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Regular Session, 2013
HOUSE BILL NO. 233
BY REPRESENTATIVES SMITH, BADON, 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: Creates the La. Health Care Independence Program
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 979.6, 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 definitions; to provide for legislative findings and intent; to provide6
for reform of the Medicaid program in Louisiana; to provide for termination; and to7
provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,10
comprised of R.S. 46:979.1 through 979.6, is hereby enacted to read as follows: 11
CHAPTER 8-B. LOUISIANA HEALTH CARE INDEPENDENCE PROGRAM12
§979.1. Title13
This Chapter shall be known and may be cited as the "Louisiana Health Care14
Independence Act".15
§979.2. Definitions16
As used in this Chapter, the following terms shall have the meaning ascribed17
to them in this Section:18 HLS 13RS-539 ENGROSSED
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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) "Cost sharing" means the portion of the cost of a covered medical service9
that must be paid by or on behalf of eligible individuals, consisting of copayments10
or coinsurance, but not deductibles.11
(3) "Department" means the Department of Health and Hospitals.12
(4) "Health insurance marketplace" means the federal vehicle created to help13
individuals, families, and small businesses shop for and select health insurance14
coverage in a way that permits comparison of available qualified health plans based15
upon price, benefits, services, and quality, regardless of the governance structure of16
the marketplace.17
(5) "Independence account" means individual financing structures that18
operate similar to a health savings account or a medical savings account.19
(6) "Medicaid" and "medical assistance program" mean the medical20
assistance program provided for in Title XIX of the Social Security Act.21
(7) "Premium" means a charge that must be paid as a condition of enrolling22
in health care coverage.23
(8) "Program" means the Louisiana Health Care Independence Program24
established by this Chapter.25
(9) "Qualified health plan" means a federally certified individual health26
insurance plan offered by a carrier through the federal health insurance marketplace.27
(10) "Secretary" means the secretary of the Department of Health and28
Hospitals.29 HLS 13RS-539 ENGROSSED
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§979.3. Legislative findings; purpose1
A. The Legislature of Louisiana does hereby find and declare the following:2
(1) The Affordable Care Act, referred to hereafter in this Chapter as the3
"ACA", sets forth health policy reforms which reshape the way virtually all4
Americans will receive and finance their health care.5
(2) In a decision announced on June 28, 2012, the Supreme Court of the6
United States in National Federation of Independent Business Et Al. v. Sebelius,7
Secretary of Health and Human Services, Et Al. upheld the overall constitutionality8
of the ACA; but in the same ruling, a majority of the court held that the mandatory9
expansion of Medicaid eligibility as provided in the ACA is unconstitutionally10
coercive of states, thereby making participation in the Medicaid expansion a11
voluntary proposition for each state.12
(3) At twenty-five percent of the federal poverty level, or just under five13
thousand eight hundred dollars in annual income for a family of four presently, the14
income eligibility threshold of this state for Medicaid benefits for parents of15
Medicaid-eligible children is the second-lowest in the nation.16
(4) The legislature declares that due to compelling moral and economic17
reasons, participation in the expansion of Medicaid eligibility as provided in the18
ACA is in the best interest of this state.19
B. The purposes of this state in expanding Medicaid eligibility to conform20
to the standards provided in the ACA, as required by this Chapter, are as follows:21
(1) To maximize the number of Louisianians who are covered by some form22
of health insurance.23
(2) To provide basic health coverage to the working poor of the state who24
are not offered insurance through their employer and do not earn enough money to25
meet basic family needs and pay for private health insurance.26
(3) To assure health care providers who serve low- to moderate-income27
persons of some amount of compensation for the care they provide, as the ACA28 HLS 13RS-539 ENGROSSED
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provides for a dramatic reduction in funding to federal programs which currently1
finance care for the uninsured as a means of financing the Medicaid expansion.2
(4) To avert the economic and human costs of crises in both access to health3
care and health services financing which are likely to result from not participating4
in an expansion of a major federal program while other sources of financing for5
medical care for the uninsured and the indigent are being drastically reduced or6
eliminated.7
§979.4. Expansion of Medicaid eligibility in Louisiana; administration of the8
Louisiana Health Care Independence Program by the Department of Health9
and Hospitals10
A. The department shall create and administer the Louisiana Health Care11
Independence Program within the department. After receiving the approval of the12
Senate and House committees on health and welfare, the department shall on or13
before September 1, 2013, submit and apply for all of the following:14
(1) Federal waivers necessary to implement the program in a manner15
consistent with this Chapter, including without limitation approval for a16
comprehensive waiver under Section 1115 of the Social Security Act, 42 U.S.C.17
1315.18
(2) Medicaid state plan amendments necessary to implement the program in19
a manner consistent with this Chapter.20
(3) Those Medicaid state plan amendments that are optional and therefore21
may be revoked by the state at its discretion.22
B.(1) As part of its actions, the department shall confirm that employers shall23
not be subject to the penalties, including without limitation an assessable payment,24
under Section 1513 of Pub. L. No. 111-148, as existing on January 1, 2013,25
concerning shared responsibility, for employees who are eligible individuals if the26
employees meet either of the following criteria:27
(a) Are enrolled in the program.28 HLS 13RS-539 ENGROSSED
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(b) Enroll in a qualified health plan through the federal health insurance1
marketplace.2
(2) If the department is unable to confirm provisions under this Section, the3
program shall not be implemented.4
C.(1) Implementation of the program shall be contingent upon the receipt of5
necessary federal approvals.6
(2) If the department does not receive the necessary federal approvals, the7
program shall not be implemented.8
D. The program shall include premium assistance for eligible individuals to9
enable their enrollment in a qualified health plan through the federal health insurance10
marketplace.11
E.(1) The department is hereby specifically authorized to pay premiums and12
supplemental cost-sharing subsidies directly to the federally qualified health plans13
for enrolled eligible individuals.14
(2) The intent of the payments under this Subsection is to increase15
participation in the health insurance market, intensify price pressures, and reduce16
costs for both publicly and privately funded health care.17
F. The department shall accomplish all of the following to the extent18
allowable by law:19
(1) Pursue strategies that promote insurance coverage of children in their20
parents' or caregivers' plan, including children eligible for the Louisiana Children's21
Health Insurance Program (LaCHIP).22
(2) Develop and implement a strategy to inform Medicaid recipient23
populations whose needs would be reduced or better served through participation in24
the federal health insurance marketplace.25
G. The program authorized by this Chapter shall terminate within one26
hundred twenty days after a reduction in any of the following federal medical27
assistance percentages for services to individuals determined eligible under the new28 HLS 13RS-539 ENGROSSED
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adult group and who are considered to be newly eligible as defined in section1
1905(y)(2)(A) of the Patient Protection and Affordable Care Act:2
(1) One hundred percent in 2014, 2015, or 2016.3
(2) Ninety-five percent in 2017.4
(3) Ninety-four percent in 2018.5
(4) Ninety-three percent in 2019.6
(5) Ninety percent in 2020 or any year after 2020.7
H. An eligible individual enrolled in the program shall affirmatively8
acknowledge the existence of all of the following facts:9
(1) The program shall not be a perpetual federal or state right or a guaranteed10
entitlement.11
(2) The program shall be subject to cancellation upon appropriate notice.12
(3) The program shall not be an entitlement program.13
I.(1) The department shall develop a model and seek from the Centers for14
Medicare and Medicaid Services all necessary waivers and approvals to allow15
non-aged, non-disabled program-eligible participants to enroll in a program that shall16
create and utilize independence accounts that operate similar to a health savings17
account or medical savings account during the calendar year 2015.18
(2) The independence accounts shall accomplish all of the following19
functions:20
(a) Allow a participant to purchase cost-effective high-deductible health21
insurance.22
(b) Promote independence and self-sufficiency.23
(3) The state shall implement cost sharing and copayments, and establish as24
a condition of participation that earnings shall exceed fifty percent of the applicable25
federal poverty level.26
(4) Participants may receive rewards based on healthy living and27
self-sufficiency.28 HLS 13RS-539 ENGROSSED
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(5)(a) At the end of each fiscal year, if there are funds remaining in the1
account, a majority of the state's contribution shall remain in the participant's control2
as a positive incentive for the responsible use of the health care system and personal3
responsibility of health maintenance.4
(b) Uses of the funds may include, without limitation, rolling the funds into5
a private sector health savings account for the participant according to rules6
promulgated by the department.7
(c) The department shall promulgate rules to implement this Section in8
accordance with the Administrative Procedure Act, and shall project, track, and9
report state obligations for uncompensated care to identify potential incremental10
future decreases.11
(d) The department shall recommend appropriate adjustments in funding to12
the legislature.13
(e) Adjustments shall be made by the legislature as appropriate.14
J. On a quarterly basis, the department shall report to the Joint Legislative15
Committee on the Budget, within two weeks of the end of each quarter, information16
regarding the following aspects of the program:17
(1) Program enrollment.18
(2) Patient experience.19
(3) Economic impact including enrollment distribution.20
(4) Carrier competition.21
(5) Success in avoiding uncompensated care.22
§979.5. Medicaid program outcomes; reporting requirements23
A. On or before July 1, 2014, and annually thereafter, the secretary of the24
department shall provide to the House and Senate committees on health and welfare25
and to the governor a written report covering the most recent one-year period which26
includes at minimum all of the items required hereafter in this Section.27
B. The secretary shall make the report provided for in this Section publicly28
available on its Internet website.29 HLS 13RS-539 ENGROSSED
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C. The report shall include but shall not be limited to the following items:1
(1) Evaluation of overall health outcomes and quality of care for Medicaid2
enrollees of this state and recommendations for policy changes to improve such3
outcomes and quality of care. Measurements on which the secretary shall base the4
evaluation provided for in this Paragraph shall be derived from a metric which is5
generally accepted by public and private health care providers such as the Healthcare6
Effectiveness Data and Information Set (HEDIS).7
(2) Evaluation of major barriers to access to health care by Medicaid8
enrollees of this state and recommendations for policy changes to eliminate such9
barriers.10
(3) Summary of successful initiatives in this state for disease prevention and11
early diagnosis and management of chronic conditions among Medicaid enrollees of12
this state.13
(4) Trends in enrollment of health care providers in the Medicaid program14
of this state during the period covered by the report.15
(5) Major challenges faced by health care providers enrolled in the Medicaid16
program of this state and recommendations for policy changes to address such17
challenges.18
(6) Impacts on health outcomes and health care costs in the state during the19
period covered by the report which resulted from participation by health care20
providers enrolled in the Medicaid program in any federal or state initiatives for21
coordinated care or patient-centered medical homes.22
(7) Such other information as the secretary deems appropriate to convey a23
clear and sufficiently complete assessment of the impact of the Medicaid program24
in this state.25
§979.6. Termination26
The provisions of this Chapter shall terminate and become null and void on27
and after July 1, 2017.28 HLS 13RS-539 ENGROSSED
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Section 2. This Act shall become effective upon signature by the governor or, if not1
signed by the governor, upon expiration of the time for bills to become law without signature2
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If3
vetoed by the governor and subsequently approved by the legislature, this Act shall become4
effective on the day following such approval.5
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: Creates the La. Health Care Independence Program within the La. Medicaid
program and requires reporting of Medicaid program outcomes to the legislative
committees on health and welfare and to the governor.
Proposed law creates the Louisiana Health Care Independence Program, referred to hereafter
as the "program", to be comprised of all of the following components and functions, and
subject to conditions as follows:
(1)On or before Sept. 1, 2013, and after receiving the approval of the legislative
committees on health and welfare, DHH shall submit and apply for federal waivers
necessary to implement the program in a manner consistent with proposed law,
including without limitation approval for a comprehensive waiver under Section
1115 of the Social Security Act.
(2)DHH shall confirm that employers will not be subject to the penalties, including
without limitation an assessable payment, under Section 1513 of Pub. L. No.
111-148, as existing on Jan. 1, 2013, concerning shared responsibility, for employees
who are eligible individuals if the employees are enrolled in the program and enroll
in a qualified health plan through the federal health insurance marketplace.
(3)Implementation of the program shall be contingent upon the receipt of necessary
federal approvals.
(4)The program shall include premium assistance for eligible individuals to enable their
enrollment in a qualified health plan through the federal health insurance
marketplace.
(5)DHH is authorized to pay premiums and supplemental cost-sharing subsidies directly
to the federally qualified health plans for enrolled eligible individuals.
(6)DHH is required to pursue strategies that promote insurance coverage of children in
their parents' or caregivers' plan, including children eligible for the Louisiana
Children's Health Insurance Program (LaCHIP); and to develop and implement a
strategy to inform Medicaid recipient populations whose needs would be reduced or
better served through participation in the federal health insurance marketplace. HLS 13RS-539 ENGROSSED
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(7)The program shall terminate within 120 days after a reduction in any enhanced
federal medical assistance percentages for services to newly eligible individuals as
defined in the Patient Protection and Affordable Care Act.
(8)Program enrollees shall affirmatively acknowledge that the program is not a
perpetual federal or state right or a guaranteed entitlement, is subject to cancellation
with notice, and is not an entitlement program.
(9)DHH shall develop a model and seek from the Centers for Medicare and Medicaid
Services all necessary waivers and approvals to allow non-aged, non-disabled
program-eligible participants to enroll in a program that creates and utilizes for
specified purposes "independence accounts" that operate similar to health savings
accounts or medical savings accounts during the calendar year 2015.
(10)DHH is required to report to the Joint Legislative Committee on the Budget on a
quarterly basis, and within two weeks of the end of each quarter, information
regarding program enrollment, patient experience, economic impact, carrier
competition, and success in avoiding uncompensated care.
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.
Proposed law terminates and becomes null and void on and after July 1, 2017.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.1-979.6) HLS 13RS-539 ENGROSSED
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Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill.
1. Deleted provisions requiring 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 Jan. 1,
2014. Added in lieu thereof provisions creating the Louisiana Health Care
Independence Program, referred to hereafter as the "program", to be comprised
of all of the following components and functions, and subject to conditions as
follows:
(a)On or before Sept. 1, 2013, and after receiving the approval of the
legislative committees on health and welfare, DHH shall submit and
apply for federal waivers necessary to implement the program in a
manner consistent with proposed law, including without limitation
approval for a comprehensive waiver under Section 1115 of the Social
Security Act.
(b)DHH shall confirm that employers will not be subject to the penalties,
including without limitation an assessable payment, under Section 1513
of Pub. L. No. 111-148, as existing on Jan. 1, 2013, concerning shared
responsibility, for employees who are eligible individuals if the
employees are enrolled in the program and enroll in a qualified health
plan through the federal health insurance marketplace.
(c)Implementation of the program shall be contingent upon the receipt of
necessary federal approvals.
(d)The program shall include premium assistance for eligible individuals to
enable their enrollment in a qualified health plan through the federal
health insurance marketplace.
(e)DHH is authorized to pay premiums and supplemental cost-sharing
subsidies directly to the federally qualified health plans for enrolled
eligible individuals.
(f)DHH is required to pursue strategies that promote insurance coverage of
children in their parents' or caregivers' plan, including children eligible
for the Louisiana Children's Health Insurance Program (LaCHIP); and to
develop and implement a strategy to inform Medicaid recipient
populations whose needs would be reduced or better served through
participation in the federal health insurance marketplace.
(g)The program shall terminate within 120 days after a reduction in any
enhanced federal medical assistance percentages for services to newly
eligible individuals as defined in the Patient Protection and Affordable
Care Act.
(h)Program enrollees shall affirmatively acknowledge that the program is
not a perpetual federal or state right or a guaranteed entitlement, is
subject to cancellation with notice, and is not an entitlement program.
(i)DHH shall develop a model and seek from the Centers for Medicare and
Medicaid Services all necessary waivers and approvals to allow
non-aged, non-disabled, program-eligible participants to enroll in a
program that creates and utilizes for specified purposes "independence HLS 13RS-539 ENGROSSED
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accounts" that operate similar to health savings accounts or medical
savings accounts during the calendar year 2015.
(j)DHH is required to report to the Joint Legislative Committee on the
Budget on a quarterly basis, and within two weeks of the end of each
quarter, information regarding program enrollment, patient experience,
economic impact, carrier competition, and success in avoiding
uncompensated care.
(k)All provisions authorizing and providing for the program shall terminate
and become null and void on and after July 1, 2017.