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)]
Stokes HB No. 571
Abstract: Provides relative to contracts for managed long term supports and services within the
Medicaid program.
Proposed law defines "Louisiana HMO" as a health maintenance organization (HMO) that meets
all of the following criteria:
(1)Offers fully insured commercial or Medicare Advantage products.
(2)Is domiciled, licensed, and has been operating within the state for a period of at least ten
years.
(3)Maintains its primary corporate office and at least seventy percent of its employees in the
state.
(4)Maintains within the state its core business functions including, without limitation,
utilization review services, claims payment processes, customer service call centers,
enrollment services, information technology services and provider relations.
Proposed law authorizes the secretary of the Department of Health and Hospitals (DHH) to issue
a request for proposals, or initiate any other competitive process allowed by law, to identify and
contract with HMOs to provide for a comprehensive managed care program for La. residents who
are eligible for Medicaid and receive long term care supports and services provided for in the
Medicaid state plan.
Proposed law stipulates that if a Louisiana HMO submits a competitive proposal in response to
the request for proposals or other process provided for in proposed law, DHH shall include that
HMO in the managed care program for La. residents who are eligible for Medicaid and receive
long term care supports and services provided for in the Medicaid State Plan. However, provides
that if more than three different Louisiana HMOs submit competitive proposals, DHH shall
select at least three Louisiana HMOs for inclusion in the program.
Proposed law requires the secretary of DHH to take such actions as may be necessary to ensure
that no Medicaid enrollee participating in a Medicare Advantage plan is forced to leave his plan
in the event that he needs long term supports and services and his plan is not selected to
participate in the managed long term supports and services program of the department. Provides
that in such instances, DHH shall provide payment to the recipient's plan for the long term care supports and services he needs.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 40:1300.381-1300.383)