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Regular Session, 2013
HOUSE BILL NO. 532
BY REPRESENTATIVES KLECKLEY, ADAMS, ARMES, BARROW, BERTHELOT,
BILLIOT, WESLEY BISHOP, BROSSETT, BROWN, BURRELL, CARMODY,
CARTER, CHANEY, COX, CROMER, DI XON, DOVE, GUI LLORY,
HARRISON, HOFFMANN, HUNTER, KATRINA JACKSON, JAMES,
JEFFERSON, LEGER, LORUSSO, MONTOUCET, MORENO, ORTEGO,
PYLANT, REYNOLDS, SMITH, ST. GERMAIN, THIBAUT, THIERRY, ALFRED
WILLIAMS, AND PATRICK WILLIAMS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
FUNDS/FUNDING: (Constitutional Amendment) Provides for a hospital stabilization
formula and assessment and creates the Hospital Stabilization Fund and provides for
uses of the fund
A JOINT RESOLUTION1
Proposing to add Article VII, Section 10.13 of the Constitution of Louisiana, to provide2
relative to health care funding; to provide for a hospital stabilization formula; to3
provide for a hospital assessment; to create the Hospital Stabilization Fund as a4
treasury fund; to provide for deposit, use, and investment of the fund; to provide for5
submission of the proposed amendment to the electors; and to provide for related6
matters.7
Section 1. Be it resolved by the Legislature of Louisiana, two-thirds of the members8
elected to each house concurring, that there shall be submitted to the electors of the state of9
Louisiana, for their approval or rejection in the manner provided by law, a proposal to add10
Article VII, Section 10.13 of the Constitution of Louisiana, to read as follows:11
§10.13. Hospital stabilization formula and assessment; Hospital Stabilization Fund12
(A) Hospital Stabilization Formula. (1) The legislature may annually adopt13
a Hospital Stabilization Formula, hereafter referred to in this Section as "the14
formula", by concurrent resolution by a favorable vote of a majority of the elected15
members of each house. Such resolution shall be referred to the standing committees16 HLS 13RS-881 RE-REENGROSSED
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of the legislature that hear the general appropriation bill. The formula shall, to the1
maximum extent possible, enhance the economic viability of Louisiana hospitals and2
reduce shifting the cost of caring for Louisiana's needy residents to the state's insured3
residents.4
(2)(a) The first formula established pursuant to Subparagraph (1) of this5
Paragraph, which shall require a favorable vote of two-thirds of the elected members6
of each house for adoption, shall define and establish as the base reimbursement7
level under the Louisiana medical assistance program provided for in Title XIX of8
the Social Security Act, hereafter referred to as the "Medicaid Program", to hospitals9
for inpatient and outpatient services in Fiscal Year 2012-2013. The formula shall10
also provide for the preservation and protection of rural hospitals as provided for by11
law. Each formula established thereafter may apply a rate of inflation, which shall12
not be a negative rate, to the base reimbursement level from the previous formula13
adopted by the legislature.14
(b) Each formula shall also include and establish assessments to be paid by15
hospitals and the basis on which such assessments shall be calculated, provided the16
amount of the assessments does not exceed the nonfederal share of the17
reimbursement enhancements.18
(c) Each formula shall also establish reimbursement enhancements under19
the Medicaid Program, or its successor, achieving the maximum reimbursement by20
federal law and resulting in distributing such reimbursement enhancements21
exclusively among hospitals for hospital services. Reimbursement enhancements22
may also be distributed for uninsured services delivered.23
(d) Each formula shall also include any additional provisions necessary to24
the implementation of the formula. Neither the assessments nor the reimbursement25
enhancements established in the formula adopted by the legislature shall be26
implemented until each has been approved by the federal authority which27
administers the Medicaid Program.28 HLS 13RS-881 RE-REENGROSSED
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(3) The base reimbursement level resulting from the formula shall not be1
paid from the Hospital Stabilization Fund.2
(4) No additional assessment shall be collected and any assessment shall be3
terminated for the remainder of the fiscal year from the date on which any of the4
following occur:5
(a) The legislature fails to adopt a formula for the subsequent fiscal year.6
(b) The Department of Health and Hospitals, or its successor or contractors,7
reduces or does not pay reimbursement enhancements established in the current8
formula as adopted by the legislature.9
(c) The appropriations provided for in Subparagraph (B)(2) of this Section10
are reduced.11
(5) The treasurer shall return any monies collected after the date of12
termination of an assessment to the hospital from which it was collected.13
(B) Appropriation. (1) The legislature shall annually appropriate an amount14
necessary to fund the base reimbursement level for hospitals established in the most15
recent formula adopted by the legislature.16
(2) The legislature shall annually appropriate the balance of the Hospital17
Stabilization Fund solely to fund the reimbursement enhancements as provided in the18
most recent formula adopted by the legislature.19
(3) Notwithstanding Article VII, Section 10(F) of this constitution, neither20
the governor nor the legislature may reduce the appropriation funding the base21
reimbursement level or the reimbursement enhancements to satisfy a budget deficit,22
except the governor may reduce the appropriation to the base reimbursement level23
if the following occur:24
(a) Such reduction does not exceed the average reduction of those made to25
the appropriations and reimbursement for other providers under the Medicaid26
Program, or its successor; and27
(b)(i) If the legislature is in session, the reduction is consented to in writing28
by two-thirds of the elected members of each house in a manner provided by law; or29 HLS 13RS-881 RE-REENGROSSED
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(ii) If the legislature is not in session, the reduction is approved by two-thirds1
of the members of the Joint Legislative Committee on the Budget, or its successor.2
(C) Hospital Stabilization Fund. There is hereby established as a special3
fund in the state treasury the Hospital Stabilization Fund, hereafter referred to as "the4
fund". After compliance with the requirements of Article VII, Section 9(B) of this5
constitution relative to the Bond Security and Redemption Fund, the treasurer shall6
deposit all proceeds from the assessment collected pursuant to the Hospital7
Stabilization Formula provided for in this Section. The monies in the fund shall be8
invested in the same manner as monies in the state general fund, and all interest9
earned on the investment of the fund shall be deposited in and credited to the fund.10
Appropriations from the fund shall be restricted to funding the reimbursement11
enhancements established in the Hospital Stabilization Formula adopted by the12
legislature for the fiscal year in which the assessment is collected.13
Section 2. Be it further resolved that this proposed amendment shall be submitted14
to the electors of the state of Louisiana at the statewide election to be held on November 4,15
2014, or the first statewide election occurring after the adoption of this Joint Resolution.16
Section 3. Be it further resolved that on the official ballot to be used at the election,17
there shall be printed a proposition, upon which the electors of the state shall be permitted18
to vote YES or NO, to amend the Constitution of Louisiana, which proposition shall read as19
follows:20
Do you support an amendment to create the Hospital Stabilization Fund to21
stabilize and protect Medicaid reimbursements for health care services by22
depositing assessments paid by hospitals, as authorized by the legislature,23
into a fund to support Louisiana hospital reimbursement? (Adds Article VII,24
Section 10.13)25 HLS 13RS-881 RE-REENGROSSED
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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)]
Kleckley HB No. 532
Abstract: Provides for the legislature to establish a formula for funding hospitals by
establishing reimbursement increases for hospitals; by establishing an assessment on
hospitals; by creating the Hospital Stabilization Fund to deposit assessments; and
using the monies in the fund for reimbursement enhancements.
Proposed constitutional amendment provides for an annual Hospital Stabilization Formula
by concurrent resolution by a favorable vote of 2/3 of the elected members of each house in
the first resolution. The resolution requires a favorable vote of a majority of the elected
members of each house in subsequent years. Further, the resolution shall be referred to the
standing committees of the legislature that hear the general appropriation bill. The formula
provided for in the resolution includes:
(1)A base reimbursement level that is the payment levels under the Medicaid Program
to hospitals for inpatient and outpatient services in FY 2012-2013 in the first year
and each subsequent formula may apply a rate of inflation to the base reimbursement
level rate from the previous fiscal year.
(2)Assessments to be paid by La. hospitals, provided the amount of the assessment
does not exceed the nonfederal share of the reimbursement enhancement.
(3)Reimbursement enhancements for those hospitals subject to an assessment provided
for in the formula.
(4)Any additional provisions necessary to the implementation of the formula. Neither
the assessments nor the reimbursement enhancements established in the formula
adopted by the legislature shall be implemented until each has been approved by the
federal authority which administers the Medicaid Program.
Proposed constitutional amendment provides that the base reimbursement level shall not be
paid from the Hospital Stabilization Fund.
Proposed constitutional amendment provides that no additional assessment shall be collected
and any assessment shall be terminated for the remainder of the fiscal year from the date on
which any of the following occur:
(1)The legislature fails to adopt a formula for the subsequent fiscal year.
(2)The Department of Health and Hospitals reduces or does not pay reimbursement
enhancements established in the current formula.
(3)The appropriations provided for in proposed constitutional amendment are reduced.
Proposed constitutional amendment provides that the treasurer shall return any monies
collected after the date of termination of an assessment to the hospital from which it was
collected.
Proposed constitutional amendment provides for annual appropriation of an amount
necessary to fund the base reimbursement level for hospitals and appropriate the balance of HLS 13RS-881 RE-REENGROSSED
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the Hospital Stabilization Fund created in the proposed constitutional amendment for
reimbursement enhancements.
Proposed constitutional amendment provides for reductions to the appropriations if the
following occur:
(1)The reduction does not exceed the average reduction of those made to the
appropriations and reimbursement for other providers under the Medicaid Program.
(2)If the legislature is in session, the reduction is consented to in writing by two-thirds
of the elected members of each house in a manner provided by law, or if the
legislature is not in session, the reduction is approved by two-thirds of the members
of the Joint Legislative Committee on the Budget.
Proposed constitutional amendment creates the Hospital Stabilization Fund and provides
appropriations only for funding the reimbursement enhancement established in the Hospital
Stabilization Formula for the fiscal year in which the assessment is collected.
Provides for submission of the proposed amendment to the voters at the statewide election
to be held Nov. 4, 2014, or the first statewide election occurring after the adoption of this
Joint Resolution.
(Adds Const. Art. VII, §10.13)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Appropriations to the
original bill.
1. Changed the vote necessary for approval of the resolution establishing the
formula from two-thirds of elected members to a majority, except the resolution
for the first formula which shall require a favorable vote of 2/3 of the elected
members of each house.
2. Required the resolution providing for the formula be referred to the standing
committees of the legislature that receive the general appropriation bill.
3. Added that the formula provide for the preservation and protection of rural
hospitals as provided for by law.
4. Clarified that rate enhancements established in the formula will be distributed
among hospitals for hospital services and deletes the provision that the rate
enhancements will be distributed in proportion to the Medicaid services
delivered.
House Floor Amendments to the reengrossed bill.
1. Clarified that the rate referenced in the proposed constitutional amendment is a
reimbursement.
2. Changed the provisions regarding the rate of inflation used in the formula.
3. Provided that neither the assessments nor the reimbursement enhancements
established in the formula shall be implemented until each has been approved by
the federal authority which administers the Medicaid Program.
4. Changed the provisions required for a reduction in reimbursement level. HLS 13RS-881 RE-REENGROSSED
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5. Changed the provisions regarding the collection and termination of the
assessment.
6. Changed the provision regarding the submission of the proposed amendment to
the electors.