1. A. A “638” facility shall provide preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished to outpatients by or under the direction of a:

   1. 1. physician;
   2. 2. dentist;
   3. 3. physician’s assistant;
   4. 4. psychologist or licensed counselor;
   5. 5. nurse practitioner, nurse midwife or clinical nurse specialist;
   6. 6. x-ray technician; or
   7. 7. pharmacist.

2. B. The facility shall furnish covered services as an “encounter”, which is defined as a face-to-face visit between a facility health professional and an eligible patient for the purpose of providing outpatient services. An encounter shall, at a minimum, consist of the following:

   1. 1. A detailed history (chief complaint, history of present illness, problem pertinent system review, pertinent past history/social);
   2. 2. A detailed exam (extended exam of the affected body area(s) and other symptomatic or related organ systems); and.
   3. 3. Low to moderate complexity of medical decision making based on the number of possible diagnoses/management options; the amount and complexity of medical records, diagnostic tests and other information to be reviewed; and the risk of complications, morbidity and/or mortality associated with the patient’s presenting problems.

3. C. The following services shall be provided on-site by the “638” facility and included as part of the encounter:

   1. 1. physician and mid-level practitioner services;
   2. 2. dental services;
   3. 3. psychological services;
   4. 4. prescription drugs services;
   5. 5. laboratory services;
   6. 6. x-ray services; and
   7. 7. nutrition services.

4. D. The facility may not bill an encounter rate if the only “services” performed were tasks incidental to services including, but not limited to:

   1. 1. taking blood pressure and temperature;
   2. 2. giving an injection;
   3. 3. changing dressings;
   4. 4. diagnostic procedures;
   5. 5. laboratory services such as EKG, Peak Flow, Spirometry Respiratory Flow Volume, Loop and injections; or
   6. 6. a referral for other services.

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, Office of the Secretary, Bureau of Health Services Financing, LR 31:2029 (August 2005).