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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2011
SENATE BILL NO. 207
BY SENATOR MOUNT
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID. Requires DHH to submit annual reports concerning the Coordinated Care
Network Medicaid initiative. (gov sig)
AN ACT1
To enact Part XLII of Chapter 5 of Title 40 of the Louisiana Revised Statutes of 1950, to be2
comprised of R.S. 40:1300.21 through 1300.22, relative to Medicaid; to require the3
Department of Health and Hospitals to submit an annual report to the legislature on4
the Coordinated Care Network Medicaid initiative; and to provide for related5
matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. Part XLII of Chapter 5 of Title 40 of the Louisiana Revised Statutes of8
1950, comprised of R.S. 40:1300.21 through 1300.22, is hereby enacted to read as follows:9
PART XLII. LOUISIANA MEDICAID COORDINATED CARE10
PROGRAM TRANSPARENCY11
§1300.21. Legislative intent12
It is in the best interest of the citizens of the state that the Legislature of13
Louisiana ensure that the Louisiana Medicaid program is operated in the most14
efficient and sustainable method possible. With the transition of over two-15
thirds of the Medicaid eligible population from a fee-for-service based program16
to a managed care organization based program, it is imperative that there is17 SB NO. 207
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
adequate reporting from the Department of Health and Hospitals in order to1
ensure the following outcomes are being achieved:2
(1) Improved care coordination with patient-centered medical homes for3
Medicaid recipients.4
(2) Improved health outcomes and quality of care as measured by metric,5
such as HEDIS.6
(3) Increased emphasis on disease prevention and the early diagnosis and7
management of chronic conditions.8
(4) Improved access to Medicaid services.9
(5) Improved accountability with a decrease in fraud, abuse, and10
wasteful spending.11
(6) A more financially sustainable Medicaid program.12
§1300.22. Coordinated care program; reporting13
Beginning October 1, 2013, and annually thereafter, the Department of14
Health and Hospitals shall submit an annual report concerning the Louisiana15
Medicaid Coordinated Care Program to the Senate and House committees on16
health and welfare which shall include, but not limited to, the following17
information:18
(1) The name of each coordinated care network which has contracted19
with the Department of Health and Hospitals.20
(2) The total number of health care professionals in each coordinated21
care network broken down by provider type and specialty.22
(3) The total and monthly average of the number of members enrolled23
in each network broken down by eligibility group.24
(4) The percentage of primary care practices that provide verified25
continuous phone access with the ability to speak with a primary care provider26
clinician within thirty minutes of member contact for each coordinated care27
network.28
(5) The percentage of regular and expedited service authorization29 SB NO. 207
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words in boldface type and underscored are additions.
requests processed within the timeframes specified by the contract for each1
coordinated care network.2
(6) The percentage of clean claims paid for each provider type within3
thirty calendar days and the average number of days to pay all claims for each4
coordinated care network.5
(7) The number of members who chose the coordinated care network6
and the number of members who were autoenrolled into each coordinated care7
network, broken down by coordinated care network.8
(8) The amount of the total payments and average per member per9
month payment paid to each coordinated care network.10
(9) The Medical Loss Ratio of each coordinated care network and the11
amount of any refund to the state for failure to maintain the required Medical12
Loss Ratio.13
(10) A comparison of the following health outcomes among each14
coordinated care network:15
(a) Adult asthma admission rate.16
(b) Congestive heart failure admission rate.17
(c) Uncontrolled diabetes admission rate.18
(d) Adult access to preventative/ambulatory health services.19
(e) Breast cancer screening rate.20
(f) Well child visits.21
(g) Childhood immunization rates.22
(11) A copy of the member and provider satisfaction survey report for23
each coordinate care network.24
(12) A copy of the annual audited financial statements for each25
coordinated care network.26
(13) The total amount of savings to the state for each shared savings27
coordinated care network.28
(14) A brief factual narrative of any sanctions levied by the Department29 SB NO. 207
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of Health and Hospitals against a coordinated care network.1
(15) The number of members, broken down by each coordinated care2
network, who file a grievance or appeal and the number of members who3
accessed the state fair hearing process and the total number and percentage of4
grievances or appeals which reversed or otherwise resolved in favor of the5
member.6
Section 2. This Act shall become effective upon signature by the governor or, if not7
signed by the governor, upon expiration of the time for bills to become law without signature8
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If9
vetoed by the governor and subsequently approved by the legislature, this Act shall become10
effective on the day following such approval.11
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Greg Waddell.
DIGEST
Proposed law requires that beginning October 1, 2013, and annually thereafter, the
Department of Health and Hospitals shall submit an annual report concerning the Louisiana
Medicaid Coordinated Care Program to the Senate and House committees on health and
welfare which shall include certain information as provided for in proposed law.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 40:1300.21 - 1300.22)