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Regular Session, 2013
SENATE BILL NO. 76
BY SENATOR BUFFINGTON
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
FUNDS/FUNDING. Provides for use of monies in the Louisiana Medical Assistance Trust
Fund. (gov sig)
AN ACT1
To amend and reenact R.S. 46:2623 and 2625, relative to the Louisiana Medical Assistance2
Trust Fund; to provide for sub-accounts within the fund; to provide for the use of the3
fund; to provide for the disposition of health care provider fees; and to provide for4
related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 46:2623 and 2625 are hereby amended and reenacted to read as7
follows:8
§2623. Louisiana Medical Assistance Trust Fund9
A. There is hereby established as a special fund in the state treasury the10
Louisiana Medical Assistance Trust Fund, hereinafter referred to as the "fund",11
which shall consist of monies generated by the fees on providers of health care12
services collected under the authority of R.S. 46:2625. The monies in the fund shall13
be available for appropriation by the legislature to the Medicaid program solely in14
order to accomplish the purposes of this Chapter as provided for in Subsection C15
of this Section. The monies in the fund shall be invested by the state treasurer in the16
same manner as monies in the state general fund. All interest earned from the17 SB NO. 76
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investment of monies in the fund shall be deposited in and remain to the credit of the1
fund. All unexpended and unencumbered monies remaining in the fund at the close2
of each fiscal year shall remain in the fund.3
B. The monies from the fund as appropriated by the legislature shall be used4
and expended under the supervision of the secretary of the Department of Health and5
Hospitals for the Medicaid program. (1) Within the fund there shall be segregated6
sub-accounts, one for each health care provider group that pays fees pursuant7
to R.S. 46:2625. Monies collected from each health care provider group shall8
accrue to the sub-account of that health care provider group.9
(2) Monies shall be allocated, with accompanying federal matching10
money, to each of the health care provider groups in proportion to the amount11
of fees collected in each sub-account, based upon fees established by the12
Department of Health and Hospitals pursuant to R.S. 46:2625. Such allocation13
shall be calculated using collections data from the most recent four quarters14
where data is available prior to the state fiscal year for which the allocation will15
be made.16
C.(1) Notwithstanding any other provisions of this Chapter, the17
legislature shall be authorized to appropriate as state funds to the department18
for use in any fiscal year, all revenues dedicated and deposited into each19
segregated sub-account. Such appropriations shall be made for the sole purpose20
to obtain federal financial participation in the provision of support to health21
care provider groups listed in R.S. 46:2625. Any appropriation from the22
segregated sub-account for any purpose other than medical assistance payments23
to health care provider groups listed in R.S. 46:2625 shall be void.24
(2) Appropriations from monies generated by health care provider group25
fees, including federal financial participation on those fees shall be expended as26
follows: for the fiscal year commencing July 1, 2013, and fiscal years thereafter,27
all of such appropriations in each sub-account shall be used for the purpose of28
Medicaid reimbursement payments to the health care provider groups29 SB NO. 76
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generating those fees listed in R.S. 46:2625.1
C. D. The monies in the fund shall not be used to displace, replace, or2
supplant appropriations from the state general fund for the Medicaid program below3
the amount of state general fund appropriations to the agency for the 1992-19934
2012-2013 Fiscal Year.5
D. E. The state treasurer shall report the status of the fund and its sub-6
accounts at least quarterly to the secretary of the Department of Health and7
Hospitals and the Joint Legislative Committee on the Budget.8
E. Use of the monies in the fund shall be limited to those programs for which9
federal financial participation under Title XIX of the Social Security Act is available.10
* * *11
§2625. Fees on health care providers; disposition of fees12
A.(1) The Department of Health and Hospitals is hereby authorized to adopt13
and impose fees for health care services provided by the Medicaid program on every14
nursing facility, every intermediate care facility for people with developmental15
disabilities, every pharmacy in the state of Louisiana and certain out-of-state16
pharmacies, dispensing physicians, and medical transportation providers. The17
amount of any fee shall not exceed the total cost to the state of providing the health18
care service subject to such fee. In addition, the amount of the fees imposed under19
the rules and regulations adopted shall not exceed the following: maximum allowed20
by federal law and regulations.21
(a) Ten dollars per occupied bed per day for nursing facilities.22
(b) Thirty dollars per occupied bed per day for intermediate care facilities for23
people with developmental disabilities.24
(c) Ten cents per out-patient prescription.25
(d) Ten cents per out-patient out-of-state prescription.26
(e) Ten cents per out-patient prescription dispensed by dispensing physicians.27
(f) Seven dollars and fifty cents per medical service trip for medical28
transportation providers.29 SB NO. 76
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(2) Any fee authorized by and imposed pursuant to this Section shall be1
considered an allowable cost for purposes of insurance or other third party2
reimbursements and shall be included in the establishment of reimbursement rates.3
(3) Subject to the exceptions contained in Article VII, Section 9(A) of the4
Constitution of Louisiana, all fees collected pursuant to the authority granted in this5
Section shall be paid into the state treasury and shall be credited to the Bond Security6
and Redemption Fund. Out of the funds remaining in the Bond Security and7
Redemption Fund after a sufficient amount is allocated from that fund to pay all8
obligations secured by the full faith and credit of the state which become due and9
payable within any fiscal year, the treasurer shall, prior to placing such remaining10
funds in the state general fund, pay into the Louisiana Medical Assistance Trust Fund11
an amount equal to the total amount of such fees collected.12
B. Notwithstanding any other provision of law to the contrary, except the13
maximum fee of ten dollars as provided in R.S. 46:2625(A)(1)(a), the Department14
of Health and Hospitals shall not impose any new fee or increase any fee on any15
nursing home on or after April 1, 1992, without prior approval of the specific fee16
amount by record vote of a majority of the elected members of each house of the17
legislature while in session. Any such fee imposed or increased by the department18
on or after such date shall be null and of no effect.19
C. B.(1) The department is hereby authorized and directed to adopt and20
promulgate, pursuant to the Administrative Procedure Act, such rules and regulations21
as are necessary to administer the fees imposed herein, including but not limited to22
rules and regulations regarding the collection and payment of the fees and the23
records necessary to be maintained and made available by the providers on whom24
the fees are imposed. Any such information, other than the amount of fees collected25
from each provider and the total amount of revenues generated by the fees authorized26
herein, which is received by any department or agency of the state pursuant to this27
Chapter shall be held confidential.28
(2) The department is authorized and directed to adopt and promulgate,29 SB NO. 76
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pursuant to the Administrative Procedure Act, rules and regulations governing the1
rights and obligations of those on whom said fees will be imposed. Such rules and2
regulations shall include the administrative appeal rights and procedures governing3
disputes arising out of the collection or administration of the fees authorized herein,4
subject to the provisions of Subsection E D of this Section.5
D. C. The governor, by executive order, may designate any agency,6
department, or division of state government to collect the fees authorized herein.7
E. D.(1) All disputes arising from submission of reports and fees due from8
a pharmacy which are deemed untimely as described herein or disputes regarding the9
amount of fees due from a pharmacy pursuant to Paragraph A(1) of this Section shall10
be handled as provided in this Subsection. All other disputes regarding pharmacy11
fees pursuant to this Section which are not related to timeliness and accuracy of12
reports or fees due the department, or which involve fees due from a dispensing13
physician under this Section, shall be handled as provided for in rules promulgated14
pursuant to Paragraph C B(2) of this Section.15
(2) Beginning January 1, 2000, the Louisiana Board of Pharmacy, hereinafter16
"the board", shall take necessary action to suspend the registration and permit of any17
registered in-state or out-of-state pharmacy which fails to timely submit a quarterly18
statement with the Department of Health and Hospitals containing the number of19
prescriptions filled, compounded, or dispensed, and delivered in or into the state of20
Louisiana during the previous three-month period, or for failure to timely submit the21
appropriate prescription fees due pursuant to this Section. A report or fee shall be22
considered untimely if it is received by the department thirty days after the close of23
the most recent quarter. Each report of the quarterly statement shall be signed and24
verified as to accuracy of information contained therein by the preparer of the25
statement on a form provided by the department.26
(3) The board in consultation with the department shall promulgate rules, in27
accordance with the Administrative Procedure Act, as necessary to comply with the28
requirements of the board herein, including rules to strictly define criteria for29 SB NO. 76
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exceptions to the suspension requirements herein, and to provide rules for1
reinstatement procedures. Any revocation action taken pursuant to this Subsection2
shall proceed in accordance with laws and rules applicable to suspension of3
pharmacy permits in general, including the hearing and appeal rights provided4
pursuant to R.S. 37:1200 and 1201.5
(4) The department shall promptly notify the board by certified mail of any6
reports or fees as described herein which are untimely as described herein, or fees7
in which the department considers the amount due from the pharmacy to be in8
dispute thirty calendar days after the date such fees are due to be received by the9
department. A copy of such notification shall also be sent by certified mail to the10
pharmacy which is the subject of the untimely reports or fees. The department shall11
promulgate rules, in accordance with the Administrative Procedure Act, as necessary12
to comply with the requirements of this Subsection, including rules to continuously13
apprise the board of fees and reports received by the department from any pharmacy14
which has been referred to the board for suspension proceedings.15
(5) Nothing in this Subsection shall be construed to prevent the department16
from enforcing existing rules which assess monetary penalties against a pharmacy17
for late filing of reports or fees, which are not otherwise in conflict with the18
provisions herein. 19
Section 2. This Act shall become effective upon signature by the governor or, if not20
signed by the governor, upon expiration of the time for bills to become law without signature21
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If22
vetoed by the governor and subsequently approved by the legislature, this Act shall become23
effective on the day following such approval.24
The original instrument was prepared by Christopher D. Adams. The
following digest, which does not constitute a part of the legislative
instrument, was prepared by Jay Lueckel.
DIGEST
Buffington (SB 76)
Present law provides for the Louisiana Medical Assistance Trust Fund and how monies from
the fund as appropriated by the legislature shall be used and expended under the supervision SB NO. 76
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of the secretary of the Department of Health and Hospitals (DHH) for the Medicaid program.
Proposed law amends present law to provide for within the fund there shall be segregated
sub-accounts, one for each health care provider group that pays fees pursuant to present law.
Proposed law provides monies collected from each health care provider group shall accrue
to the sub-account of that health care provider group. Proposed law provides monies shall
be allocated, with accompanying federal matching money, to each of the health care provider
groups in proportion to the amount of fees collected in each sub-account, based upon fees
established by DHH pursuant to present law, and such allocation shall be calculated using
collections data from the most recent four quarters where data is available prior to the state
fiscal year for which the allocation will be made.
Proposed law provides the legislature shall be authorized to appropriate as state funds to the
department for use in any fiscal year, all revenues dedicated and deposited into each
segregated sub-account. Proposed law provides such appropriations shall be made for the
sole purpose to obtain federal financial participation in the provision of support to health
care provider groups listed in present law. Proposed law provides any appropriation from
the segregated sub-account for any purpose other than medical assistance payments to health
care provider groups listed in present law shall be void. Appropriations from monies
generated by health care provider group fees, including federal financial participation on
those fees, shall be expended as follows:
For the first year commencing July 1, 2013, and fiscal years thereafter, all of such
appropriations in each sub-account shall be used for the purpose of Medicaid
reimbursement payments to the health care provider groups generating those fees
listed in present law.
Proposed law amends present law to provide the monies in the fund shall not be used to
displace, replace, or supplant appropriations from the state general fund for the Medicaid
program below the amount of state general fund appropriations to the agency for the 2012-
2013 Fiscal Year.
Proposed law amends present law to provide the state treasurer shall report the status of the
fund and its sub-accounts at least quarterly to the secretary of DHH and the Joint Legislative
Committee on the Budget.
Proposed law amends present law to remove the requirement that use of the monies in the
fund shall be limited to those programs for which federal financial participation under Title
XIX of the Social Security Act is available.
Present law provides DHH is hereby authorized to adopt and impose fees for health care
services provided by the Medicaid program on every nursing facility, every intermediate
care facility for people with developmental disabilities, every pharmacy in the state of
Louisiana and certain out-of-state pharmacies, dispensing physicians, and medical
transportation providers.
Proposed law amends present law to provide the amount of the fees imposed under the rules
and regulations adopted shall not exceed the maximum allowed by federal law and
regulations.
Proposed law amends present law and removes the requirement that notwithstanding any
other provision of law to the contrary, except the maximum fee of ten dollars as provided
in present law, DHH shall not impose any new fee or increase any fee on any nursing home
on or after April 1, 1992, without prior approval of the specific fee amount by record vote
of a majority of the elected members of each house of the legislature while in session. Any
such fee imposed or increased by DHH on or after such date shall be null and of no effect.
Effective upon signature of the governor or lapse of time for gubernatorial action. SB NO. 76
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(Amends R.S. 46:2623 and 2625)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Finance to the original
bill
1. Relative to appropriations from the La. Medical Assistance Trust Fund and
monies generated by provider groups which are segregated into sub-accounts,
changes the implementation date from a three year phase-in to full
implementation July 1, 2013.
2.Prohibits using monies in the fund to displace, replace, or supplant
appropriations from the state general fund for the Medicaid program below
the amount of such funds for the 2012-2013 Fiscal Year.