1. A. Effective for dates of service on or after September 1, 2009, the reimbursement amount paid to children’s specialty hospitals for outpatient hospital surgery services shall be as follows.

   1. 1. Qualifying hospitals shall receive an interim payment equal to the Medicaid fee schedule amount on file for each service.
   2. 2. Final reimbursement shall be 97 percent of allowable cost as calculated through the cost report settlement process.

2. B. Effective for dates of service on or after February 3, 2010, the reimbursement paid to children’s specialty hospitals for outpatient surgery shall be reduced by five percent of the fee schedule on file as of February 2, 2010.

   1. 1. Final reimbursement shall be 92.15 percent of allowable cost as calculated through the cost report settlement process.

3. C. Effective for dates of service on or after August 1, 2010, the reimbursement paid to children’s specialty hospitals for outpatient surgery shall be reduced by 4.6 percent of the fee schedule on file as of July 31, 2010.

   1. 1. Final reimbursement shall be 87.91 percent of allowable cost as calculated through the cost report settlement process.

4. D. Effective for dates of service on or after January 1, 2011, the reimbursement paid to children’s specialty hospitals for outpatient surgery shall be reduced by 2 percent of the fee schedule on file as of December 31, 2010.

   1. 1. Final reimbursement shall be 86.15 percent of allowable cost as calculated through the cost report settlement process.
5. E. Effective for dates of service on or after August 1, 2012, the reimbursement rates paid to children’s specialty hospitals for outpatient surgery shall be reduced by 3.7 percent of the fee schedule on file as of July 31, 2012.
6. F. Effective for dates of service on or after February 1, 2013, the reimbursement rates paid to children’s specialty hospitals for outpatient surgery shall be reduced by 1 percent of the fee schedule on file as of January 31, 2013.

7. G. Effective for dates of service on or after January 1, 2017, the reimbursement paid to children specialty hospitals for outpatient surgery shall be increased by 7.03 percent of the rates on file as of December 31, 2016.

   1. 1. Final reimbursement shall be 87.91 percent of allowable cost as calculated through the cost report settlement process.

8. H. Effective for dates of service on or after January 1, 2018, the reimbursement paid to children’s specialty hospitals for outpatient surgery shall be increased by 4.82 percent of the rates on file as of December 31, 2017.

   1. 1. Final reimbursement shall be 92.15 percent of allowable cost as calculated through the cost report settlement process.

9. I. Effective for dates of service on or after January 1, 2019, the reimbursement rates paid to children’s specialty hospitals for outpatient surgery shall be increased by 5.26 percent of the rates on file as of December 31, 2018.

   1. 1. Final reimbursement shall be 97 percent of allowable cost as calculated through the cost report settlement process.

10. J. Effective for dates of service on or after January 1, 2020, the reimbursement rates paid to children’s specialty hospitals for outpatient surgery shall be increased by 3.2 percent of the rates on file as of December 31, 2019.

    1. 1. Final reimbursement shall be 100 percent of allowable cost as calculated through the cost report settlement process.

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 and Hospitals, Bureau of Health Services Financing, LR 36:2042 (September 2010), amended LR 37:3266 (November 2011), LR 40:313 (February 2014), amended by the Department of Health, Bureau of Health Services Financing, LR 43:965 (May 2017), LR 43:2534 (December 2017), LR 44:2167 (December 2018), LR 45:1773 (December 2019).