HLS 16RS-627 ORIGINAL
2016 Regular Session
HOUSE BILL NO. 566
BY REPRESENTATIVE RICHARD
MEDICAID: Requires the Department of Health and Hospitals to institute certain Medicaid
cost containment measures
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 Medicaid cost
4 containment; to provide for legislative findings; to provide for definitions; to require
5 implementation of certain federally authorized cost sharing functions; to limit
6 coverage for certain health services delivered in hospital emergency departments; to
7 provide for rulemaking authority; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of
101950, comprised of R.S. 46:460.101 through 460.122, is hereby enacted to read as follows:
11 PART XIV. MEDICAID COST CONTAINMENT
12 SUBPART A. GENERAL PROVISIONS
13 §460.101. Definitions
14 As used in this Part, the following terms have the meaning ascribed in this
15 Section:
16 (1) "Centers for Medicare and Medicaid Services" means the division of the
17 United States Department of Health and Human Services which regulates the
18 Medicaid program.
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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 of Louisiana does hereby find and declare the following:
14 (1) Medicaid constitutes the largest single programmatic item in the budget
15 of this state.
16 (2) The system of funding for the Medicaid program as currently structured
17 is unsustainable, and cost containment in this major assistance program is an urgent
18 priority of this state.
19 (3) It is the intent of the legislature by enactment of this Part to contain
20 Medicaid program costs while protecting the health of the persons who utilize the
21 program.
22 (4) Limiting Medicaid coverage of nonemergency services delivered in
23 hospital emergency departments is a sensible and fiscally responsible policy as it
24 provides a prudent means of containing Medicaid costs.
25 B. Cost containment measures in the Medicaid program are essential means
26 for enhancing the efficiency and effectiveness of health care delivered to the
27 population served by the program. Therefore the legislature declares that it shall be
28 the policy of this state to pursue all available Medicaid cost containment
29 opportunities authorized by federal law, regulation, and policy.
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HB NO. 566
1 SUBPART B. COST SHARING
2 §460.111. Federally authorized Medicaid cost sharing; implementation
3 A.(1) The secretary shall develop and implement medical assistance program
4 policies which apply each cost sharing function authorized pursuant to federal
5 Medicaid regulations, 42 CFR 447.50 et seq., to Medicaid enrollees who are not
6 specifically exempted from such cost sharing functions by the provisions of Section
7 1916 of the Social Security Act; except the secretary shall not be required to apply
8 any cost sharing function which is based upon an eligibility standard, health service,
9 or any other factor or measure which is not encompassed by the Medicaid program
10 of this state.
11 (2) In implementing the cost sharing functions required in this Subsection,
12 the secretary shall set the amount of each cost assigned to nonexempt Medicaid
13 enrollees at a level allowed by federal Medicaid regulations which maximizes the net
14 savings to the state resulting from the respective cost sharing function. In no case
15 shall the department institute a Medicaid cost sharing function for which it estimates
16 that the administrative costs of implementing the function would exceed the savings
17 estimated to result from the function.
18 (3) Whenever a Medicaid cost sharing function is added, deleted, expanded,
19 limited, or otherwise revised pursuant to rules and regulations promulgated by the
20 Centers for Medicare and Medicaid Services, the secretary shall, as soon as is
21 practicable pursuant to the effective date of such rules or regulations, revise and
22 reinstate pertinent medical assistance program policies correspondingly to provide
23 for such cost sharing functions and their respective levels in accordance with the
24 provisions of Paragraphs (1) and (2) of this Subsection.
25 B. The department shall implement the coverage limitation authorized by 42
26 CFR 447.54 for nonemergency use of a hospital emergency room in accordance with
27 the provisions of Subpart C of this Part.
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1 §460.112. Rules and regulations
2 The secretary shall promulgate all rules and regulations in accordance with
3 the Administrative Procedure Act, submit any Medicaid state plan amendments, and
4 take all other actions as are necessary to institute the Medicaid cost sharing functions
5 provided for in this Subpart.
6 SUBPART C. COVERAGE LIMITATION FOR NONEMERGENCY SERVI CES
7 §460.121. Limitation on coverage for nonemergent conditions
8 The secretary of the department shall develop and implement medical
9 assistance program policies which provide for a prohibition on Medicaid
10 reimbursement for any healthcare service delivered in an emergency room to a
11 Medicaid enrollee when all of the following conditions apply:
12 (1) The service is to treat any health condition classified by Medicaid
13 program policy as nonemergent.
14 (2) The enrollee has been treated in an emergency room for any health
15 condition classified by Medicaid program policy as nonemergent on three separate
16 occasions within the past year, and the Medicaid program provided reimbursement
17 on each occasion for such treatment.
18 §460.122. Rules and regulations
19 The secretary shall promulgate all rules and regulations in accordance with
20 the Administrative Procedure Act, submit any Medicaid state plan amendments, and
21 take all other actions as are necessary to institute the limitation on coverage for
22 nonemergent conditions provided for in this Subpart.
23 Section 2. This Act shall become effective upon signature by the governor or, if not
24signed by the governor, upon expiration of the time for bills to become law without signature
25by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
26vetoed by the governor and subsequently approved by the legislature, this Act shall become
27effective on the day following such approval.
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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)
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