This subpart establishes a Medicaid supplemental payment program for government-owned or quasi-governmental behavioral health providers in Louisiana, effective January 20, 2013. Eligible providers must be state-licensed, enrolled as Medicaid providers, and furnish one or more of the listed behavioral health service types. Supplemental payments are calculated quarterly by applying a Medicare-to-community-rate conversion factor to bring Medicaid reimbursement up to commercial payer rate levels. Providers must periodically submit data to support the community rate calculation.
View official sourceSubpart 17. Supplemental Payments Chapter 161.General Provisions §16101.Qualifying Criteria A.Effective for dates of service on or after January 20, 2013, providers of behavioral health services may qualify for supplemental payments for services rendered to Medicaid recipients. To qualify for the supplemental payment, the behavioral health provider must be: 1.licensed as necessary by the state of Louisiana; 2.enrolled as a Medicaid provider; and 3.a government-owned and operated entity or a quasi-governmental entity. B.Providers of the following services shall be eligible to receive supplemental payments: 1.providers furnishing services thru a statewide management organization; 2.children’s mental health services; 3.behavioral health services; 4.home and community-based waiver services; 5.psychiatric residential treatment facility services; 6.therapeutic group home services; 7.substance abuse services; and 8.local government juvenile justice programs. 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, Bureau of Health Services Financing and the Office of Behavioral Health, LR 40:1529 (August 2014). §16103.Payment Methodology A.The supplemental payment shall be calculated in a manner that will bring payments for these services up to the community rate level. 1.For purposes of these provisions, the community rate shall be defined as the rates paid by commercial payers for the same service. B.The behavioral health provider shall periodically furnish satisfactory data for calculating the community rate as requested by the department. C.The supplemental payment amount shall be determined by establishing a Medicare to community rate conversion factor for the behavioral health provider. At the end of each quarter, for each Medicaid claim paid during the quarter, a Medicare payment amount will be calculated and the Medicare to community rate conversion factor will be applied to the result. Medicaid payments made for the claims paid during the quarter will then be subtracted from this amount to establish the supplemental payment amount for that quarter. 1.The Medicare to community rate conversion factor shall be recalculated at least every three years. D.The supplemental payments shall be made on a quarterly basis. 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, Bureau of Health Services Financing and the Office of Behavioral Health, LR 40:1530 (August 2014).