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Regular Session, 2014
SENATE BILL NO. 107
BY SENATOR NEVERS
MEDICAID. Provides for the Louisiana Health Care Independence Act. (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 Louisiana Health Care Independence3
Act; to provide for the creation and administration of the Louisiana Health Care4
Independence Program; to provide for access to basic health insurance coverage for5
Louisiana citizens with certain incomes; to provide for legislative findings and6
intent; to provide definitions; to provide for certain waiver applications and Medicaid7
state plan amendments; to provide for medical assistance programs; to provide8
relative to funding and legislative oversight; to provide for certain eligibility factors9
and reports; to provide relative to termination of the program; to provide certain10
terms, conditions and procedures; and to provide for related matters.11
Be it enacted by the Legislature of Louisiana:12
Section 1. Chapter 8-B of Title 46 of the Louisiana Revised Statutes of 1950,13
comprised of R.S. 46:979.1 through 979.6, is hereby enacted to read as follows:14
CHAPTER 8-B. LOUISIANA HEALTH CARE INDEPENDENCE PROGRAM15
§979.1. Title16
This Chapter shall be known and may be cited as the "Louisiana Health17 SB NO. 107
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Care Independence Act".1
§979.2. Definitions2
As used in this Chapter, the following terms shall have the following3
definitions, unless the context clearly indicates otherwise:4
(1) "ACA" and "Affordable Care Act" mean the following acts of5
Congress, collectively:6
(a) The Patient Protection and Affordable Care Act, which originated7
as H.R. 3590 in the One Hundred Eleventh United States Congress and became8
Public Law 111-148.9
(b) The Health Care and Education Reconciliation Act, which originated10
as H.R. 4872 in the One Hundred Eleventh United States Congress and became11
Public Law 111-152.12
(2) "Department" means the Department of Health and Hospitals.13
(3) "Medicaid" and "medical assistance program" mean the medical14
assistance program provided for in Title XIX of the Social Security Act.15
(4) "Secretary" means the secretary of the Department of Health and16
Hospitals.17
(5) "Health insurance marketplace" means the federal vehicle created18
to help individuals, families, and small businesses shop for and select health19
insurance coverage in a way that permits comparison of available qualified20
health plans based upon price, benefits, services, and quality, regardless of the21
governance structure of the marketplace.22
(6) "Program" means the Louisiana Health Care Independence23
Program established by this Chapter.24
(7) "Qualified health plan" means a federally certified individual health25
insurance plan offered by a carrier through the federal health insurance26
marketplace, or any state certified individual health insurance plan approved27
by the Centers for Medicare and Medicaid Services.28
(8) "Cost sharing" means the portion of the cost of a covered medical29 SB NO. 107
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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 that, due4
to compelling moral and economic reasons, participation in the expansion of5
Medicaid eligibility as provided in the ACA or the creation of some alternative6
health insurance program as provided by the department so that the state may7
maximize access to health care for Louisiana residents whose income is at or8
below one hundred thirty-eight percent of the federal poverty level is in the best9
interest of this state.10
B. The purposes of this state in maximizing the efficient use of federal11
funds to provide access to health care for Louisiana residents whose income is12
at or below one hundred thirty-eight percent of the federal poverty level, as13
required by this Chapter, are as follows:14
(1) To maximize the number of Louisianians who are covered by some15
form of health insurance.16
(2) To provide basic health insurance coverage to the citizens of17
Louisiana whose income is at or below one hundred thirty-eight percent of the18
federal poverty level.19
(3) To assure health care providers who serve low to moderate income20
persons of some amount of compensation for the care they provide.21
§979.4. Administration of the Louisiana Health Care Independence Program22
by the Department of Health and Hospitals23
A. The Department of Health and Hospitals shall create and administer24
the Louisiana Health Care Independence Program within the department. The25
department shall promulgate rules to implement this Section in accordance with26
the Administrative Procedure Act.27
B. The department shall on or before September 1, 2014, submit and28
apply for all of the following:29 SB NO. 107
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(1) Federal waivers necessary to implement the program in a manner1
consistent with this Chapter, including without limitation approval for a2
comprehensive waiver under Section 1115 of the Social Security Act, 42 U.S.C.3
1315.4
(2) Medicaid state plan amendments necessary to implement the5
program in a manner consistent with this Chapter.6
C. Implementation of the program shall be conditioned upon the receipt7
of necessary federal approvals.8
D. The program may include premium assistance for eligible individuals9
to enable their enrollment in a qualified health plan through the federal health10
insurance marketplace.11
E. The department shall be specifically authorized to pay supplemental12
cost-sharing subsidies directly to qualified health plans for enrolled eligible13
individuals.14
F. The department shall accomplish the following:15
(1) Pursue strategies that promote insurance coverage of children in16
their parents' or caregivers' plan, including children eligible for the LaCHIP,17
the Louisiana Children's Health Insurance Program.18
(2) Provide every Louisiana citizen whose income is at or below one19
hundred thirty-eight percent of federal poverty level Medicaid coverage or20
access to health insurance with health benefits as provided by federal law.21
(3) Develop and implement a strategy to inform Medicaid recipient22
populations whose needs would be reduced or better served through23
participation in the federal health insurance marketplace.24
G. The program authorized under this Chapter shall terminate within25
one hundred twenty days after a reduction in any of the following federal26
medical assistance percentages:27
(1) One hundred percent in 2015 or 2016.28
(2) Ninety-five percent in 2017.29 SB NO. 107
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(3) Ninety-four percent in 2018.1
(4) Ninety-three percent in 2019.2
(5) Ninety percent in 2020 or any year after 2020.3
H. An eligible individual enrolled in the program shall affirmatively4
acknowledge the existence of all of the following facts:5
(1) The program shall not be a perpetual federal or state right or a6
guaranteed entitlement.7
(2) The program shall be subject to cancellation upon appropriate8
notice.9
(3) The program shall not be an entitlement program.10
I. The state may implement cost sharing and copays, as a condition of11
participation in the program, for program participants whose earnings shall12
exceed fifty percent of the applicable federal poverty level.13
J. The department shall recommend appropriate adjustments in funding14
to the legislature. Adjustments shall be made by the legislature as appropriate.15
K. On a quarterly basis, the department shall report to the Joint16
Legislative Committee on the Budget, within two weeks of the end of each17
quarter, information regarding the following aspects of the program:18
(1) Program enrollment.19
(2) Patient experience.20
(3) Economic impact including enrollment distribution.21
(4) Carrier competition.22
(5) Success in avoiding uncompensated care.23
§979.5. Medicaid program outcomes; reporting requirements24
A. On or before July 1, 2015, and annually thereafter, the secretary of25
the department shall provide to the House and Senate committees on health and26
welfare and to the governor a written report covering the most recent one-year27
period which includes at minimum all of the items required hereafter in this28
Section.29 SB NO. 107
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B. The secretary shall make the report provided for in this Section1
publicly available on its Internet website.2
C. The report shall include but shall not be limited to the following3
items:4
(1) Evaluation of major barriers to access to health care by Medicaid5
enrollees of this state and participants in the Louisiana Health Care6
Independence Program, and recommendations for policy changes to eliminate7
such barriers.8
(2) Summary of successful initiatives in this state for disease prevention9
and early diagnosis and management of chronic conditions among Medicaid10
enrollees of this state and participants in the program.11
(3) Such other information as the secretary deems appropriate to convey12
a clear and sufficiently complete assessment of the impact of the program.13
§979.6. Termination14
When federal funding is no longer available to fund ninety percent of the15
total cost of operating the program, the legislature shall have the authority to16
decide whether to continue the program.17
Section 2. This Act shall become effective upon signature by the governor or, if not18
signed by the governor, upon expiration of the time for bills to become law without signature19
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If20
vetoed by the governor and subsequently approved by the legislature, this Act shall become21
effective on the day following such approval.22
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Julie J. Baxter.
DIGEST
Nevers (SB 107)
Proposed law provides for the Louisiana Health Care Independence Act.
Proposed law directs the Department of Health and Hospitals to create and administer the
Louisiana Health Care Independence Program within the department.
Proposed law provides for definitions of certain terms relating to the Louisiana Health Care
Independence Program. SB NO. 107
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Proposed law provides for legislative findings declaring that participation in the expansion
of Medicaid eligibility or the creation of some alternative health insurance program as
provided by the Department of Health and Hospitals so that the state may maximize access
to health care for Louisiana residents whose income is at or below 138% of the federal
poverty level is in the best interest of Louisiana.
Proposed law provides that the purposes of the state in maximizing the efficient use of
federal funds to provide access to health care for Louisiana residents whose income is at or
below 138% of the federal poverty level as required by 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 insurance coverage to the citizens of Louisiana whose
income is at or below 138% of the federal poverty level.
(3)To assure health care providers who serve low to moderate income persons of some
amount of compensation for the care they provide.
Proposed law provides that the Department of Health and Hospitals shall promulgate rules
to implement proposed law in accordance with the Administrative Procedure Act.
Proposed law provides that the Department of Health and Hospitals shall on or before
September 1, 2014, 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, 42 U.S.C. 1315.
(2)Medicaid state plan amendments necessary to implement the program in a manner
consistent with proposed law.
Proposed law provides implementation of the program shall be conditioned upon the receipt
of necessary federal approvals.
Proposed law provides the program may 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 supplemental
cost-sharing subsidies directly to qualified health plans for enrolled eligible individuals.
Proposed law directs the department to pursue strategies that promote insurance coverage
of children in their parents' or caregivers' plan, including children eligible for the LaCHIP.
Proposed law directs the department to provide every Louisiana citizen whose income is at
or below 138% of the federal poverty level Medicaid coverage or access to health insurance
with essential health benefits as provided by federal law.
Proposed law further directs the department to 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 2015 or 2016. SB NO. 107
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(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 of all 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 state may implement cost sharing and co-pays, as a condition of
participation, for program participants whose earnings shall exceed 50% of the applicable
federal poverty level.
Proposed law provides that the department shall recommend appropriate adjustments in
funding to the legislature. Proposed law further provides that adjustments shall be made by
the legislature as appropriate.
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, 2015, 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 major barriers to access to health care by Medicaid enrollees of this
state and participants in the Louisiana Health Care Independence Program, and
recommendations for policy changes to eliminate such barriers.
(2)Summary of successful initiatives in Louisiana for disease prevention and early
diagnosis and management of chronic conditions among Medicaid enrollees of this
state and participants in the program.
(3)Such other information as the secretary deems appropriate to convey a clear and
sufficiently complete assessment of the impact of the program.
Proposed law requires the Department of Health and Hospitals to make such report publicly
available on its website. SB NO. 107
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Proposed law provides that when federal funding is no longer available to fund 90% of the
total cost of operating the program, the legislature shall have the authority to decide whether
to continue the program.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:979.1-979.6)