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Regular Session, 2014
HOUSE BILL NO. 571
BY REPRESENTATIVE STOKES
MEDICAID: Provides relative to contracts for managed long term supports and services
within the Medicaid program
AN ACT1
To enact Part LXXV of Chapter 5 of Title 40 of the Louisiana Revised Statutes of 1950, to2
be comprised of R.S. 40:1300.381 through 1300.383, relative to managed long term3
supports and services; to provide for contracting by the Department of Health and4
Hospitals for certain managed care services; to provide relative to long term care5
services for certain Medicaid enrollees; to require remittance of payment by the6
Department of Health and Hospitals to certain health plans in specific circumstances;7
and to provide for related matters.8
Be it enacted by the Legislature of Louisiana:9
Section 1. Part LXXV of Chapter 5 of Title 40 of the Louisiana Revised Statutes of10
1950, comprised of R.S. 40:1300.381 through 1300.383, is hereby enacted to read as11
follows:12
PART LXXV. MEDICAID MANAGED LONG TERM13
SUPPORTS AND SERVICES14
§1300.381. Definitions15
As used in this Part, the following terms have the meaning ascribed to them16
in this Section:17
(1) "Department" means the Department of Health and Hospitals.18
(2) "Louisiana HMO" means a health maintenance organization that meets19
all of the following criteria:20 HLS 14RS-1210 ORIGINAL
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(a) Offers fully insured commercial or Medicare Advantage products.1
(b) Is domiciled, licensed, and has been operating within the state for a2
period of at least ten years.3
(c) Maintains its primary corporate office and at least seventy percent of its4
employees in the state.5
(d) Maintains within the state its core business functions including, without6
limitation, utilization review services, claims payment processes, customer service7
call centers, enrollment services, information technology services and provider8
relations.9
§1300.382. Medicaid managed long term supports and services; contracts with10
health maintenance organizations11
A. The secretary of the department is hereby authorized to issue a request for12
proposals, or initiate any other competitive process allowed by law, to identify and13
contract with health maintenance organizations to provide for a comprehensive14
managed care program for Louisiana residents who are eligible for Medicaid and15
receive long term care supports and services provided for in the Medicaid state plan.16
B. If a Louisiana HMO submits a competitive proposal in response to the17
request for proposals or other competitive process provided for in Subsection A of18
this Section, the department shall include that Louisiana HMO in the managed care19
program for Louisiana residents who are eligible for Medicaid and receive long term20
care supports and services provided for in the Medicaid State Plan. However, if21
more than three different Louisiana HMOs submit competitive proposals, the22
department shall select at least three Louisiana HMOs for inclusion in the program.23
§1300.383. Medicaid enrollees participating in Medicare Advantage plans;24
safeguards25
The secretary of the department shall take all such actions as may be26
necessary to ensure that no Medicaid enrollee participating in a Medicare Advantage27
plan is forced to leave his plan in the event that he needs long term supports and28
services and his plan is not selected to participate in the managed long term supports29 HLS 14RS-1210 ORIGINAL
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and services program of the department. In such instances, the department shall1
provide payment to the recipient's plan for the long term care supports and services2
he needs.3
Section 2. This Act shall become effective upon signature by the governor or, if not4
signed by the governor, upon expiration of the time for bills to become law without signature5
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If6
vetoed by the governor and subsequently approved by the legislature, this Act shall become7
effective on the day following such approval.8
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. HLS 14RS-1210 ORIGINAL
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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)