LAC 50:V.965. Hemophilia Blood Products

A. Effective for dates of service on or after July 1, 2015, the Department of Health and Hospitals shall provide additional reimbursements to certain non-rural, non-state acute care hospitals for the extraordinary costs incurred in purchasing blood products for certain Medicaid recipients diagnosed with, and receiving inpatient treatment for hemophilia. B. Hospital Qualifications. To qualify for the additional reimbursement, the hospital must: 1. be classified as a major teaching hospital and contractually affiliated with a university located in Louisiana that is recognized by the Centers for Disease Control and Prevention and the Health Resource and Services Administration, Maternal and Child Health Bureau as maintaining a comprehensive hemophilia care center; 2. have provided clotting factors to a Medicaid recipient who: a. has been diagnosed with hemophilia or other rare bleeding disorders for which the use of one or more clotting factors is Food and Drug Administration (FDA) approved; and b. has been hospitalized at the qualifying hospital for a period exceeding six days; and 3. have actual cost exceeding $50,000 for acquiring the blood products used in the provision of clotting factors during the hospitalization; a. actual cost is the hospital's cost of acquiring blood products for the approved inpatient hospital dates of service as contained on the hospital’s original invoices, less all discount and rebate programs applicable to the invoiced products. C. Reimbursement. Hospitals who meet the qualifications in §965.B may receive reimbursement for their actual costs that exceed $50,000 if the hospital submits a request for reimbursement to the Medicaid Program within 180 days of the patient’s discharge from the hospital. 1. The request for reimbursement shall be submitted in a format specified by the department.