HLS 17RS-888 ENGROSSED
2017 Regular Session
HOUSE CONCURRENT RESOL UTION NO. 8
BY REPRESENTATIVE BARRAS
HOSPITALS: Provides for a hospital stabilization formula
1 A CONCURRENT RESOL UTION
2To provide for a hospital stabilization formula pursuant to Article VII, Section 10.13 of the
3 Constitution of Louisiana; to establish the level and basis of hospital assessments;
4 to establish certain reimbursement enhancements for inpatient and outpatient hospital
5 services; to establish certain criteria for the implementation of the formula; and to
6 provide for related matters.
7 WHEREAS, through the adoption of this Resolution, the Legislature of Louisiana
8hereby seeks to:
9 (1)Preserve and enhance the availability of inpatient and outpatient hospital
10 services for the citizens of Louisiana.
11 (2)Preserve and protect rural hospitals as provided in the Rural Hospital
12 Preservation Act, pursuant to R.S. 40:1189.1 et seq.
13 (3)Enhance the stability of hospital funding by utilizing a fiscally-prudent
14 healthcare driven solution that does not rely on the use of state general fund
15 and provides a reliable and recurring source of funding for healthcare
16 services.
17 (4)Minimize the effects of shifting the cost of caring for those Louisiana
18 residents who are uninsured to those who are able to obtain health insurance.
19 (5)Create flexibility to design a plan to provide for more efficient and effective
20 ways to maximize the state's use of monies currently expended for the
21 provision of healthcare services to the state's low income and uninsured
22 residents.
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1 THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby
2enact the annual hospital stabilization formula pursuant to Article VII, Section 10.13 of the
3Constitution of Louisiana:
4 I. Hospital Stabilization Assessment.
5 A. The Louisiana Department of Health shall calculate, levy, and collect an
6 assessment for each assessed hospital in accordance with Subsection B of this
7 Section if all of the following occur:
8 (1) The applicable federal financial participation, as set forth in 42 U.S.C.
9 1396d(y) of Title XIX of the Social Security Act, is less than one hundred percent.
10 (2) The Louisiana Department of Health has submitted a Medicaid
11 assessment report to the Joint Legislative Committee on the Budget. The Medicaid
12 assessment report shall include a description of the proposed assessment, the basis
13 for the calculation of the assessment, and a listing of each hospital included in the
14 proposed assessment.
15 B.(1) The total assessment for the state fiscal year 2017-2018 shall not
16 exceed the lesser of the following:
17 (a) The state portion of the cost of the reimbursement enhancements
18 provided for in Subsection A of Section II of this Resolution which are directly
19 attributable to payments to hospitals, excluding any federal financial participation
20 and any costs associated with Full Medicaid Pricing.
21 (b) One percent of the total inpatient and outpatient hospital net patient
22 revenue of all hospitals included in the assessment, as reported in the Medicare cost
23 report ending in state fiscal year 2015.
24 (2) The Louisiana Department of Health shall allocate, levy, and collect the
25 assessment in accordance with the provisions of the Louisiana Administrative Code
26 48:I.4001(F)(2) through (4) as published in Volume 42, Number 11, of the Louisiana
27 Register and with Subsection B of this Section. Any hospital meeting the definition
28 of a rural hospital as defined in R.S. 40:1189.3 shall be excluded from the
29 assessment.
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1 (3) The Louisiana Department of Health shall publish on a quarterly basis,
2 no later than thirty days after the end of each quarter, a report containing data
3 directly related to the revenue enhancement provided for in Subsection A of Section
4 II of this Resolution. The report shall include the following:
5 (a) Total Medicaid enrollment on a monthly basis.
6 (b) The average monthly premium paid to managed care organizations
7 providing benefits and services to eligible Medicaid enrollees and the portion of
8 premium related to hospital payments included in this assessment.
9 (c) The aggregate Medicaid claims payment by provider type.
10 (d) The total amount of inpatient and outpatient Medicaid claims paid to
11 hospitals delineated by individual hospital.
12 II. Reimbursement Enhancements.
13 The Louisiana Department of Health shall provide for reimbursement
14 enhancements as follows:
15 (A) Payment for healthcare services through the implementation of a health
16 coverage expansion of the Louisiana medical assistance program that meets all the
17 requirements necessary for the state to maximize federal matching funds as set forth
18 in 42 U.S.C. 1396d(y) of Title XIX of the Social Security Act.
19 (B) Payment of hospital reimbursement rates in an amount no less than the
20 greater of the following:
21 (1) The reimbursement rates in effect for dates of service on or after January
22 1, 2017, as provided for in State Plan Amendments TN 17-004 and TN 17-006.
23 (2) For dates of service on or after January 1, 2018, for:
24 (a) Inpatient reimbursement rates indexed as follows to the highest non-state
25 hospital per diem rate in effect on January 1, 2017, excluding carve-out specialty
26 intensive care units and any graduate medical education portion of the per diem:
27 (i) Long-term acute hospitals indexed to forty-two percent.
28 (ii) Separately licensed, Medicare designated, rehabilitation hospitals indexed
29 to thirty-six percent.
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1 (iii) Distinct part psychiatric units and freestanding psychiatric hospitals
2 indexed to thirty-one percent.
3 (iv) General acute hospitals, excluding carve-out specialty intensive care
4 units, burn units, and nursery boarder and well baby services, indexed to fifty-six
5 percent.
6 (b) Outpatient reimbursement rates which were in effect on June 30, 2010.
7 III. Administration
8 The Louisiana Department of Health shall submit any necessary state plan
9 amendment that may be required in order to implement the provisions of this
10 Resolution to the Centers for Medicare and Medicaid Services no later than one
11 hundred and twenty days from the date this Resolution is adopted.
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)]
HCR 8 Engrossed 2017 Regular Session Barras
Provides for a hospital stabilization formula pursuant to Art. VII, ยง10.13 of the Constitution
of La., including an assessment and reimbursement enhancements.
Requires the La. Dept. of Health (LDH) to calculate, collect, and levy an assessment from
hospitals not to exceed the lesser of one of the following:
(1)The state portion of the cost of the reimbursement enhancements from the payment
for healthcare services through the implementation of Medicaid expansion which are
directly attributable to payments to hospitals, excluding any federal financial
participation and supplemental Medicaid payments.
(2)1% of the total net patient revenue of all hospitals included in the assessment, as
reported in the Medicare cost report ending in state FY 2015.
Provides for the assessment if the following occur:
(1)The applicable federal financial participation for newly eligible Medicaid recipients
under Medicaid expansion is less than 100%.
(2)LDH submits a medicaid assessment report to the Joint Legislative Committee on
the Budget.
Provides for reimbursement enhancements as follows:
(1)Payment for healthcare services through the implementation of Medicaid expansion.
(2)Payment of hospital reimbursement rates in an amount no less than the greater of the
following:
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(a)The reimbursement rates in effect for dates of service on or after Jan. 1,
2017, as provided for in State Plan Amendments TN 17-004 and TN 17-006.
(b)For dates of service on or after Jan. 1, 2018, for inpatient reimbursement
rates indexed to the highest non-state hospital per diem rate in effect on Jan.
1, 2017, excluding carve-out specialty intensive care units and any graduate
medical education portion of the per diem, and outpatient reimbursement
rates which were in effect on June 30, 2010.
Requires LDH to publish a report quarterly that includes total Medicaid enrollment, average
monthly Medicaid managed care premium rates, aggregate claims by provider, and the total
amount of hospital claims by hospital.
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Appropriations to the
original bill:
1. Clarify that rural hospitals are excluded from the assessment.
2. Provide that in determining the inpatient reimbursement rates, the highest non-
state hospital per diem is used, the per diem rates used in the determination were
in effect on Jan. 1, 2017, and the specialty intensive care unit portion of the per
diem is excluded.
3. Specify the determination of the inpatient reimbursement rates for separately
licensed rehabilitation hospitals is for hospitals that are Medicare designated.
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