1. A. In order to qualify as a high Medicaid utilization academic hospital effective for dates of service on or after July 1, 2024, the hospital shall meet the following criteria per the Medicare/Medicaid as filed cost report for their fiscal year ended in SFY 2023:

   1. 1. have a Medicaid inpatient utilization percent of at least 39 percent; and
   2. 2. have an approved graduate medical education program with at least 400 intern and resident full-time equivalents (FTEs). The intern and resident FTE count must be included on the Medicare/Medicaid cost report on worksheet E-4, line 6 plus worksheet E-3, Part II, line 6.

2. B. Qualifying hospitals shall not add additional locations under their license, without prior written approval of the department.

   1. 1. The addition of any off-site campus, beyond an outpatient primary care clinic, to the license of this hospital will invalidate the provisions of this reimbursement methodology.

NOTE: Payments will not be processed and claims will not be recycled until the Rule is final.

Authority Note

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

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 50:1157 (August 2024).