLIC HEALTH─MEDICAL ASSISTANCE

Part XI. Clinic Services

Subpart 13. Federally Qualified Health Centers

Chapter 105. Services

§10503. Service Limits

A. Federally qualified health center visits (encounters) are limited to 12 visits per year for medically necessary services rendered to Medicaid recipients who are 21 years of age or older. Visits for Medicaid recipients who are under 21 years of age and for prenatal and postpartum care are excluded from the service limitation.

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

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 32:1902 (October 2006), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to Don Gregory, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821 9030. He is responsible for responding to inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.

Alan Levine

Secretary

1007#074

DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Home Health Program―Durable Medical Equipment
Repeal of Provider Accreditation Requirements
(LAC 50:XIII.8501)

The Department of Health and Hospitals, Bureau of Health Services Financing amends LAC 50:XIII.8501 in the

Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

Section 302 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173) established provisions which mandated that suppliers of durable medical equipment (DME) and prosthetic and orthotic devices must be accredited by one of the independent accreditation organizations recognized by Medicare in order to receive reimbursement. The Department of Health and Hospitals, Bureau of Health Services Financing amended the provisions governing Medicaid coverage of medical equipment, supplies and appliances in the Home Health Program to adopt Medicare’s requirements for provider accreditation (Louisiana Register, Volume 36, Number 3). The department promulgated an Emergency Rule which repealed the provisions governing provider accreditation for medical equipment, supplies and appliances since federal regulations governing Medicare’s provider accreditation requirements have changed (Louisiana Register, Volume 36, Number 4). This Emergency Rule is being promulgated to continue the provisions of the April 20, 2010 Emergency Rule. This action is being taken to promote the health and welfare of Medicaid recipients by ensuring continued provider participation, thereby ensuring recipient access to durable medical equipment, supplies and appliances.

Effective August 19, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing provider participation for durable medical equipment to repeal the provisions governing provider accreditation.

Title 50

PUBLIC HEALTH―MEDICAL ASSISTANCE

Part XIII. Home Health Program

Subpart 3. Medical Equipment, Supplies and Appliances

Chapter 85. Provider Participation

§8501. Accreditation Requirements

Repealed.

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

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:512 (March 2010), repealed LR 36:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to Don Gregory, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. He is responsible for responding to all inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.

Alan Levine

Secretary

1007#075

DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Nursing Facilities―Reimbursement Rate Reduction
(LAC 50:VII.1305)

The Department of Health and Hospitals, Bureau of Health Services Financing proposes to amend LAC 50:VII.1305 in the Medical Assistance Program as authorized by R.S. 36:254 and pursuant to Title XIX of the Social Security Act. This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

In anticipation of projected expenditures in the Medical Vendor Program exceeding the funding allocated in the General Appropriations Act for state fiscal year 2010, the department promulgated an Emergency Rule to reduce the per diem rates and wage enhancement payments made to non-state nursing facilities (Louisiana Register, Volume 35, Number 7). In compliance with Act 244 of the 2009 Regular Session of the Louisiana Legislature, the department promulgated an Emergency Rule to implement periodic rebasing of the nursing facility rates (Louisiana Register, Volume 35, Number 7). The department amended the July 3, 2009 rate reduction Emergency Rule to repeal the per diem rate reduction and continued the wage enhancement reduction (Louisiana Register, Volume 35, Number 10). The final Rule will be published July 20, 2010 (Louisiana Register, Volume 36, Number 6). As a result of a budgetary shortfall in state fiscal year 2010, the department determined that it was necessary to amend the provisions governing the reimbursement methodology for nursing facilities to reduce the per diem rate paid to non-state nursing facilities (Louisiana Register, Volume 36, Number 2). The department subsequently amended the provisions governing the reimbursement methodology for non-state nursing facilities to reduce the reimbursement rates which were increased on July 1, 2010 as a result of the FY 2009-10 rebasing (Louisiana Register, Volume 36, Number 3). The March 20, 2010 Rule also clarified the provisions governing the reimbursement methodology for state-owned or operated nursing facilities and non-state, government-owned or operated nursing facilities. The department promulgated an Emergency Rule to amend the January 22, 2010 Emergency Rule to clarify the reduction of the per diem rate (Louisiana Register, Volume 36, Number 5).

In anticipation of projected expenditures in the Medical Vendor Program exceeding the funding allocated in the General Appropriations Act for state fiscal year 2011, the department has now determined that it is necessary to amend the provisions governing the reimbursement methodology for nursing facilities to further reduce the per diem rates paid to non-state nursing facilities. This action is being taken in order to avoid a budget deficit in the medical assistance programs. It is estimated that implementation of this Emergency Rule will reduce expenditures in the Medicaid Program by approximately $33,047,894 for state fiscal year 2009-2010.

Effective July 1, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing the reimbursement methodology for non-state nursing facilities to reduce the per diem rates.

Title 50

PUBLIC HEALTH─MEDICAL ASSISTANCE

Part VII. Long Term Care Services

Subpart 1. Nursing Facilities

Chapter 13. Reimbursement

§1305. Rate Determination

A. …

B. For dates of service on or after January 1, 2003, the Medicaid daily rates shall be based on a case-mix price-based reimbursement system. Rates shall be calculated from cost report and other statistical data.

1. Effective July 3, 2009, and at a minimum, every second year thereafter, the base resident-day-weighted median costs and prices shall be rebased using the most recent four month or greater unqualified audited or desk reviewed cost reports that are available as of the April 1,prior to the July 1 rate setting. The department, at its discretion, may rebase at an earlier time.

a. For rate periods between rebasing, an index factor shall be applied to the base resident-day weighted medians and prices.

C. - E. …

F. Effective for dates of service on or after January 22, 2010, the reimbursement paid to non-state nursing facilities shall be reduced by 1.5 percent of the per diem rate on file as of January 21, 2010 ($1.95 per day) until such time as the rate is rebased.

G. Effective for dates of service on or after July 1, 2010, the per diem rate paid to non-state nursing facilities shall be reduced by an amount equal to 4.8 percent of the non-state owned nursing facilities statewide average daily rate on file as of July 1, 2010 until such time as the rate is rebased.

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

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 28:1791 (August 2002), amended LR 31:1596 (July 2005), LR 32:2263 (December 2006), LR 33:2203 (October 2007), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:325 (February 2010), repromulgated LR 36:520 (March 2010), amended LR 36:

Implementation of the provisions of this Rule may be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), if it is determined that submission to CMS for review and approval is required.

Interested persons may submit written comments to Don Gregory, Bureau of Health Services Financing, P.O. Box 91030, Baton Rouge, LA 70821-9030. He is responsible for responding to inquiries regarding this Emergency Rule. A copy of this Emergency Rule is available for review by interested parties at parish Medicaid offices.

Alan Levine

Secretary

1007#024

DECLARATION OF EMERGENCY

Department of Health and Hospitals

Bureau of Health Services Financing

Nursing Facility Minimum Licensing Standards
Nurse Aide Training and Competency Evaluation Program
(LAC 48:I.Chapter 100)

The Department of Health and Hospitals, Bureau of Health Services Financing amends LAC 48:I.Chapter 100 in the Medical Assistance Program as authorized by R.S. 36:254. This Emergency Rule is promulgated in accordance with the provisions of the Administrative Procedure Act, R.S. 49:953(B)(1) et seq., and shall be in effect for the maximum period allowed under the Act or until adoption of the final Rule, whichever occurs first.

The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing repealed the provisions governing the Nurse Aide Training and Competency Evaluation Program in Title 50 of the Louisiana Administrative Code (LAC) and repromulgated these provisions in LAC 48:I.Chapter 100, under licensing standards for nursing facilities (Louisiana Register, Volume 32, Number 11).

ACT 357 of the 2009 Regular Session of the Louisiana Legislature directed the department to establish provisions for state registration of all certified nurse aides (CNAs) working in nursing homes and skilled nursing facilities and related matters, including restricted registrations, minimum requirements to maintain certification and provisions for complaint investigations. In compliance with Act 357, the Department of Health and Hospitals, Bureau of Health Services Financing proposes to amend the provisions governing the Nurse Aide Training and Competency Evaluation Program in order to establish state registration requirements for CNAs who work in nursing facilities and hospital-based skilled nursing facility units. This Emergency Rule will also establish minimum requirements to maintain nurse aide certification and complaint investigation procedures. This action is being taken to promote the health and welfare of nursing facility residents by assuring that CNAs have the proper training and certifications. It is estimated that implementation of this Emergency Rule will have no programmatic costs for state fiscal year 2010-2011.

Effective August 15, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing amends the provisions governing the Nurse Aide Training and Competency Evaluation Program.

Title 48

PUBLIC HEALTH – GENERAL

Part I. General Administration

Subpart 3. Licensing and Certification

Chapter 100. Nurse Aide Training and Competency Evaluation Program

Subchapter A. General Provisions

§10001. Definitions

* * *

Certified Nurse Aide—an individual who has completed a nurse aide training and competency evaluation program

(NATCEP) approved by the state as meeting the requirements of 42 CFR 483.151-483.154, or has been determined competent as provided in 42 CFR 483.150(a) and (b), and is listed as certified and in good standing on Louisiana’s nurse aide registry.

* * *

Nursing Homes or Nursing Facilities—any entity or facility serving two or more persons, who are not related to the operator by blood or marriage, that undertakes to provide maintenance, personal care or nursing for persons who are unable to properly care for themselves by reason of illness, age or physical infirmity.

Trainee—an individual who is at least 17 years old and is enrolled in a nurse aide training and competency evaluation program, whether at a nursing facility or educational facility, with a goal of becoming a certified nurse aide.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and P.L. 100-203.

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 32:2074 (November 2006), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 36:

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