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Prepared by Christopher D. Adams.
S. Bishop HB No. 392
(KEYWORD, SUMMARY, AND DIGEST as amended by Senate committee
amendments)
MEDICAID. Provides relative to continuity of care for newborns enrolled in Medicaid
managed care
DIGEST
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
provided, however, monthly capitation rates offered to managed care organizations continue
to be actuarially sound and consistent with requirements set forth in 42 CFR 438.6(c).
(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. Page 2 of 2
Prepared by Christopher D. Adams.
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.
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to the
reengrossed bill
1. Adds to the 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 to add that the monthly capitation rates
offered to managed care organizations continue to be actuarially sound and
consistent with requirements set forth in federal regulations.