HLS 18RS-1556 ENGROSSED
2018 Regular Session
HOUSE BILL NO. 734 (Substitute for House Bill No. 238 by Representative McFarland)
BY REPRESENTATIVE MCFARLAND
MEDICAID: Requires reporting of data on healthcare provider claims submitted to
Medicaid managed care organizations
1 AN ACT
2To enact Subpart E of Part XIII of Chapter 3 of Title 46 of the Louisiana Revised Statutes
3 of 1950, to be comprised of R.S. 46:460.91, relative to the state medical assistance
4 program known commonly as Medicaid; to require the Louisiana Department of
5 Health to submit reports to certain legislative committees concerning the Medicaid
6 managed care program; to provide for the content of the reports; to establish a
7 reporting schedule; and to provide for related matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. Subpart E of Part XIII of Chapter 3 of Title 46 of the Louisiana Revised
10Statutes of 1950, comprised of R.S. 46:460.91, is hereby enacted to read as follows:
11 SUBPART E. CLAIMS PROCESSING DATA - REPORTING
12 ยง460.91. Claims processing data; reports to legislative committees
13 A. On a quarterly basis, the department shall produce and submit to the Joint
14 Legislative Committee on the Budget and the House and Senate committees on
15 health and welfare a report entitled the "Healthy Louisiana Quarterly Report" which
16 conforms with the requirements of this Subpart.
17 B. The report shall include the following data on healthcare provider claims
18 delineated by individual Medicaid managed care organization and separated by
19 provider type:
Page 1 of 5
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 18RS-1556 ENGROSSED
HB NO. 734
1 (1) The following data on claims submitted by all healthcare providers
2 except behavioral health providers:
3 (a) The total number and dollar amount of claims for which there was at least
4 one denied claim line.
5 (b) The total number and dollar amount of completely denied claims.
6 (c) The total number and dollar amount of claims adjudicated in the
7 reporting period.
8 (d) The total number and dollar amount of denied claims divided by the total
9 number and dollar amount of claims adjudicated.
10 (e) The total number and dollar amount of adjusted claims.
11 (f) The total number and dollar amount of voided claims.
12 (g) The total number and dollar amount of duplicate claims.
13 (h) The total number and dollar amount of rejected claims.
14 (i) The total number and dollar amount of pended claims.
15 (j) For each of the five network billing providers with the highest number of
16 total denied claims, the number of total denied claims expressed as a ratio to all
17 claims adjudicated and the total dollar value of the claims.
18 (2) The following data on claims submitted by behavioral health providers:
19 (a) The total number and dollar amount of claims for which there was at least
20 one denied claim line.
21 (b) The total number and dollar amount of completely denied claims.
22 (c) The total number and dollar amount of claims adjudicated in the
23 reporting period.
24 (d) The total number and dollar amount of denied claims divided by the total
25 number and dollar amount of claims adjudicated.
26 (e) The total number and dollar amount of adjusted claims.
27 (f) The total number and dollar amount of voided claims.
28 (g) The total number and dollar amount of duplicate claims.
29 (h) The total number and dollar amount of rejected claims.
Page 2 of 5
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 18RS-1556 ENGROSSED
HB NO. 734
1 (i) The total number and dollar amount of pended claims.
2 (j) For each of the five network billing providers with the highest number of
3 total denied claims, the number of total denied claims expressed as a ratio to all
4 claims adjudicated and the total dollar value of the claims.
5 C. The report shall feature a narrative which includes, at minimum, the
6 action steps which the department plans to take in order to address all of the
7 following:
8 (1) The five most common reasons for denial of claims submitted by
9 healthcare providers other than behavioral health providers, including provider
10 education to the five network billing providers with the highest number of total
11 denied claims.
12 (2) The five most common reasons for denial of claims submitted by
13 behavioral health providers, including provider education to the five network billing
14 providers with the highest number of total denied claims.
15 (3) Means to ensure that provider education addresses root causes of denied
16 claims and actions to address those causes.
17 (4) Claims denied in error by managed care organizations.
18 D. The report shall include all of the following data relating to encounter
19 claims:
20 (1) The total number of encounter claims submitted by each Medicaid
21 managed care organization to the state or its designee.
22 (2) The total number of encounter claims submitted by each Medicaid
23 managed care organization that are not accepted by the department or its designee.
24 E. The report shall include the following information relating to case
25 management delineated by Medicaid managed care organization:
26 (1) The total number of Medicaid enrollees receiving case management
27 services.
28 (2) The total number of Medicaid enrollees receiving case management
29 services delineated by underlying reason for receiving those services.
Page 3 of 5
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 18RS-1556 ENGROSSED
HB NO. 734
1 (3) The total number of Medicaid enrollees eligible for case management
2 services.
3 Section 2. The secretary of the Louisiana Department of Health shall take such
4actions as are necessary to ensure that the first quarterly report required by R.S. 46:460.91,
5as enacted by Section 1 of this Act, is submitted to the Joint Legislative Committee on the
6Budget and the House and Senate committees on health and welfare on or before October
71, 2018, and reflects April 1, 2018 through June 30, 2018 of the contract period. The
8department shall submit each successive quarterly report on or before the first day of each
9state fiscal year quarter following the date of the first report.
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 734 Engrossed 2018 Regular Session McFarland
Abstract: Requires the La. Dept. of Health to report data on healthcare provider claims
submitted to Medicaid managed care organizations.
Proposed law requires the La. Dept. of Health (LDH), on or before Oct. 1, 2018, and on a
quarterly basis thereafter, to produce and submit to the Joint Legislative Committee on the
Budget and the House and Senate committees on health and welfare a report concerning the
Medicaid managed care program, to be entitled the "Healthy Louisiana Quarterly Report".
Proposed law requires that the report include the following data on healthcare provider
claims delineated by individual Medicaid managed care organization and separated by
provider type:
(1)The total number and dollar amount of claims for which there was at least one denied
claim line.
(2)The total number and dollar amount of completely denied claims.
(3)The total number and dollar amount of claims adjudicated in the reporting period.
(4)The total number and dollar amount of denied claims divided by the total number
and dollar amount of claims adjudicated.
(5)The total number and dollar amount of adjusted claims.
(6)The total number and dollar amount of voided claims.
(7)The total number and dollar amount of duplicate claims.
(8)The total number and dollar amount of rejected claims.
(9)The total number and dollar amount of pended claims.
Page 4 of 5
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 18RS-1556 ENGROSSED
HB NO. 734
(10)For each of the five network billing providers with the highest number of total denied
claims, the number of total denied claims expressed as a ratio to all claims
adjudicated and the total dollar value of the claims.
Proposed law requires that LDH report the data specified in proposed law separately for the
following provider groups:
(1)Behavioral health providers.
(2)All other providers, collectively.
Proposed law requires that the report feature a narrative which includes, at minimum, the
action steps which LDH plans to take in order to address all of the following:
(1)The five most common reasons for denial of claims submitted by healthcare
providers other than behavioral health providers, including provider education to the
five network billing providers with the highest number of total denied claims.
(2)The five most common reasons for denial of claims submitted by behavioral health
providers, including provider education to the five network billing providers with the
highest number of total denied claims.
(3)Means to ensure that provider education addresses root causes of denied claims and
actions to address those causes.
(4)Claims denied in error by managed care organizations.
Proposed law requires that the report include all of the following data relating to encounter
claims:
(1)The total number of encounter claims submitted by each Medicaid managed care
organization to the state or its designee.
(2)The total number of encounter claims submitted by each Medicaid managed care
organization that are not accepted by LDH or its designee.
Proposed law requires that the report include the following information relating to case
management delineated by Medicaid managed care organization:
(1)The total number of Medicaid enrollees receiving case management services.
(2)The total number of Medicaid enrollees receiving case management services
delineated by underlying reason for receiving those services.
(3)The total number of Medicaid enrollees eligible for case management services.
(Adds R.S. 46:460.91)
Page 5 of 5
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.