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Regular Session, 2011 ENROLLED
SENATE BILL NO. 207
BY SENATOR MOUNT AND REPRESENTATIVES AUBERT, AUSTIN BADON,
BALDONE, BARROW, BROSSETT, BURRELL, CARMODY,
DANAHAY, DIXON, GISCLAIR, GUINN, HARDY, HARRISON,
HAZEL, HENSGENS, HINES, HUTTER, ROSALIND JONES,
LABRUZZO, LEBAS, LIGI, LORUSSO, NORTON, RICHARD,
SMILEY, ST. GERMAIN, STIAES AND WILLIAMS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
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 termination of5
legislative authority; and 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
adequate reporting from the Department of Health and Hospitals in order to18
ensure the following outcomes are being achieved:19
(1) Improved care coordination with patient-centered medical homes for20
Medicaid recipients.21
(2) Improved health outcomes and quality of care as measured by metric,22
such as HEDIS.23
(3) Increased emphasis on disease prevention and the early diagnosis and24 SB NO. 207 ENROLLED
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management of chronic conditions.1
(4) Improved access to Medicaid services.2
(5) Improved accountability with a decrease in fraud, abuse, and3
wasteful spending.4
(6) A more financially sustainable Medicaid program.5
§1300.22. Coordinated care program; reporting6
A. Beginning January 1, 2013, and annually thereafter, the Department7
of Health and Hospitals shall submit an annual report concerning the Louisiana8
Medicaid Coordinated Care Program to the Senate and House committees on9
health and welfare which shall include but not be limited to the following10
information:11
(1) The name and geographic service area of each coordinated care12
network which has contracted with the Department of Health and Hospitals.13
(2) The total number of health care providers in each coordinated care14
network broken down by provider type and specialty and by each geographic15
service area.16
(3) The total and monthly average of the number of members enrolled17
in each network broken down by eligibility group.18
(4) The percentage of primary care practices that provide verified19
continuous phone access with the ability to speak with a primary care provider20
clinician within thirty minutes of member contact for each coordinated care21
network.22
(5) The percentage of regular and expedited service authorization23
requests processed within the timeframes specified by the contract for each24
coordinated care network.25
(6) The percentage of clean claims paid for each provider type within26
thirty calendar days and the average number of days to pay all claims for each27
coordinated care network.28
(7) The number of claims denied or reduced by each coordinated care29
network for each of the following reasons:30 SB NO. 207 ENROLLED
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(a) Lack of documentation to support medical necessity.1
(b) Prior authorization was not on file.2
(c) Member has other insurance that must be billed first.3
(d) Claim was submitted after the filing deadline.4
(e) Service was not covered by the coordinated care network.5
(f) Due to process, procedure, notification, referrals, or any other6
required administrative function of a coordinated care network.7
(8) The number and dollar value of all claims paid to non-network8
providers by claim type categorized by emergency services and non-emergency9
services for each coordinated care network by geographic service area.10
(9) The number of members who chose the coordinated care network11
and the number of members who were autoenrolled into each coordinated care12
network, broken down by coordinated care network.13
(10) The amount of the total payments and average per member per14
month payment paid to each coordinated care network.15
(11) The Medical Loss Ratio of each coordinated care network and the16
amount of any refund to the state for failure to maintain the required Medical17
Loss Ratio.18
(12) A comparison of health outcomes, which includes but is not limited19
to the following outcomes among each coordinated care network:20
(a) Adult asthma admission rate.21
(b) Congestive heart failure admission rate.22
(c) Uncontrolled diabetes admission rate.23
(d) Adult access to preventative/ambulatory health services.24
(e) Breast cancer screening rate.25
(f) Well child visits.26
(g) Childhood immunization rates.27
(13) A copy of the member and provider satisfaction survey report for28
each coordinated care network.29
(14) A copy of the annual audited financial statements for each30 SB NO. 207 ENROLLED
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coordinated care network.1
(15) The total amount of savings to the state for each shared savings2
coordinated care network.3
(16) A brief factual narrative of any sanctions levied by the Department4
of Health and Hospitals against a coordinated care network.5
(17) The number of members, broken down by each coordinated care6
network, who file a grievance or appeal and the number of members who7
accessed the state fair hearing process and the total number and percentage of8
grievances or appeals which reversed or otherwise resolved in favor of the9
member.10
(18) The number of members who receive unduplicated medicaid11
services from each coordinated care network broken down by provider type,12
specialty, and place of service.13
(19) The number of members who received unduplicated outpatient14
emergency services broken down by coordinated care network and aggregated15
by the following hospital classifications:16
(a) State.17
(b) Non-state non-rural.18
(c) Rural.19
(d) Private.20
(20) The number of total inpatient medicaid days broken down by21
Coordinated Care Network and aggregated by the following hospital22
classifications:23
(a) State.24
(b) Public non-state non-rural.25
(c) Rural.26
(d) Private.27
(21) Any other metric or measure in which the Department of Health28
and Hospitals Coordinated Care Network Quality Committee deems29
appropriate for inclusion into the report.30 SB NO. 207 ENROLLED
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B. The Department of Health and Hospitals shall submit all quarterly1
reports required to be submitted by coordinated care networks to the Senate2
Committee on Health and Welfare, the House Committee on Health and3
Welfare, and the Senate Committee on Finance and House Committee on4
Appropriations.5
§1300.23. Sunset6
All authority for that portion of the Louisiana Medical Assistance7
Program which is administered by a coordinated care program, or meets the8
definition of managed care pursuant to federal law or regulation, excluding9
those portions which provide for behavioral health services, shall hereby10
terminate on December 31, 2014. After that date, the department shall11
administer the services encompassed by the portion terminated herein12
according to rules and regulations promulgated prior to the establishment of13
the coordinated care program within the Louisiana Medical Assistance14
Program.15
Section 2. This Act shall become effective upon signature by the governor or, if not16
signed by the governor, upon expiration of the time for bills to become law without signature17
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If18
vetoed by the governor and subsequently approved by the legislature, this Act shall become19
effective on the day following such approval.20
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: