1. A. The department or its fiscal intermediary shall make monthly capitation payments to the MCOs. The capitation rates paid to the MCOs shall be actuarially sound rates and the MCOs will determine the rates paid to its contracted providers. No payment shall be less than the minimum Medicaid rate.

   1. 1. Reimbursement for covered TGH services shall be inclusive of, but not limited to:

      1. a. allowable cost of clinical and related services;
      2. b. psychiatric support services;
      3. c. allowable cost of integration with community resources; and
      4. d. skill-building services provided by unlicensed practitioners.
   2. 2. Allowable and non-allowable costs components, as defined by the department.
2. B. All in-state Medicaid participating TGH providers are required to file an annual Medicaid cost report according to the department’s specifications and departmental guides and manuals.

3. C. Costs reports must be submitted annually. The due date for filing annual cost reports is the last day of the fifth month following the facility’s fiscal year end. Separate cost reports must be filed for the facilities central/home office when costs of that entity are reported on the facilities cost report. If the facility experiences unavoidable difficulties in preparing the cost report by the prescribed due date, a filing extension may be requested. A filing extension must be submitted to Medicaid prior to the cost report due date.

   1. 1. Facilities filing a reasonable extension request will be granted an additional 30 days to file their cost report.
4. D. Services provided by psychologists and licensed mental health practitioners shall be billed to the MCO or CSoC contractor separately.

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 38:429 (February 2012), amended by the Department of Health and Hospitals, Bureau of Health Services Financing and the Office of Behavioral Health, LR 41:2372 (November 2015), amended by the Department of Health, Bureau of Health Services Financing and the Office of Behavioral Health, LR 44:1904 (October 2018).