Review of Central Louisiana State Hospital's Hurricane-Related Uncompensated Care Claims

摘要

BACKGROUND. In response to Hurricane Katrina, section 6201 of the Deficit Reduction Act of 2005 authorized Federal funding for the total costs of medically necessary uncompensated care furnished to evacuees and affected individuals without other coverage in eligible States, i.e., States that provided care to such individuals in accordance with section 1115 projects. Pursuant to section 1115 of the Social Security Act, the Centers for Medicare & Medicaid Services (CMS) approved Louisianas request for demonstration authority related to Hurricanes Katrina and Rita. For Hurricane Katrina evacuees and affected individuals, CMS approved an uncompensated care pool to reimburse providers for medically necessary services provided to individuals without other coverage. CMS subsequently authorized the State to operate an uncompensated care pool for Hurricane Rita evacuees without other coverage. In approving the States uncompensated care pool plan (the UCCP plan), CMS authorized reimbursement for uncompensated care provided to Katrina evacuees and affected individuals from August 24, 2005, through January 31, 2006, and to Rita evacuees from September 23, 2005, through January 31, 2006. The pool was 100 percent federally funded. Before CMS approved the UCCP plan, Louisiana published an emergency regulation stating that reimbursement from the uncompensated care pool was available for specified services covered under the State Medicaid plan. In approving the UCCP plan, CMS specified that payment would be made in accordance with both the Medicaid plan and the UCCP plan and that expenditures above those limits were not reimbursable. The Medicaid plan limits inpatient psychiatric coverage for patients in institutions for mental diseases to those who are under the age of 21, and in some cases under the age of 22, as well as to those who are 65 years old or older. As of December 31, 2006, the Louisiana Department of Health and Hospitals (the State agency) reported $123.2 million in uncompensated care reimbursement to 834 health care providers. Central Louisiana State Hospital (the Hospital), an institution for mental diseases, received $3.7 million of this reimbursement. OBJECTIVE. Our objective was to determine whether the State agency claimed reimbursement for services provided by the Hospital in accordance with Federal and State laws and regulations and with the approved provisions of the UCCP plan.