HLS 13RS-1018 REENGROSSED
Page 1 of 4
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2013
HOUSE BILL NO. 392
BY REPRESENTATIVES STUART BISHOP AND ANDERS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Provides relative to continuity of care for newborns enrolled in Medicaid
managed care
AN ACT1
To enact Part XI of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be2
comprised of R.S. 46:460.41 through 460.42, relative to the medical assistance3
program; to provide for managed care organizations which provide health care4
services to medical assistance program enrollees; to provide for payment for services5
rendered to newborns; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. Part XI of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950,8
comprised of R.S. 46:460.41 through 460.42, is hereby enacted to read as follows: 9
PART XI. CONTINUITY OF CARE FOR NEWBORNS ENROLLED IN 10
MEDICAID MANAGED CARE11
§460.41. Definitions12
As used in this Part, the following terms shall have the meaning ascribed to13
them in this Section unless the context clearly indicates otherwise:14
(1) "Department" means the Department of Health and Hospitals.15
(2) "Health care provider" or "provider" means a physician licensed to16
practice medicine by the Louisiana State Board of Medical Examiners or other17
individual health care practitioner licensed, certified, or registered to perform18
specified health care services consistent with state law.19 HLS 13RS-1018 REENGROSSED
HB NO. 392
Page 2 of 4
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
(3) "Managed care organization" shall have the same meaning as provided1
for that term in 42 CFR 438.2 and shall also mean any entity providing primary care2
case management services to Medicaid recipients pursuant to a contract with the3
department.4
(4) "Medicaid" and "medical assistance program" mean the medical5
assistance program provided for in Title XIX of the Social Security Act.6
§460.42. Claims payment for care rendered to newborns; reporting7
A. Each managed care organization shall compensate, at a minimum, the8
Medicaid fee-for-service rate in effect for the dates of service for all primary care9
services rendered to a newborn Medicaid beneficiary within thirty days of the10
beneficiary's birth regardless of whether the Medicaid provider rendering the11
services is contracted with the managed care organization.12
B. On or before January 1, 2014, and annually thereafter, the department13
shall report to the House and Senate committees on health and welfare the incidence14
and causes of all re-hospitalizations of infants born premature at less than15
thirty-seven weeks gestational age and who are within the first six months of life.16
Section 2. The Department of Health and Hospitals shall be prohibited from17
amending or otherwise altering any existing per member per month contractual rate of a18
managed care organization, as defined by this Act, that is in effect on the effective date of19
this Act for any purpose which is related to the implementation of the provisions of this Act.20
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)]
Stuart Bishop HB No. 392
Abstract: Provides relative to continuity of care for newborns enrolled in Medicaid
managed care.
Proposed law requires each Medicaid managed care organization which contracts with DHH
to compensate, at a minimum, the Medicaid fee-for-service rate in effect for the dates of
service for all primary care services rendered to a newborn Medicaid beneficiary within 30
days of the beneficiary's birth regardless of whether the Medicaid provider rendering the
services is contracted with the managed care organization. HLS 13RS-1018 REENGROSSED
HB NO. 392
Page 3 of 4
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Proposed law requires that on or before Jan. 1, 2014, and annually thereafter, DHH report
to the legislative committees on health and welfare the incidence and causes of all
re-hospitalizations of infants born premature at less than 37 weeks gestational age and who
are within the first six months of life.
Proposed law prohibits DHH from amending or otherwise altering any existing per member
per month contractual rate of a managed care organization in effect on the effective date of
proposed law for any purpose which is related to the implementation of proposed law.
(Adds R.S. 46:460.41-460.42)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill.
1. Added exemption from provisions of proposed law for any entity that contracts
with DHH to provide fiscal intermediary services in processing claims of health
care providers.
2. Deleted language providing that nothing in proposed law relative to provider
credentialing shall be construed to require a managed care organization
credentialing or approval in determining inclusion or participation in the
organization's contracted network.
3. Deleted a requirement that each CPT code listed on the approved Medicaid
fee-for-service fee schedule be considered payable by each Medicaid managed
care organization or a fiscal agent or intermediary of the organization. Added in
lieu thereof a requirement that all managed care organizations recognize in their
fee schedules all CPT codes which are included in the Medicaid fee-for-service
fee schedule.
4. Deleted a requirement that each managed care organization compensate, at a
minimum, the Medicaid fee-for-service rate in effect on the dates of service for
all care rendered to a newborn Medicaid beneficiary by a nonparticipating
Medicaid provider within 30 days of the beneficiary's birth. Added in lieu
thereof a requirement that each managed care organization compensate, at a
minimum, the Medicaid fee-for-service rate in effect for the dates of service for
all primary care services rendered to a newborn Medicaid beneficiary within 30
days of the beneficiary's birth regardless of whether the Medicaid provider
rendering the services is contracted with the managed care organization.
5. Added a requirement that on or before Jan. 1, 2014, and annually thereafter,
DHH report to the legislative committees on health and welfare the incidence and
causes of all re-hospitalizations of infants born premature at less than 37 weeks
gestational age and who are within the first six months of life.
6. Changed effective date of proposed law from date of signature by governor or
lapse of time for gubernatorial action to August 1, 2013.
7. Made technical changes.
House Floor Amendments to the engrossed bill.
1. Changed heading of new Part created by proposed law from "Medicaid Managed
Care Administrative Simplification" to "Continuity of Care for Newborns
Enrolled in Medicaid Managed Care". HLS 13RS-1018 REENGROSSED
HB NO. 392
Page 4 of 4
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
2. Deleted the following defined terms and their respective definitions from
proposed law: "applicant", "credentialing", "enrollee", "health care services",
"primary care case management", "secretary", "standardized information", and
"verification".
3. Deleted all provisions of proposed law relative to provider credentialing.
4. Deleted all provisions of proposed law relative to claim payment except for those
relative to payment for care rendered to newborns.
5. Added provision prohibiting DHH from amending or otherwise altering any
existing per member per month contractual rate of a managed care organization
in effect on the effective date of proposed law for any purpose which is related
to the implementation of proposed law.