HLS 16RS-711 ORIGINAL
2016 Regular Session
HOUSE BILL NO. 170
BY REPRESENTATIVE TALBOT
MEDICAID: Requires the Dept. of Health and Hospitals to institute Medicaid cost
containment measures to the extent allowed by federal regulations
1 AN ACT
2To enact Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be
3 comprised of R.S. 46:460.101 through 460.122, relative to the medical assistance
4 program of this state commonly known as Medicaid; to provide for duties of the
5 Department of Health and Hospitals with respect to administration of the Medicaid
6 program; to require implementation of certain federally authorized Medicaid cost
7 sharing functions; to restrict Medicaid coverage of nonemergency services delivered
8 in hospital emergency departments; to require promulgation of administrative rules;
9 to provide for findings and definitions; and to provide for related matters.
10Be it enacted by the Legislature of Louisiana:
11 Section 1. Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of
121950, comprised of R.S. 46:460.101 through 460.122, is hereby enacted to read as follows:
13 PART XIV. MEDICAID COST CONTAINMENT
14 SUBPART A. GENERAL PROVISIONS
15 §460.101. Definitions
16 As used in this Part, the following terms have the meaning ascribed in this
17 Section:
18 (1) "Centers for Medicare and Medicaid Services" means the division of the
19 United States Department of Health and Human Services which regulates the
20 Medicaid program.
Page 1 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-711 ORIGINAL
HB NO. 170
1 (2) "Cost sharing" means a contribution that a Medicaid enrollee makes
2 toward the cost of a Medicaid-covered health service which he utilizes, through
3 mechanisms including but not limited to deductibles, copayments, and coinsurance.
4 (3) "Department" means the Department of Health and Hospitals.
5 (4) "Emergency room" means an emergency department operated within a
6 hospital facility licensed pursuant to the Hospital Licensing Law, R.S. 40:2100 et
7 seq.
8 (5) "Medicaid" and "medical assistance program" mean the medical
9 assistance program provided for in Title XIX of the Social Security Act.
10 (6) "Secretary" means the secretary of the Department of Health and
11 Hospitals.
12 §460.102. Legislative findings; declaration
13 A. The legislature hereby finds and affirms the following:
14 (1) From state fiscal year 2007-2008 to state fiscal year 2015-2016:
15 (a) The total annual operating budget of this state decreased by eleven and
16 nine tenths percent.
17 (b) Total expenditures on the Medicaid program of this state increased by
18 forty and nine tenths percent.
19 (c) State expenditures on the Medicaid program increased by ninety-four and
20 seven tenths percent.
21 (d) Medicaid remained the largest single item in Louisiana's operating
22 budget.
23 (2) At over eight billion three hundred eighty million dollars, Medicaid
24 comprises thirty-four and two tenths percent of Louisiana's total operating budget in
25 state fiscal year 2015-2016; whereas Medicaid comprised twenty-one and five tenths
26 percent of the state's operating budget in state fiscal year 2007-2008.
27 (3) Limiting Medicaid coverage of nonemergency services delivered in
28 hospital emergency departments is a sensible and fiscally responsible policy as it
29 provides a prudent means of containing Medicaid costs.
Page 2 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-711 ORIGINAL
HB NO. 170
1 (4) Cost containment measures in the Medicaid program are essential means
2 for enhancing the efficiency and effectiveness of health care delivered to the
3 population served by the program.
4 B. The legislature hereby declares that cost containment in the Medicaid
5 program is an urgent fiscal and public health priority of this state.
6 SUBPART B. COST SHARING
7 §460.111. Federally authorized Medicaid cost sharing; implementation
8 A.(1) The secretary shall develop and implement medical assistance program
9 policies which apply each cost sharing function authorized pursuant to federal
10 Medicaid regulations, 42 CFR 447.50 et seq., to Medicaid enrollees who are not
11 specifically exempted from such cost sharing functions by the provisions of Section
12 1916 of the Social Security Act; except the secretary shall not be required to apply
13 any cost sharing function which is based upon an eligibility standard, health service,
14 or any other factor or measure which is not encompassed by the Medicaid program
15 of this state.
16 (2) In implementing the cost sharing functions required in this Subsection,
17 the secretary shall set the amount of each cost assigned to nonexempt Medicaid
18 enrollees at a level allowed pursuant to 42 CFR 447.50 et seq. which maximizes the
19 net reduction of state Medicaid program expenditures resulting from the respective
20 cost sharing function.
21 (3) Whenever a Medicaid cost sharing function is added, deleted, expanded,
22 limited, or otherwise revised pursuant to rules and regulations promulgated by the
23 Centers for Medicare and Medicaid Services, the secretary shall, as soon as is
24 practicable pursuant to the effective date of such rules or regulations, revise and
25 reinstate pertinent medical assistance program policies correspondingly to provide
26 for such cost sharing functions and their respective levels in accordance with the
27 provisions of Paragraphs (1) and (2) of this Subsection.
Page 3 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-711 ORIGINAL
HB NO. 170
1 B. The department shall implement the coverage limitation authorized by 42
2 CFR 447.54 for nonemergency use of a hospital emergency room in accordance with
3 the provisions of Subpart C of this Part.
4 §460.112. Rules and regulations
5 The secretary shall promulgate all rules and regulations in accordance with
6 the Administrative Procedure Act, submit any Medicaid state plan amendments, and
7 take all other actions as are necessary to institute the Medicaid cost sharing functions
8 provided for in this Subpart.
9 SUBPART C. COVERAGE LIMITATION FOR
10 NONEMERGENCY SERVI CES
11 §460.121. Coverage for nonemergency services; limitation
12 The secretary of the department shall develop and implement medical
13 assistance program policies which provide for a prohibition on Medicaid
14 reimbursement for any health care service delivered in an emergency room to a
15 Medicaid enrollee when all of the following conditions apply:
16 (1) The service is to treat any health condition classified by Medicaid
17 program policy as nonemergent.
18 (2) The enrollee has been treated in an emergency room for any health
19 condition classified by Medicaid program policy as nonemergent on three separate
20 occasions within the past year, and the Medicaid program provided reimbursement
21 on each occasion for such treatment.
22 §460.122. Rules and regulations
23 The secretary shall promulgate all rules and regulations in accordance with
24 the Administrative Procedure Act, submit any Medicaid state plan amendments, and
25 take all other actions as are necessary to institute the limitation on coverage for
26 nonemergent conditions provided for in this Subpart.
27 Section 2. This Act shall become effective upon signature by the governor or, if not
28signed by the governor, upon expiration of the time for bills to become law without signature
29by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
Page 4 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-711 ORIGINAL
HB NO. 170
1vetoed by the governor and subsequently approved by the legislature, this Act shall become
2effective on the day following such approval.
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)]
HB 170 Original 2016 Regular Session Talbot
Abstract: Requires the Dept. of Health and Hospitals, to the extent allowed by federal
regulations, to institute Medicaid cost containment measures including cost sharing
and a limitation on coverage of nonemergency services delivered in hospital
emergency rooms.
General provisions
Proposed law provides the following findings relative to the cost of the Medicaid program:
(1)From state fiscal year 2007-2008 to state fiscal year 2015-2016:
(a)The total annual operating budget of this state decreased by 11.9%.
(b)Total expenditures on the Medicaid program of this state increased by 40.9%.
(c)State expenditures on the Medicaid program increased by 94.7%.
(d)Medicaid remained the largest single item in Louisiana's operating budget.
(2)At over $8,380,000,000, Medicaid comprises 34.2% of Louisiana's total operating
budget in state fiscal year 2015-2016; whereas Medicaid comprised 21.5% of the
state's operating budget in state fiscal year 2007-2008.
Proposed law finds that limiting Medicaid coverage of nonemergency services delivered in
hospital emergency departments is a sensible and fiscally responsible policy as it provides
a prudent means of containing Medicaid costs; and that cost containment measures in the
Medicaid program are essential means for enhancing the efficiency and effectiveness of
health care delivered to the population served by the program.
Proposed law declares that cost containment in the Medicaid program is an urgent fiscal and
public health priority of this state.
Proposed law requires the secretary of the Department of Health and Hospitals (DHH) to
promulgate all rules and regulations, submit any Medicaid state plan amendments, and take
all other actions as are necessary to implement the provisions of proposed law.
Medicaid Cost Sharing
Proposed law requires DHH to develop and implement policies which apply each cost
sharing function authorized pursuant to federal Medicaid regulations, 42 CFR 447.50 et seq.,
to Medicaid enrollees who are not specifically exempted from such cost sharing functions
by federal law; except the secretary shall not be required to apply any cost sharing function
which is based upon an eligibility standard, health service, or any other factor or measure
which is not encompassed by the Medicaid program of this state.
Page 5 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-711 ORIGINAL
HB NO. 170
Functions authorized pursuant to federal Medicaid regulations which proposed law requires
DHH to impose include the following:
(1)Cost sharing for inpatient and outpatient services (42 CFR 447.52).
(2)Cost sharing for preferred and nonpreferred drugs (42 CFR 447.53).
(3)Cost sharing for nonemergency services furnished in a hospital emergency
department (42 CFR 447.54).
(4)Assessment of premiums upon individuals whose income exceeds certain levels
specified in federal regulations (42 CFR 447.55).
Proposed law provides that in implementing the cost sharing functions required in proposed
law, DHH shall set the amount of each cost assigned to nonexempt Medicaid enrollees at a
level allowed by federal regulations which maximizes the net reduction of state Medicaid
program expenditures resulting from the respective cost sharing function.
Proposed law provides that whenever a Medicaid cost sharing function is added, deleted,
expanded, limited, or otherwise revised pursuant to rules and regulations promulgated by the
federal Medicaid agency, DHH shall revise and reinstate the pertinent policies
correspondingly to provide for such cost sharing functions and their respective levels.
Limitation on Medicaid Coverage for Certain Nonemergency Services
Proposed law requires DHH to develop and implement policies which provide for a
prohibition on Medicaid reimbursement for any health care service delivered in an
emergency room to a Medicaid enrollee when all of the following conditions apply:
(1)The service is to treat any health condition classified by Medicaid program policy
as nonemergent.
(2)The enrollee has been treated in an emergency room for any health condition
classified by Medicaid program policy as nonemergent on three separate occasions
within the past year, and the Medicaid program provided reimbursement on each
occasion for such treatment.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:460.101-460.122)
Page 6 of 6
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.