HLS 13RS-539 ORIGINAL
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Regular Session, 2013
HOUSE BILL NO. 233
BY REPRESENTATIVES SMITH, BARROW, WESLEY BISHOP, BROSSETT,
BURRELL, KATRINA JACKSON, JAMES, MORENO, AND PATRI CK
WILLIAMS AND SENATOR BROOME
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Provides that eligibility standards for the La. Medicaid program shall conform
to those established by the Affordable Care Act and requires reporting of program
outcomes
AN ACT1
To enact Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950, to be comprised2
of R.S. 46:979.1 through 979.5, relative to the medical assistance program; to3
provide for eligibility for benefits of the medical assistance program; to require state4
participation in the medical assistance program expansion provided in federal law;5
to provide for duties of the secretary of the Department of Health and Hospitals; to6
provide relative to the medical assistance program state plan; to authorize7
promulgation of rules; to require reports concerning the medical assistance program8
to the legislative committees on health and welfare and the governor; to specify the9
minimum required content of such reports; and to provide for related matters.10
Be it enacted by the Legislature of Louisiana:11
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,12
comprised of R.S. 46:979.1 through 979.5, is hereby enacted to read as follows: 13
CHAPTER 8-B. MEDICAL ASSISTANCE PROGRAM EXPANSI ON AND14
ENHANCED OUTCOMES REPORTI NG15
§979.1. Definitions16
As used in this Chapter, the following terms shall have the meaning ascribed17
to them in this Section:18 HLS 13RS-539 ORIGINAL
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(1) "ACA" and "Affordable Care Act" mean the following acts of congress,1
collectively:2
(a) The Patient Protection and Affordable Care Act, which originated as H.R.3
3590 in the One Hundred Eleventh United States Congress and became Public Law4
111-148.5
(b) The Health Care and Education Reconciliation Act, which originated as6
H.R. 4872 in the One Hundred Eleventh United States Congress and became Public7
Law 111-152.8
(2) "Department" means the Department of Health and Hospitals.9
(3) "Medicaid" and "medical assistance program" mean the medical10
assistance program provided for in Title XIX of the Social Security Act.11
(4) "Secretary" means the secretary of the Department of Health and12
Hospitals.13
§979.2. Legislative findings; declaration14
A. The Legislature of Louisiana does hereby find and declare the following:15
(1) The Affordable Care Act, referred to hereafter in this Chapter as the16
"ACA", sets forth health policy reforms which reshape the way virtually all17
Americans will receive and finance their health care.18
(2) In a decision announced on June 28, 2012, the Supreme Court of the19
United States in National Federation of Independent Business Et Al. v. Sebelius,20
Secretary of Health and Human Services, Et Al. upheld the overall constitutionality21
of the ACA; but in the same ruling, a majority of the court held that the mandatory22
expansion of Medicaid eligibility as provided in the ACA is unconstitutionally23
coercive of states, thereby making participation in the Medicaid expansion a24
voluntary proposition for each state.25
(3) At twenty-five percent of the federal poverty level, or just under five26
thousand eight hundred dollars in annual income for a family of four presently, the27
income eligibility threshold of this state for Medicaid benefits for parents of28
Medicaid-eligible children is the second-lowest in the nation.29 HLS 13RS-539 ORIGINAL
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(4) All of the following provisions of the ACA apply in states which1
participate in the Medicaid expansion:2
(a) The Medicaid income eligibility threshold increases to one hundred3
thirty-three percent of the federal poverty level, or thirty thousand seven hundred4
thirty-three dollars in annual income for a family of four presently, for all persons5
of ages nineteen to sixty-four beginning on January 1, 2014.6
(b) The federal share of funding for Medicaid benefits for persons who7
became eligible due to the expansion is one hundred percent from 2014 through8
2017.9
(c) The federal share of funding for Medicaid benefits for persons who10
became eligible due to the expansion phases down from one hundred percent to11
ninety percent between 2017 and 2020, with the federal share remaining at ninety12
percent in ensuing years.13
(5) Within federally provided guidelines, the secretary of the department14
may establish and modify eligibility standards for the Medicaid program through15
amendments to the Medicaid state plan and to administrative rules providing for16
operation of the program.17
(6) The legislature declares that due to compelling moral and economic18
reasons, participation in the expansion of Medicaid eligibility as provided in the19
ACA is in the best interest of this state.20
B. In a publication entitled "Louisiana Medicaid Annual Report", the21
department traditionally provides summary data on inputs (spending) and outputs22
(services delivered) of the Medicaid program; however, as evidenced in part by the23
final passage of Senate Bill No. 207 of the 2011 Regular Session of the Legislature24
and Senate Bill No. 629 of the 2012 Regular Session of the Legislature, the25
legislature intends that the department should undertake a more comprehensive and26
transparent effort to report actual health outcomes of the Medicaid program and27
program accountability measures, as such enhanced reporting would be essential to28
facilitation of a clearer understanding by policymakers and the general public of the29 HLS 13RS-539 ORIGINAL
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effectiveness of a program which would serve nearly forty percent of this state's1
population if expanded pursuant to the provisions of this Chapter.2
§979.3. Purposes3
The purposes of this state in expanding Medicaid eligibility to conform to the4
standards provided in the ACA, as required by this Chapter, are as follows:5
(1) To maximize the number of Louisianians who are covered by some form6
of health insurance.7
(2) To provide basic health coverage to the working poor of the state who8
are not offered insurance through their employer and do not earn enough money to9
meet basic family needs and pay for private health insurance.10
(3) To assure health care providers who serve low- to moderate-income11
persons of some amount of compensation for the care they provide, as the ACA12
provides for a dramatic reduction in funding to federal programs which currently13
finance care for the uninsured as a means of financing the Medicaid expansion.14
(4) To avert the economic and human costs of crises in both access to health15
care and health services financing which are likely to result from not participating16
in an expansion of a major federal program while other sources of financing for17
medical care for the uninsured and the indigent are being drastically reduced or18
eliminated.19
§979.4. Expansion of Medicaid eligibility; duties of the secretary of the Department20
of Health and Hospitals21
On or before September 1, 2013, the secretary of the department shall take22
all of the following actions:23
(1) File a Medicaid state plan amendment with the Centers for Medicare and24
Medicaid Services to provide that beginning on January 1, 2014, eligibility standards25
for medical assistance program benefits in Louisiana conform to the minimum26
eligibility standards as provided in the Patient Protection and Affordable Care Act27
(P.L. 111-148) and codified in federal regulations relative to medical assistance28
program coverage (42 CFR 435.119).29 HLS 13RS-539 ORIGINAL
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(2) Promulgate all rules and regulations in accordance with the1
Administrative Procedure Act as are necessary to implement the provisions of this2
Chapter.3
§979.5. Medicaid program outcomes; reporting requirements4
A. On or before July 1, 2014, and annually thereafter, the secretary of the5
department shall provide to the House and Senate committees on health and welfare6
and to the governor a written report covering the most recent one-year period which7
includes at minimum all of the items required hereafter in this Section.8
B. The secretary shall make the report provided for in this Section publicly9
available on its Internet website.10
C. The report shall include but shall not be limited to the following items:11
(1) Evaluation of overall health outcomes and quality of care for Medicaid12
enrollees of this state and recommendations for policy changes to improve such13
outcomes and quality of care. Measurements on which the secretary shall base the14
evaluation provided for in this Paragraph shall be derived from a metric which is15
generally accepted by public and private health care providers such as the Healthcare16
Effectiveness Data and Information Set (HEDIS).17
(2) Evaluation of major barriers to access to health care by Medicaid18
enrollees of this state and recommendations for policy changes to eliminate such19
barriers.20
(3) Summary of successful initiatives in this state for disease prevention and21
early diagnosis and management of chronic conditions among Medicaid enrollees of22
this state.23
(4) Trends in enrollment of health care providers in the Medicaid program24
of this state during the period covered by the report.25
(5) Major challenges faced by health care providers enrolled in the Medicaid26
program of this state and recommendations for policy changes to address such27
challenges.28 HLS 13RS-539 ORIGINAL
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(6) Impacts on health outcomes and health care costs in the state during the1
period covered by the report which resulted from participation by health care2
providers enrolled in the Medicaid program in any federal or state initiatives for3
coordinated care or patient-centered medical homes.4
(7) Such other information as the secretary deems appropriate to convey a5
clear and sufficiently complete assessment of the impact of the Medicaid program6
in this state.7
Section 2. This Act shall become effective upon signature by the governor or, if not8
signed by the governor, upon expiration of the time for bills to become law without signature9
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If10
vetoed by the governor and subsequently approved by the legislature, this Act shall become11
effective on the day following such approval.12
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)]
Smith HB No. 233
Abstract: Provides that eligibility standards for the La. Medicaid program shall conform
to those established by the Affordable Care Act and requires reporting of program
outcomes to the legislative committees on health and welfare and to the governor.
Proposed law requires the secretary of DHH to take such actions as are necessary to expand
Louisiana's Medicaid eligibility standards to conform to those established by the Affordable
Care Act (ACA) commencing on January 1, 2014. Provides that such actions by the
secretary shall include:
(1)On or before September 1, 2013, filing of the Medicaid state plan amendment
necessary to expand Medicaid eligibility in accordance with proposed law.
(2)On or before September 1, 2013, promulgating all rules and regulations as are
necessary to expand Medicaid eligibility in accordance with proposed law.
Proposed law declares that the purposes of the state in expanding Medicaid eligibility as
provided in proposed law are as follows:
(1)To maximize the number of Louisianians who are covered by some form of health
insurance.
(2)To provide basic health coverage to the working poor of the state who are not offered
insurance through their employer and do not earn enough money to meet basic
family needs and pay for private health insurance. HLS 13RS-539 ORIGINAL
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(3)To assure health care providers who serve low- to moderate-income persons of some
amount of compensation for the care they provide.
(4)To avert the economic and human costs of crises in both access to health care and
health services financing which are likely to result from not participating in an
expansion of a major federal program while other sources of financing for medical
care for the uninsured and the indigent are being drastically reduced or eliminated.
Proposed law requires that on or before July 1, 2014, and annually thereafter, the secretary
of DHH shall provide to the legislative committees on health and welfare and the governor
a written report covering the most recent one-year period which includes at minimum all of
the following items:
(1)Evaluation of overall health outcomes and quality of care for La. Medicaid enrollees,
and recommendations for policy changes to improve such outcomes and quality of
care. Requires that the secretary base such evaluation on measurements derived
from a metric which is generally accepted by public and private health care providers
such as the Healthcare Effectiveness Data and Information Set (HEDIS).
(2)Evaluation of major barriers to access to health care by La. Medicaid enrollees and
recommendations for policy changes to eliminate such barriers.
(3)Summary of successful initiatives in La. for disease prevention and early diagnosis
and management of chronic conditions among Medicaid enrollees.
(4)Trends in enrollment of health care providers in the La. Medicaid program during the
period covered by the report.
(5)Major challenges faced by health care providers enrolled in the La. Medicaid
program and recommendations for policy changes to address such challenges.
(6)Impacts on health outcomes and health care costs in La. during the period covered
by the report which resulted from participation by health care providers enrolled in
the Medicaid program in any federal or state initiatives for coordinated care or
patient-centered medical homes.
(7)Such other information as the secretary deems appropriate to convey a clear and
sufficiently complete assessment of the impact of the Medicaid program in La.
Proposed law requires DHH to make such report publicly available on its website.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.1-979.5)