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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 for the Louisiana Health Care Independence Program and requires
reporting of the 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 979.6, 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 definitions; to provide for legislative findings and intent; to provide6
for reform of the Medicaid program in Louisiana; to provide for termination; and to7
provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,10
comprised of R.S. 46:979.1 through 979.6, is hereby enacted to read as follows: 11
CHAPTER 8-B. LOUISIANA HEALTH CARE INDEPENDENCE PROGRAM12
§979.1. Title13
This Chapter shall be known and may be cited as the "Louisiana Health14
Care Independence Act".15
§979.2. 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
(5) "Health insurance marketplace" means the federal vehicle created15
to help individuals, families, and small businesses shop for and select health16
insurance coverage in a way that permits comparison of available qualified17
health plans based upon price, benefits, services, and quality, regardless of the18
governance structure of the marketplace.19
(6) "Premium" means a charge that must be paid as a condition of20
enrolling in health care coverage.21
(7) "Program" means the Louisiana Health Care Independence Program22
established by this Chapter.23
(8) "Qualified health plan" means a federally certified individual health24
insurance plan offered by a carrier through the federal Health Insurance25
Marketplace.26
(9) "Independence account" means individual financing structures that27
operate similar to a health savings account or a medical savings account.28
(10) "Cost sharing" means the portion of the cost of a covered medical29 SB NO. 125
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service that must be paid by or on behalf of eligible individuals, consisting of1
copayments or coinsurance, but not deductibles.2
§979.3. Legislative findings; purpose3
A. The Legislature of Louisiana does hereby find and declare the4
following:5
(1) The Affordable Care Act, referred to hereafter in this Chapter as the6
"ACA", sets forth health and policy reforms which reshape the way virtually7
all Americans will receive and finance their healthcare.8
(2) In a decision announced on June 28, 2012, the Supreme Court of the9
United States, in National Federation of Independent Business, et al. v. Sebelius,10
Secretary of Health and Human Services, et al. upheld the overall11
constitutionally of the ACA; but in the same ruling, a majority of the court held12
that the mandatory expansion of Medicaid eligibility as provided in the ACA is13
unconstitutionally coercive of states, thereby making participation in the14
Medicaid expansion a voluntary proposition for each state.15
(3) At twenty-five percent of the federal poverty level, or just under16
eight thousand dollars in annual income for a family of four presently, the17
income eligibility threshold of this state for Medicaid benefits for parents of18
Medicaid-eligible children is the second-lowest in the nation.19
(4) 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. The purposes of this state in expanding Medicaid eligibility to23
conform to the standards provided in the ACA, as required by this Chapter, are24
as follows:25
(1) To maximize the number of Louisianians who are covered by some26
form of health insurance.27
(2) To provide basic health coverage to the working poor of the state28
who are not offered insurance through their employer and do not earn enough29 SB NO. 125
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money to meet basic family needs and pay for private health insurance.1
(3) To assure health care providers who serve low to moderate income2
persons of some amount of compensation for the care they provide, as the ACA3
provides for a dramatic reduction in funding to federal programs which4
currently finance care for the uninsured as a means of financing the Medicaid5
expansion.6
(4) To avert the economic and human costs of crises in both access to7
health care and health services financing which are likely to result from not8
participating in an expansion of a major federal program while other sources9
of financing for medical care for the uninsured and the indigent are being10
drastically reduced or eliminated.11
§979.4. Expansion of Medicaid eligibility in Louisiana; administration of the12
Louisiana Health Care Independence Program by the13
Department of Health and Hospitals14
A. The Department of Health and Hospitals shall create and administer15
the Louisiana Health Care Independence Program within the department.16
After receiving the approval of the Senate and House Committees on Health17
and Welfare, the department shall on or before September 1, 2013, submit and18
apply for all of the following:19
(1) Federal waivers necessary to implement the program in a manner20
consistent with this Chapter, including without limitation approval for a21
comprehensive waiver under Section 1115 of the Social Security Act, 42 U.S.C.22
1315.23
(2) Medicaid state plan amendments necessary to implement the24
program in a manner consistent with this Chapter.25
(3) Those Medicaid state plan amendments that are optional and26
therefore may be revoked by the state at its discretion.27
B.(1) As part of its actions the department shall confirm that employers28
shall not be subject to the penalties, including without limitation an assessable29 SB NO. 125
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payment, under Section 1513 of Pub. L. No. 111-148, as existing on January 1,1
2013, concerning shared responsibility, for employees who are eligible2
individuals if the employees meet either of the following criteria:3
(a) Are enrolled in the program.4
(b) Enroll in a qualified health plan through the federal health insurance5
marketplace.6
(2) If the department is unable to confirm provisions under this Section,7
the program shall not be implemented.8
C.(1) Implementation of the program shall be conditioned upon the9
receipt of necessary federal approvals.10
(2) If the department does not receive the necessary federal approvals,11
the program shall not be implemented.12
D. The program shall include premium assistance for eligible individuals13
to enable their enrollment in a qualified health plan through the federal health14
insurance marketplace. 15
E.(1) The department shall be specifically authorized to pay premiums16
and supplemental cost-sharing subsidies directly to the federally qualified17
health plans for enrolled eligible individuals.18
(2) The intent of the payments under this Subsection is to increase19
participation in the health insurance market, intensify price pressures, and20
reduce costs for both publicly and privately funded health care. 21
F. The department shall accomplish the following to the extent allowable22
by law:23
(1) The department shall pursue strategies that promote insurance24
coverage of children in their parents' or caregivers' plan, including children25
eligible for the LaCHIP, the Louisiana Children's Health Insurance Program.26
(2) The department shall develop and implement a strategy to inform27
Medicaid recipient populations whose needs would be reduced or better served28
through participation in the federal health insurance marketplace.29 SB NO. 125
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G. The program authorized under this Chapter shall terminate within1
one hundred twenty days after a reduction in any of the following federal2
medical assistance percentages: 3
(1) One hundred percent in 2014, 2015, or 2016.4
(2) Ninety-five percent in 2017.5
(3) Ninety-four percent in 2018.6
(4) Ninety-three percent in 2019.7
(5) Ninety percent in 2020 or any year after 2020.8
H. An eligible individual enrolled in the program shall affirmatively9
acknowledge the existence of all of the following facts:10
(1) The program shall not be a perpetual federal or state right or a11
guaranteed entitlement.12
(2) The program shall be subject to cancellation upon appropriate notice.13
(3) The program shall not be an entitlement program.14
I.(1) The department shall develop a model and seek from the Center for15
Medicare and Medicaid Services all necessary waivers and approvals to allow16
nonaged, nondisabled program-eligible participants to enroll in a program that17
shall create and utilize independence accounts that operate similar to a health18
savings account or medical savings account during the calendar year 2015.19
(2) The independence accounts shall accomplish both of the following:20
(a) Allow a participant to purchase cost-effective high-deductible health21
insurance.22
(b) Promote independence and self-sufficiency.23
(3) The state shall implement cost sharing and copays and, as a condition24
of participation, earnings shall exceed fifty percent of the applicable federal25
poverty level. 26
(4) Participants may receive rewards based on healthy living and self-27
sufficiency. 28
(5)(a) At the end of each fiscal year, if there are funds remaining in the29 SB NO. 125
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account, a majority of the state's contribution shall remain in the participant's1
control as a positive incentive for the responsible use of the health care system2
and personal responsibility of health maintenance.3
(b) Uses of the funds may include, without limitation, rolling the funds4
into a private sector health savings account for the participant according to5
rules promulgated by the department.6
(c) The department shall promulgate rules to implement this Section in7
accordance with the Administrative Procedure Act. State obligations for8
uncompensated care shall be projected, tracked, and reported to identify9
potential incremental future decreases.10
(d) The department shall recommend appropriate adjustments in11
funding to the legislature.12
(e) Adjustments shall be made by the legislature as appropriate.13
J. On a quarterly basis, the department shall report to the Joint14
Legislative Committee on the Budget, within two weeks of the end of each15
quarter, information regarding the following aspects of the program:16
(1) Program enrollment.17
(2) Patient experience.18
(3) Economic impact including enrollment distribution.19
(4) Carrier competition.20
(5) Success in avoiding uncompensated care.21
§979.5. Medicaid program outcomes; reporting requirements22
A. On or before July 1, 2014, and annually thereafter, the secretary of23
the department shall provide to the House and Senate committees on health and24
welfare and to the governor a written report covering the most recent one-year25
period which includes at minimum all of the items required hereafter in this26
Section.27
B. The secretary shall make the report provided for in this Section28
publicly available on its Internet website.29 SB NO. 125
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C. The report shall include but shall not be limited to the following1
items:2
(1) Evaluation of overall health outcomes and quality of care for3
Medicaid enrollees of this state and recommendations for policy changes to4
improve such outcomes and quality of care. Measurements on which the5
secretary shall base the evaluation provided for in this Paragraph shall be6
derived from a metric which is generally accepted by public and private health7
care providers such as the Healthcare Effectiveness Data and Information Set8
(HEDIS).9
(2) Evaluation of major barriers to access to health care by Medicaid10
enrollees of this state and recommendations for policy changes to eliminate such11
barriers.12
(3) Summary of successful initiatives in this state for disease prevention13
and early diagnosis and management of chronic conditions among Medicaid14
enrollees of this state.15
(4) Trends in enrollment of health care providers in the Medicaid16
program of this state during the period covered by the report.17
(5) Major challenges faced by health care providers enrolled in the18
Medicaid program of this state and recommendations for policy changes to19
address such challenges.20
(6) Impacts on health outcomes and health care costs in the state during21
the period covered by the report which resulted from participation by health22
care providers enrolled in the Medicaid program in any federal or state23
initiatives for coordinated care or patient-centered medical homes.24
(7) Such other information as the secretary deems appropriate to convey25
a clear and sufficiently complete assessment of the impact of the Medicaid26
program in this state.27
§979.6. Termination28
The provisions of this Chapter shall terminate and become null and void29 SB NO. 125
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on and after July 1, 2017.1
Section 2. This Act shall become effective upon signature by the governor or, if not2
signed by the governor, upon expiration of the time for bills to become law without signature3
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If4
vetoed by the governor and subsequently approved by the legislature, this Act shall become5
effective on the day following such approval.6
The original instrument was prepared by Mary Dozier O'Brien. The
following digest, which does not constitute a part of the legislative
instrument, was prepared by Christopher D. Adams.
DIGEST
Peterson (SB 125)
Proposed law provides the Department of Health and Hospitals create and administer the
Louisiana Health Care Independence Program within the department.
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 provides that after receiving the approval of the Senate and House committees
on health and welfare, the department shall on or before September 1, 2013, submit and
apply for all of the following:
(1) Federal waivers necessary to implement the program in a manner consistent with
proposed law, including without limitation approval for a comprehensive waiver
under Section 1115 of the Social Security Act.
(2)Medicaid state plan amendments necessary to implement the program in a manner
consistent with proposed law.
(3) Those Medicaid state plan amendments that are optional and therefore may be
revoked by the state at its discretion.
Proposed law provides the department shall confirm that employers shall not be subject to
the penalties, including without limitation an assessable payment, under Section 1513 of SB NO. 125
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words in boldface type and underscored are additions.
Pub. L. No. 111-148, as existing on January 1, 2013, concerning shared responsibility, for
employees who are eligible individuals if the employees meet either of the following criteria.
(1) Are enrolled in the program.
(2) Enroll in a qualified health plan through the federal health insurance marketplace.
Proposed law further provides if the department is unable to confirm provisions under the
proposed law, the program shall not be implemented.
Proposed law provides the implementation of the program shall be conditioned upon the
receipt of necessary federal approvals, and if the department does not receive the necessary
federal approvals, the program shall not be implemented.
Proposed law provides the program shall include premium assistance for eligible individuals
to enable their enrollment in a qualified health plan through the federal health insurance
marketplace.
Proposed law provides the department shall be specifically authorized to pay premiums and
supplemental cost-sharing subsidies directly to the federally qualified health plans for
enrolled eligible individuals.
Proposed law provides the department shall pursue strategies that promote insurance
coverage of children in their parents' or caregivers' plan, including children eligible for the
LaCHIP.
Proposed law further provides the department shall develop and implement a strategy to
inform Medicaid recipient populations whose needs would be reduced or better served
through participation in the federal health insurance marketplace.
Proposed law provides the program shall terminate within 120 days after a reduction in any
of the following federal medical assistance percentages:
(1) 100% in 2014, 2015, or 2016.
(2) 95% in 2017.
(3) 94% in 2018.
(4) 93% in 2019.
(5) 90% in 2020 or any year after 2020.
Proposed law provides an eligible individual enrolled in the program shall affirmatively
acknowledge the existence all of the following facts:
(1) The program shall not be a perpetual federal or state right or a guaranteed
entitlement.
(2) The program shall be subject to cancellation upon appropriate notice.
(3) The program shall not be an entitlement program.
Proposed law provides the department shall develop a model and seek from the Center for
Medicare and Medicaid Services all necessary waivers and approvals to allow non-aged,
non-disabled program-eligible participants to enroll in a program that shall create and utilize
independence accounts that operate similar to a health savings account or medical savings
account during the calendar year 2015. SB NO. 125
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Proposed law provides the independence accounts shall accomplish both of the following:
(1) Allow a participant to purchase cost-effective high-deductible health insurance.
(2) Promote independence and self-sufficiency.
Proposed law provides the state shall implement cost sharing and co-pays and, as a condition
of participation, earnings shall exceed fifty percent of the applicable federal poverty level.
Proposed law provides participants may receive rewards based on healthy living and self-
sufficiency.
Proposed law provides that at the end of each fiscal year, if there are funds remaining in the
account, a majority of the state's contribution shall remain in the participant's control as a
positive incentive for the responsible use of the health care system and personal
responsibility of health maintenance.
Proposed law provides that on a quarterly basis, the department shall report to the Joint
Legislative Committee on the Budget, within two weeks of the end of each quarter,
information regarding the following aspects of the program:
(1) Program enrollment.
(2) Patient experience.
(3) Economic impact including enrollment distribution.
(4) Carrier competition.
(5) Success in avoiding uncompensated care.
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. SB NO. 125
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(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.
Proposed law provides for a termination date of July 1, 2017.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.1-979.6)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill
1. Provides for the Louisiana Health Care Independence Program.
2. Provides a program termination date of July 1, 2017.