La. Admin. Code tit. 48 § V-6701
Current through Register Vol. 50, No. 11, November 20, 2024
A. Insurance carriers shall be charged by the program for special formulas required for children with PKU and Maple Syrup Urine Disease (MSUD) which are dispensed by OPPHS and for clinic visits at regional genetics clinics.B. Cost for special formula is determined by actual charges made to OPPHS by the formula manufacturers plus a 25 percent fee for dispensing, shipping and delivery by OPPHS. As an example, the prices for the distribution of the three types of formulas, as of January 1, 1985, are listed below. Type of Formula | Quantity | Cost |
Phenyl-Free | 1 Case (6 cans) | $280.13 |
Lofenalac | 1 Case (6 cans) | $208.35 |
MSUD | 1 Case (6 cans) | $221.78 |
C. The cost for a clinic visit depends on the type of service rendered by the attending medical geneticist. The medical geneticist shall base his cost on the type of service level in accordance with the definitions found in the Physician's Current Procedural Terminology Fourth Edition 1985 published by the American Medical Association and copyrighted 1984.D. The prices associated with these levels of service are derived from average prices identified through a nationwide survey conducted by the Genetic Services Committee of the American Society of Human Genetics and found in their report of 1983, Report on Costs and Payment for Genetic Services. The FY'86 DHHR annual economic indicator index for medical care is included in the prices which appear below: 1. First Clinic Visit For Genetic Evaluation and Counseling-Fee Charged: Limited | $49 |
Intermediate | $69 |
Comprehensive | $102 |
Complex | $128 |
2. Clinic Visit After Initial For Genetic Evaluation and Counseling-Fee Charged: Limited | $27 |
Intermediate | $38 |
Extended | $62 |
Comprehensive | $69 |
Complex | $113 |
3. Genetic Counseling Only By A Medical Geneticist, Initial Or After Initial visit-Fee Charged: E. Fees charged may vary, subject to changes in the indicators mentioned above.F. A clinic visit is defined as a medical genetic evaluation and counseling session conducted by the medical geneticist with the index patient and his/her family members.G. A charge for one service rendered to the index patient would be made to the third party payor. In cases where extended families are provided genetic counseling and two index patients are identified by the geneticist, one service charge will be made for each index patient.La. Admin. Code tit. 48, § V-6701
Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, LR 13:246 (April 1987).AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1299.