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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 1300.23, 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; to provide for a sunset date; and5
to provide for related 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 1300.23, 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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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
A. Beginning January 1, 2013, and annually thereafter, the Department14
of 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 and geographic service area of each coordinated care19
network which has contracted with the Department of Health and Hospitals.20
(2) The total number of health care providers in each coordinated care21
network broken down by provider type and specialty and by each geographic22
service area.23
(3) The total and monthly average of the number of members enrolled24
in each network broken down by eligibility group.25
(4) The percentage of primary care practices that provide verified26
continuous phone access with the ability to speak with a primary care provider27
clinician within thirty minutes of member contact for each coordinated care28
network.29 SB NO. 207
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(5) The percentage of regular and expedited service authorization1
requests processed within the timeframes specified by the contract for each2
coordinated care network.3
(6) The percentage of clean claims paid for each provider type within4
thirty calendar days and the average number of days to pay all claims for each5
coordinated care network.6
(7) The number of claims denied by each coordinated care network for7
each the following reasons:8
(a) Lack of documentation to support medical necessity.9
(b) Prior authorization was not on file.10
(c) Member has other insurance that must be billed first.11
(d) Claim was submitted after the filing deadline.12
(e) Service was not covered by the coordinated care network.13
(8) The number and dollar value of all claims paid to non-network14
providers by claim type categorized by emergency services and non-emergency15
services for each coordinated care network by geographic service area.16
(9) The number of members who chose the coordinated care network17
and the number of members who were autoenrolled into each coordinated care18
network, broken down by coordinated care network.19
(10) The amount of the total payments and average per member per20
month payment paid to each coordinated care network.21
(11) The Medical Loss Ratio of each coordinated care network and the22
amount of any refund to the state for failure to maintain the required Medical23
Loss Ratio.24
(12) A comparison of, which includes but is not limited to, the following25
health outcomes among each coordinated care network:26
(a) Adult asthma admission rate.27
(b) Congestive heart failure admission rate.28
(c) Uncontrolled diabetes admission rate.29 SB NO. 207
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(d) Adult access to preventative/ambulatory health services.1
(e) Breast cancer screening rate.2
(f) Well child visits.3
(g) Childhood immunization rates.4
(13) A copy of the member and provider satisfaction survey report for5
each coordinated care network.6
(14) A copy of the annual audited financial statements for each7
coordinated care network.8
(15) The total amount of savings to the state for each shared savings9
coordinated care network.10
(16) A brief factual narrative of any sanctions levied by the Department11
of Health and Hospitals against a coordinated care network.12
(17) The number of members, broken down by each coordinated care13
network, who file a grievance or appeal and the number of members who14
accessed the state fair hearing process and the total number and percentage of15
grievances or appeals which reversed or otherwise resolved in favor of the16
member.17
(18) The number of members who receive unduplicated medicaid18
services from each coordinated care network broken down by provider type,19
specialty, and place of service.20
(19) The number of members who received unduplicated outpatient21
emergency services broken down by coordinated care network and aggregated22
by the following hospital classifications:23
(a) State.24
(b) Non-state non-rural.25
(c) Rural.26
(d) Private.27
(20) The number of total inpatient medicaid days broken down by28
Coordinated Care Network and aggregated by the following hospital29 SB NO. 207
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classifications:1
(a) State.2
(b) Public non-state non-rural.3
(c) Rural.4
(d) Private.5
(21) Any other metric or measure in which the Department of Health6
and Hospitals Coordinated Care Network Quality Committee deems7
appropriate for inclusion into the report.8
B. The Department of Health and Hospitals shall submit all quarterly9
reports required to be submitted by coordinated care networks to the Senate10
Committee on Health and Welfare, the House Committee on Health and11
Welfare, and the Senate Committee on Finance and House Committee on12
Appropriations.13
§1300.23. Sunset14
All portions of the Louisiana Medical Assistance Program which are15
administered by a managed care organization or meet the definition of managed16
care pursuant to federal law or regulation shall sunset on December 31, 2014.17
Section 2. This Act shall become effective upon signature by the governor or, if not18
signed by the governor, upon expiration of the time for bills to become law without signature19
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If20
vetoed by the governor and subsequently approved by the legislature, this Act shall become21
effective on the day following such approval.22
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Greg Waddell.
DIGEST
Mount (SB 207)
Proposed law requires that beginning January 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.
Proposed law requires DHH to submit all quarterly reports submitted by the coordinated care SB NO. 207
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networks to the Senate Committee on Health and Welfare, House Committee on Health and
Welfare, Senate Committee on Finance, and the House Committee on Appropriations.
Proposed law provides that any portion of the Louisiana Medical Assistance Program which
are administered by a managed care organization or meet the definition of managed care
pursuant to federal law or regulation shall sunset on December 31, 2014.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 40:1300.21 - 1300.23)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill.
1. Technical conforming amendments
2. Changes the reporting date from October 1, 2013, to January 1, 2013.
3. Adds additional metric or measures to be reported by the Department of
Health and Hospitals.
4. Provides for submission of certain reports received by DHH from CCN's to
certain legislative committees.
5. Provides that certain portions of the Louisiana Medical Assistance Program
shall sunset on December 31, 2014.