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.
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".
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.