HLS 12RS-2727 ORIGINAL
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Regular Session, 2012
HOUSE CONCURRENT RESOLUTI ON NO. 88
BY REPRESENTATIVE BARROW
MEDICAID: Authorizes and directs the Dept. of Health and Hospitals to cease its policy
of Medicaid provider payment delays
A CONCURRENT RESOLUTI ON1
To authorize and direct the Department of Health and Hospitals to discontinue its policy of2
Medicaid provider payment delays and to reinstate the Medicaid payment processing3
cycle in effect on June 30, 2011.4
WHEREAS, the Department of Health and Hospitals, referred to hereafter as5
"department", established a Medicaid provider payment policy for the present state fiscal6
year which extended by one week the period of time between claims submission by7
Medicaid providers and payment of those claims; and8
WHEREAS, under the current policy, the department pays Medicaid claims on a9
fourteen-day processing cycle; and10
WHEREAS, the stated purpose of the payment delay policy is to enable the11
department to better detect fraud and abuse by providers; and12
WHEREAS, certain in-home support providers presume that this policy is based on13
allegations of provider fraud by the department and assert that such allegations are14
unsubstantiated; and15
WHEREAS, in addition to the general Medicaid payment delays currently in effect,16
in-home support providers are subjected to a further three- to four-day payment delay17
resulting from a process termed "review of billing irregularities" by Statistical Resources,18
Incorporated (SRI), a contractor of the department; and19 HLS 12RS-2727 ORIGINAL
HCR NO. 88
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WHEREAS, with respect to fraud and abuse detection, there are several processes1
in place beyond the review of billing irregularities by SRI to which in-home support2
providers are subjected, which include the following:3
(1) Required quarterly self-monitoring by providers to validate that service delivery4
occurs in compliance with the patient's plan of care.5
(2) Licensing surveys conducted by the Health Standards Section of the department.6
(3) Comprehensive provider audits initiated by the office of program integrity of the7
department.8
(4) Periodic Payment Error Rate Measurement audits by the medical vendor9
administration unit of the department.10
(5) Claims review by Molina Medicaid Solutions, the Medicaid fiscal intermediary11
of the department.12
(6) Reviews to determine prior authorization for billing by the waiver units of the13
office of aging and adult services and the office for citizens with developmental disabilities14
of the department.15
(7) Supports Intensity Scale and Minimum Data Set assessments of level of service16
need administered by the office of aging and adult services and the office for citizens with17
developmental disabilities of the department.18
(8) Examination by the Surveillance and Utilization Review System of the Louisiana19
legislative auditor.20
(9) Examination by the Medicaid Fraud Control Unit of the United States21
Department of Justice; and22
WHEREAS, eighty-five to ninety percent of a typical in-home support provider's23
payroll is comprised of wages for direct support workers; and24
WHEREAS, the payment delay policy of the department currently in place is25
preventing providers from meeting their payroll obligations for services provided; and26
WHEREAS, failure by providers to meet payroll creates workforce instability which27
in turn jeopardizes the health and safety of service recipients; and28 HLS 12RS-2727 ORIGINAL
HCR NO. 88
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WHEREAS, many long-term care and New Opportunities Waiver providers are1
facing closure in the near term based on a Supported Living Network statewide survey of2
in-home support providers; and3
WHEREAS, a forced closure of providers would violate provisions of federal law4
(42 U.S.C. 1396 et seq.) which guarantee equal access to services by Medicaid enrollees.5
THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby6
authorize and direct the Department of Health and Hospitals to discontinue its policy of7
Medicaid provider payment delays and to reinstate the Medicaid payment processing cycle8
in effect on June 30, 2011.9
BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the10
secretary of the Department of Health and Hospitals.11
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Barrow HCR No. 88
Authorizes and directs the Dept. of Health and Hospitals to discontinue its policy of
Medicaid provider payment delays and to reinstate the Medicaid payment cycle in effect on
June 30, 2011.