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 566 Original 2016 Regular Session Richard
Abstract: Requires DHH, 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.
Proposed law defines key terms used in proposed law including "cost sharing", "emergency room",
"Medicaid", and "medical assistance program".
Proposed law requires DHH to develop and implement each cost sharing function applicable to the
Medicaid program of this state as authorized by federal regulations to Medicaid enrollees who are
not specifically exempted from such cost sharing functions, such as children, pregnant women, and
institutionalized individuals.
Proposed law requires DHH to set the amount of each cost assigned to nonexempt Medicaid
enrollees at a level allowed by federal Medicaid regulations which maximizes the net savings to the
state resulting from the respective cost sharing function. Proposed law prohibits DHH from
instituting a cost sharing function for which the administrative costs of implementing the function
would exceed the savings estimated to result from the function.
Proposed law requires DHH, whenever a cost sharing function is added, deleted, expanded, limited,
or otherwise revised by the Centers for Medicare and Medicaid Services, to revise and reinstate
pertinent Medicaid policies correspondingly to provide for the cost sharing functions and their
respective levels.
Proposed law establishes a limit for coverage for nonemergency use of a hospital emergency room
for any healthcare 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.
Proposed law requires DHH to promulgate all rules and regulations, submit any Medicaid state plan
amendments, and take all other actions as are necessary to institute the Medicaid cost sharing functions required by proposed law.
Effective upon signature of governor or lapse of time for gubernatorial action.
(Adds R.S. 46:460.101-460.122)