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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2014
SENATE BILL NO. 349
BY SENATOR MORRELL
MEDICAID. Provides relative to Medicaid managed long term care support and services.
(gov sig)
AN ACT1
To enact Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be2
comprised of R.S. 46:460.91, relative to Medicaid; to provide for Medicaid managed3
long term care supports and services; to provide definitions; to provide relative to4
request for proposals; to provide for requirements of the Department of Health and5
Hospitals; to provide for an effective date; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of8
1950, comprised of R.S. 46:460.91, is hereby enacted to read as follows: 9
PART XIV. MEDICAID MANAGED LONG TERM CARE SUPPORTS10
AND SERVICES11
ยง460.91. Medicaid managed care long term care supports and services;12
definition; request for proposal13
A. For the purposes of this Part, the following terms shall have the14
following meanings:15
(1) "Louisiana HMO" shall mean a health maintenance organization16
that meets the following criteria:17 SB NO. 349
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(a) Offers fully insured commercial and/or Medicare Advantage1
products.2
(b) Is domiciled, licensed, and has been operating within the state for not3
less than ten years.4
(c) Maintains its primary corporate office and at least seventy percent5
of its employees within the state.6
(d) Maintains within the state its core business functions that shall7
include but not be limited to utilization review services, claims payment8
processes, customer service call centers, enrollment services, information9
technology services, and provider relations.10
(2) "Medicare Advantage plan" means a type of Medicare health plan11
offered by a private company that contracts under the Medicare program to12
provide an individual with Part A and Part B benefits.13
B. The secretary of the Department of Health and Hospitals may issue14
a request for proposals or any type of competitive process authorized by law to15
identify and contract with health maintenance organizations to provide for a16
comprehensive managed care program for Louisiana residents eligible for17
Medicaid and receiving long term care supports and services provided for in the18
Medicaid state plan.19
C. A Louisiana HMO submitting a competitive proposal to a20
Department of Health and Hospitals' request for proposal pursuant to21
Subsection B shall participate in such a program for Medicaid managed long22
term care supports and services. However, if three or more Louisiana HMOs23
submit competitive proposals to a Department of Health and Hospitals' request24
for proposal pursuant to Subsection B, the department shall select at least three25
Louisiana HMOs to participate in such a program for Medicaid managed long26
term care supports and services.27
D.(1) The department shall prohibit any Medicaid recipient28
participating in a Medicare Advantage plan, on or after January 1, 2014, from29 SB NO. 349
SLS 14RS-701 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
being forced to leave his plan if the recipient needs long term care supports and1
services, and if such a plan is not selected to participate in the Medicaid2
managed long term care supports and services program.3
(2) For the provisions of this Subsection, the Department of Health and4
Hospitals shall provide payment to a recipient's Medicare Advantage plan for5
a recipient's long term care supports and services.6
Section 2. This Act shall become effective upon signature by the governor or, if not7
signed by the governor, upon expiration of the time for bills to become law without signature8
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If9
vetoed by the governor and subsequently approved by the legislature, this Act shall become10
effective on the day following such approval.11
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christopher D. Adams.
DIGEST
Morrell (SB 349)
Proposed law defines "Louisiana HMO" to mean a health maintenance organization that
meets the following criteria:
(1)Offers fully insured commercial and/or Medicare Advantage products.
(2)Is domiciled, licensed, and has been operating within the state for not less than ten
years.
(3)Maintains its primary corporate office and at least seventy percent of its employees
within the state.
(4)Maintains within the state its core business functions that shall include but not be
limited to utilization review services, claims payment processes, customer service
call centers, enrollment services, information technology services, and provider
relations.
Proposed law defines Medicare Advantage plan to mean a type of Medicare health plan
offered by a private company that contracts under the Medicare program to provide an
individual with Part A and Part B benefits.
Proposed law provides the secretary of the Department of Health and Hospitals (DHH) may
issue a request for proposals or any type of competitive process authorized by law to identify
and contract with health maintenance organizations to provide for a comprehensive managed
care program for Louisiana residents eligible for Medicaid and receiving long term care
supports and services provided for in the Medicaid state plan.
Proposed law provides a Louisiana HMO submitting a competitive proposal to a DHH's
request for proposal pursuant to proposed law shall participate in such a program for
Medicaid managed care long term care supports and services. However, if three or more SB NO. 349
SLS 14RS-701 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Louisiana HMOs submit competitive proposals to DHH's request for proposal pursuant to
proposed law, DHH shall select at least three Louisiana HMOs to participate in such a
program for Medicaid managed long term care supports and services.
Proposed law provides DHH shall prohibit any Medicaid recipient participating in a
Medicare Advantage plan, on or after January 1, 2014, from being forced to leave his plan
if the recipient needs long term care supports and services, and if such a plan is not selected
to participate in the Medicaid managed long term care supports and services program.
Proposed law provides for DHH shall provide payment to a recipient's Medicare Advantage
plan for a recipient's long term care supports and services.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Adds R.S. 46:460.91)