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DECLARATION OF EMERGENCY

Department of Health and Hospitals

Office of the Secretary Bureau of Health Services Financing

Rural Health Clinics—Reimbursement Methodology (LAC 50:XI.16705)

The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing adopts LAC 50:XI.16705 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.

The Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing adopted provisions governing services, provider participation and reimbursement methodology for rural health clinics (Louisiana Register, Volume 32, Number 12). The bureau amended the provisions of the December 20, 2006 Rule governing the reimbursement methodology for rural health clinics to allow for the reimbursement of an additional payment to rural health clinics for professional services provided during evening, weekend or holiday hours (Louisiana Register, Volume 34, Number 6).

Act 327 of the 2007 Regular Session of the Louisiana Legislature authorized the department to amend the reimbursement methodology governing state fiscal year 2009 Medicaid payments to small rural hospitals for inpatient and outpatient hospital services and psychiatric services, including services provided by hospital-based rural health clinics. In compliance with the directives of Act 327, the department promulgated an Emergency Rule to amend the provisions governing the reimbursement methodology for hospital-based rural health clinics (Louisiana Register, Volume 34, Number 5). The department now proposes to amend the July 1, 2008 Emergency Rule to further clarify the provisions governing the reimbursement methodology for hospital-based rural health clinics. This Emergency Rule is being promulgated to promote the health and welfare of Medicaid recipients by ensuring sufficient provider participation in the Medicaid Program and recipient access to providers of these medically necessary services.

Effective October 20, 2008, the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing amends the reimbursement methodology governing payments to hospital-based rural health clinics for state fiscal year 2009.

Title 50

PUBLIC HEALTH—MEDICAL ASSISTANCE

Part XI.  Clinic Services

Subpart 15.  Rural Health Clinics

Chapter 167.Reimbursement Methodology

§16705.Hospital-Based Rural Health Clinics

A.Effective for dates of service on or after July 1, 2008, the reimbursement methodology for services rendered by a rural health clinic that was licensed as part of a small rural hospital as of July 1, 2007 shall be as follows:

1.Hospital-based rural health clinics shall be reimbursed in the aggregate at 110 percent of reasonable costs.
2.The interim payment for claims shall be the Medicaid Benefits Improvement and Protection Act of 2000 (BIPA) Prospective Payment System (PPS) per visit rate currently in effect for each provider. Final reimbursement shall be the greater of BIPA PPS payments or the alternative payment methodology of 110 percent of allowable costs as calculated through the cost settlement process.
3.The payment received under this methodology will be compared each year to the BIPA PPS rate to assure the clinic that their payment under this alternative payment methodology is at least equal to the BIPA PPS rate. If the payment calculation at 110 percent of allowable cost is less than the BIPA PPS payments, the clinic will be paid the difference.

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 35:

Implementation of the provisions of this Rule shall be contingent upon the approval of the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Interested persons may submit written comments to Jerry Phillips, 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

0810#089

DECLARATION OF EMERGENCY

Department of Insurance

Office of the Commissioner

Emergency Rule 24—Suspension of Certain Statutes and Regulations Regarding Cancellations, Non-Renewals, Reinstatements, Premium Payments, Claim Filings and Related Provisions Regarding Any and All Insurance Matters Affecting Insureds in Louisiana Caused by Hurricane Gustav (LAC 37:XI.Chapter 44)

Emergency Rule 24 is issued to address Hurricane Gustav which made landfall in Louisiana on September 1, 2008. Emergency Rule 24 is issued pursuant to the plenary authority of the Commissioner of Insurance for the State of Louisiana, including, but not limited to, the following: Proclamation No. 51 BJ 2008 issued on August 27, 2008 by Governor Bobby Jindal declaring a State of Emergency extending from August 27, 2008 through September 26, 2008; the Federal Emergency Management Agency’s Notice of a Major Disaster Declaration (FEMA-1786-DR); Amendment Nos. 1, 2, 3 and 4 to FEMA-1786-DR; Executive Order No. BJ 08-93 issued September 9, 2008 by Governor Bobby Jindal transferring authority over any and

Louisiana Register   Vol. 34, No. 10   October 20, 2008

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