La. Admin. Code tit. 40 § I-2505

Current through Register Vol. 50, No. 9, September 20, 2024
Section I-2505 - Hospital Inpatient Reimbursement
A. Reimbursement for inpatient hospital services will be limited to the lesser of covered billed charges or the per diem amount. The per diem rate assigned to the Standard Metropolitan Statistical Area in which the services are rendered will be applied to inpatient days by type of service, either medical or surgical.* The reimbursement amount will be reduced by charges for noncovered items and services.

NOTE: *The diagnosis/procedure code requiring the greatest resource consumption (severity) should be used to assign the correct category.

B. Using the following Per Diem Rate Schedule, the formula for calculating payment amount is:

Per Diem Rate x Inpatient Days = per Diem Amount

1. If billed charges per diem amount, pay per diem amount less noncovered charges.
2. If billed charges < per diem amount, pay billed charges less noncovered charges.

Per Diem Rate Schedule

SMSA*

Medical per Diem

Surgical per Diem

Alexandria

$1212

$1628

Baton Rouge

$1125

$2015

Houma-Thibodaux

$ 908

$1697

Lafayette

$1009

$1655

Lake Charles

$ 946

$1645

Monroe

$1050

$1654

New Orleans

$1186

$2059

Nonmetropolitan

$ 771

$1570

Shreveport

$1198

$1629

*Please refer to Exhibit I for listing of hospitals within each SMSA.

C. A provider formally approved by Medicare as a rural referral center will be recognized as such under these rules, and will be reimbursed under the same per diem rate as that of the SMSA assigned to the provider by the Medicare Geographic Classification Review Board.
D. Exhibit 1

Hospitals by Area

Alexandria

Bayou Rapides

Byrd Memorial

Rapides General

St. Frances Cabrini

Baton Rouge

Ascension Hospital

Baton Rouge General Medical

Lane Memorial

Medical Center of Baton Rouge

Our Lady of the Lake

Prevost Memorial Hospital

Riverview Medical Center

River West Medical Center

Seventh Ward Community

Westpark Community Hospital

Womans Hospital

Houma-Thibodaux

Lady of the Sea General

St. Anne General

Terrebonne General

Thibodaux Hospital

Lafayette

Doctors Hospital of Opelousas

Gary Memorial Hospital

Hamilton Medical Center

Lafayette General Hospital

Opelousas General Hospital

Our Lady of Lourdes

Womens and Childrens Hospital

Monroe

Glenwood Regional Medical Center

HCA North Monroe Hospital

Lincoln General

St. Francis Medical Center

St. Erlington Hospital

Lake Charles

Beauregard Memorial

Dequincy Memorial

Humana Hospital-Lake Charles

Lake Charles Memorial

St. Patrick Hospital

West Calcasieu-Cameron

Shreveport

Bossier Medical Center

Doctors Hospital

Highland Hospital

Humana Hospital-Springhill

LSU Medical Center

Minden Medical Hospital

North Caddo Memorial

Physicians and Surgeons

Riverside Community

Schumpert Hospital

Willis Knighton Medical

New Orleans

Childrens Hospital

De La Ronde Hospital

Doctors Hospital of Jefferson

East Jefferson General

Elmwood Medical Center

Eye, Ear, Nose and Throat

Highland Park Hospital

Hotel Dieu Hospital

Humana Hospital-New Orleans

Jo Ellen Smith/F. Edward Hebert

Lakeside Hospital

Meadowcrest Hospital

Mercy Hospital of New Orleans

New Orleans General

Northshore Regional Medical

Ochsner Foundation

Pendleton Memorial Methodist

River Parishes Hospital

Slidell Memorial

Southern Baptist Hospital

St. Charles Hospital

St. Charles Hospital/Luling

St. Jude Medical Center

St. Tammany Parish

Touro Infirmary

Tulane Medical Center

United Medical Center

West Jefferson Medical Center

Nonmetropolitan

Abbeville General

Abrom Kaplan Memorial

Acadia Saint Landry

Allen Parish

American Legion Hospital

Assumption General

Bienville General

Bogalusa Community

Bunkie General

Caldwell Memorial

Citizens Medical Center

Dauterive Hospital

Desoto General

East Carroll Parish

Franklin Foundation

Franklin Parish

Hardtner Medical Center

Homer Memorial

Hood Memorial

Humana Hospital-Marksville

Humana Hospital-Oakdale

Humana Hospital-Ville Platte

Humana Hospital-Winn Parish

Iberia General

Jackson Parish

Jennings American Legion

L.S. Huckabay Medical Memorial

Lakewood Hospital

Lasalle General

Madison Parish

Merryville General

Moosa Memorial Hospital

Morehouse General

Natchitoches Parish

Pointe Coupee General

Richland Parish- Delhi

Richland Parish-Rayville

Riverland Medical Center

Riverside Medical Center

Sabine Medical Center

Savoy Memorial Hospital

South Cameron Memorial

St. Helena Parish

St. James Parish

Tri Ward General

Union General

West Carroll Memorial

West Feliciana Parish

La. Admin. Code tit. 40, § I-2505

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994).
AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.