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Regular Session, 2013
SENATE BILL NO. 125
BY SENATOR PETERSON
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID. Provides that eligibility standards for the La. Medicaid program shall conform
to those established by the Affordable Care Act and requires reporting of program outcomes.
(gov sig)
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 979.5, 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 duties of the secretary of the Department of Health and Hospitals; to6
provide relative to the medical assistance program state plan; to authorize7
promulgation of rules; to require reports concerning the medical assistance program8
to the legislative committees on health and welfare and the governor; to specify the9
minimum required content of such reports; and to provide for related matters.10
Be it enacted by the Legislature of Louisiana:11
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,12
comprised of R.S. 46:979.1 through 979.5, is hereby enacted to read as follows: 13
CHAPTER 8-B. MEDICAL ASSISTANCE PROGRAM EXPANSION AND14
ENHANCED OUTCOMES REPORTING15
§979.1. Definitions16
As used in this Chapter, the following terms shall have the following17 SB NO. 125
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definitions, unless the context clearly indicates otherwise:1
(1) "ACA" and "Affordable Care Act" mean the following acts of2
Congress, collectively:3
(a) The Patient Protection and Affordable Care Act, which originated4
as H.R. 3590 in the One Hundred Eleventh United States Congress and became5
Public Law 111-148.6
(b) The Health Care and Education Reconciliation Act, which originated7
as H.R. 4872 in the One Hundred Eleventh United States Congress and became8
Public Law 111-152.9
(2) "Department" means the Department of Health and Hospitals.10
(3) "Medicaid" and "medical assistance program" mean the medical11
assistance program provided for in Title XIX of the Social Security Act.12
(4) "Secretary" means the secretary of the Department of Health and13
Hospitals.14
§979.2. Legislative findings; declaration15
A. The Legislature of Louisiana does hereby find and declare the16
following:17
(1) The Affordable Care Act, referred to hereafter in this Chapter as the18
"ACA", sets forth health and policy reforms which reshape the way virtually19
all Americans will receive and finance their healthcare.20
(2) In a decision announced on June 28, 2012, the Supreme Court of the21
United States, in National Federation of Independent Business, et al. v. Sebelius,22
Secretary of Health and Human Services, et al. upheld the overall23
constitutionally of the ACA; but in the same ruling, a majority of the court held24
that the mandatory expansion of Medicaid eligibility as provided in the ACA is25
unconstitutionally coercive of states, thereby making participation in the26
Medicaid expansion a voluntary proposition for each state.27
(3) At twenty-five percent of the federal poverty level, or just under28
eight thousand dollars in annual income for a family of four presently, the29 SB NO. 125
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income eligibility threshold of this state for Medicaid benefits for parents of1
Medicaid-eligible children is the second-lowest in the nation.2
(4) All of the following provisions of the ACA apply in states which3
participate in the Medicaid expansion:4
(a) The Medicaid income eligibility threshold increases to one hundred5
thirty-three percent of the federal poverty level, or thirty thousand seven6
hundred thirty-three dollars in annual income for a family of four presently, for7
all persons of ages nineteen to sixty-four beginning on January 1, 2014.8
(b) The federal share of funding for Medicaid benefits for persons who9
became eligible due to the expansion is one hundred percent from 2014 through10
2017.11
(c) The federal share of funding for Medicaid benefits for persons who12
became eligible due to the expansion phases down from one hundred percent to13
ninety percent between 2017 and 2020, with the federal share remaining at14
ninety percent in ensuing years.15
(5) Within federally provided guidelines, the secretary of the16
department may establish and modify eligibility standards for the Medicaid17
program through amendments to the Medicaid state plan and to administrative18
rules providing for operation of the program.19
(6) The legislature declares that due to compelling moral and economic20
reasons, participation in the expansion of Medicaid eligibility as provided in the21
ACA is in the best interest of this state.22
B. In a publication entitled "Louisiana Medicaid Annual Report", the23
department traditionally provides summary data on inputs (spending) and24
outputs (services delivered) of the Medicaid program; however, as evidenced in25
part by the final passage of Senate Bill No. 207 of the 2011 Regular Session of26
the Legislature and Senate Bill No. 629 of the 2012 Regular Session of the27
Legislature, the legislature intends that the department should undertake a28
more comprehensive and transparent effort to report actual health outcomes29 SB NO. 125
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of the Medicaid program and program accountability measures, as such1
enhanced reporting would be essential to facilitation of a clearer understanding2
by policymakers and the general public of the effectiveness of a program which3
would serve nearly forty percent of this state's population if expanded pursuant4
to the provisions of this Chapter.5
§979.3. Purposes6
The purposes of this state in expanding Medicaid eligibility to conform7
to the standards provided in the ACA, as required by this Chapter, are as8
follows:9
(1) To maximize the number of Louisianians who are covered by some10
form of health insurance.11
(2) To provide basic health coverage to the working poor of the state12
who are not offered insurance through their employer and do not earn enough13
money to meet basic family needs and pay for private health insurance.14
(3) To assure health care providers who serve low to moderate income15
persons of some amount of compensation for the care they provide, as the ACA16
provides for a dramatic reduction in funding to federal programs which17
currently finance care for the uninsured as a means of financing the Medicaid18
expansion.19
(4) To avert the economic and human costs of crises in both access to20
health care and health services financing which are likely to result from not21
participating in an expansion of a major federal program while other sources22
of financing for medical care for the uninsured and the indigent are being23
drastically reduced or eliminated.24
§979.4. Expansion of Medicaid eligibility; duties of the secretary of the25
Department of Health and Hospitals26
On or before September 1, 2013, the secretary of the department shall27
take all of the following actions:28
(1) File a Medicaid state plan amendment with the Centers for Medicare29 SB NO. 125
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and Medicaid Services to provide that beginning on January 1, 2014, eligibility1
standards for medical assistance program benefits in Louisiana conform to the2
minimum eligibility standards as provided in the Patient Protection and3
Affordable Care Act (P.L. 111-148) and codified in federal regulations relative4
to medical assistance program coverage (42 CFR 435.119).5
(2) Promulgate all rules and regulations in accordance with the6
Administrative Procedure Act as are necessary to implement the provisions of7
this Chapter.8
§979.5. Medicaid program outcomes; reporting requirements9
A. On or before July 1, 2014, and annually thereafter, the secretary of10
the department shall provide to the House and Senate committees on health and11
welfare and to the governor a written report covering the most recent one-year12
period which includes at minimum all of the items required hereafter in this13
Section.14
B. The secretary shall make the report provided for in this Section15
publicly available on its Internet website.16
C. The report shall include but shall not be limited to the following17
items:18
(1) Evaluation of overall health outcomes and quality of care for19
Medicaid enrollees of this state and recommendations for policy changes to20
improve such outcomes and quality of care. Measurements on which the21
secretary shall base the evaluation provided for in this Paragraph shall be22
derived from a metric which is generally accepted by public and private health23
care providers such as the Healthcare Effectiveness Data and Information Set24
(HEDIS).25
(2) Evaluation of major barriers to access to health care by Medicaid26
enrollees of this state and recommendations for policy changes to eliminate such27
barriers.28
(3) Summary of successful initiatives in this state for disease prevention29 SB NO. 125
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and early diagnosis and management of chronic conditions among Medicaid1
enrollees of this state.2
(4) Trends in enrollment of health care providers in the Medicaid3
program of this state during the period covered by the report.4
(5) Major challenges faced by health care providers enrolled in the5
Medicaid program of this state and recommendations for policy changes to6
address such challenges.7
(6) Impacts on health outcomes and health care costs in the state during8
the period covered by the report which resulted from participation by health9
care providers enrolled in the Medicaid program in any federal or state10
initiatives for coordinated care or patient-centered medical homes.11
(7) Such other information as the secretary deems appropriate to convey12
a clear and sufficiently complete assessment of the impact of the Medicaid13
program in this state.14
Section 2. This Act shall become effective upon signature by the governor or, if not15
signed by the governor, upon expiration of the time for bills to become law without signature16
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If17
vetoed by the governor and subsequently approved by the legislature, this Act shall become18
effective on the day following such approval.19
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Mary Dozier O'Brien.
DIGEST
Proposed law provides that eligibility standards for the Louisiana Medicaid program shall
conform to those established by the Affordable Care Act and requires reporting of program
outcomes to the legislative committees on health and welfare and to the governor.
Proposed law requires 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 January 1, 2014. Provides that such actions by the
secretary shall include:
(1)On or before September 1, 2013, filing of the Medicaid state plan amendment
necessary to expand Medicaid eligibility in accordance with proposed law.
(2)On or before September 1, 2013, promulgating all rules and regulations as are
necessary to expand Medicaid eligibility in accordance with proposed law. SB NO. 125
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Proposed law declares that the purposes of the state in expanding Medicaid eligibility as
provided in proposed law are as follows:
(1)To maximize the number of Louisianians who are covered by some form of health
insurance.
(2)To provide basic health coverage to the working poor of the state who are not offered
insurance through their employer and do not earn enough money to meet basic
family needs and pay for private health insurance.
(3)To assure health care providers who serve low to moderate income persons of some
amount of compensation for the care they provide.
(4)To avert the economic and human costs of crises in both access to health care and
health services financing which are likely to result from not participating in an
expansion of a major federal program while other sources of financing for medical
care for the uninsured and the indigent are being drastically reduced or eliminated.
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.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds 46:979.1-979.5)