HLS 19RS-618 ORIGINAL
2019 Regular Session
HOUSE BILL NO. 390
BY REPRESENTATIVE WHITE
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
MEDICAID: Relative to reimbursement rates paid to providers of disability services
1 AN ACT
2To enact Part II-A of Chapter 5-E of Title 40 of the Louisiana Revised Statutes of 1950, to
3 be comprised of R.S. 40:1250.1 through 1250.41, relative to services for persons
4 with disabilities; to provide relative to Medicaid reimbursement rates paid to such
5 providers by the Louisiana Department of Health; to establish procedures by which
6 the department shall set such rates; to provide for factors and data elements to be
7 utilized in the calculation of such rates; to require that rates meet certain conditions
8 and standards for adequacy; to provide for a rate review process; to require the
9 department to publish online and make available in printed form certain information
10 pertaining to rate-setting; to provide for legislative findings and intent; to provide for
11 definitions; to require administrative rulemaking; and to provide for related matters.
12Be it enacted by the Legislature of Louisiana:
13 Section 1. Part II-A of Chapter 5-E of Title 40 of the Louisiana Revised Statutes of
141950, comprised of R.S. 40:1250.1 through 1250.41, is hereby enacted to read as follows:
15 PART II-A. DISABILITY SERVICE PROVIDER REIMBURSEMENT
16 SUBPART A. GENERAL PROVISIONS
17 §1250.1. Short title
18 This Part shall be known and may be cited as the "Disability Services
19 Reimbursement Rate Act".
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1 §1250.2. Legislative findings; declaration
2 A. The legislature hereby finds all of the following:
3 (1) Access to quality services for persons with developmental, intellectual,
4 age-related, or physical disabilities furnished by private providers is essential for the
5 health, safety, and well being of those persons.
6 (2) Reliable and sufficient Medicaid reimbursement rates for private
7 providers are necessary to create and maintain a sustainable statewide system of
8 services for eligible individuals with disabilities.
9 (3) A statewide system of services is sustainable only if reimbursement rates
10 are sufficient to enlist providers in numbers great enough to allow eligible
11 individuals a choice among different providers who are capable of delivering quality
12 services that will meet the assessed needs of those individuals in a timely manner.
13 (4) Historically, instabilities in provider networks and systems of services
14 in various states resulted in decades of litigation in federal courts challenging
15 reimbursement rates set by state Medicaid agencies for providers of disability
16 services; in April of 2015, the United States Supreme Court, in Armstrong v.
17 Exceptional Child Center, Inc., 135 S.Ct. 1378 (2015), foreclosed further use of the
18 federal courts for guidance and remedies relating to such reimbursement rates.
19 B. The legislature hereby declares that this state must take steps to foster and
20 maintain a robust network that attracts and retains quality providers which are
21 capable of maintaining a stable workforce and are sufficient in number to allow for
22 meaningful choices among providers by individuals eligible to receive disability
23 services.
24 §1250.3. Purposes; intent; construction
25 A. The purposes of this Part are to provide for a reliable legal framework to
26 guide the Louisiana Department of Health, or any successor state Medicaid agency,
27 in setting reimbursement rates for providers of disability services for persons with
28 developmental, intellectual, age-related, or physical disabilities.
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1 B. The intent of this Part is to supplement the requirements of Medicaid law
2 applicable to reimbursement rates for services provided to persons with disabilities.
3 C.(1) This Part, being necessary for the welfare of the people of this state,
4 shall be liberally construed so as to effect its purposes.
5 (2) Nothing in this Part shall be construed to limit the rights or remedies to
6 which recipients or providers may be entitled under other applicable laws.
7 §1250.4. Definitions
8 As used in this Part, the following terms have the meaning ascribed to them
9 in this Section:
10 (1) "Department" means the Louisiana Department of Health.
11 (2) "Direct support professional" means an individual who works directly
12 with a person with a developmental, intellectual, age-related, or physical disability
13 to provide a service or a component of a service as an employee or independent
14 contractor of a provider.
15 (3) "Methodology" means the aggregate of methods, principles, assumptions,
16 variables, factors, and procedures used to determine a reimbursement rate.
17 (4) "Personal planning process" means a process of planning with a recipient
18 for the identification of needs and coordination and delivery of services that reflect
19 the personal preferences of the recipient.
20 (5) "Provider" means a person, public agency, nonprofit corporation, or a
21 for-profit business entity that provides services under a contract or other agreement
22 with the department.
23 (6) "Rate" means the amount of money per unit of time for a service
24 performed or the amount of money for a service performed for a flat fee, such as a
25 per diem.
26 (7) "Rebasing" means using cost report information to adjust reimbursement
27 rates to the level dictated by the reimbursement methodology for each covered
28 service.
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1 (8) "Recipient" means a person with a developmental, intellectual, age-
2 related, or physical disability receiving services from the department or a provider.
3 (9) "Reimbursement" means payment for a service in accordance with a
4 specified rate.
5 (10) "Restructure" means any alteration in the methodology used to
6 determine a rate.
7 (11) "Service" means a home- or community-based service, intermediate
8 care facility service, or support coordination service provided to a recipient by a
9 provider under a contract or other agreement with the department, regardless of
10 whether the service is funded in whole or in part by Medicaid.
11 (12) "Service plan" means a plan resulting from the personal planning
12 process for the delivery and coordination of specific authorized services to a
13 recipient.
14 (13) "Staff-to-recipient ratio" means a ratio reflecting the number of direct
15 support professionals designated to provide a service for one or more recipients.
16 (14) "Stakeholder" means a recipient, a parent or guardian of a recipient, any
17 provider, and any association or organization representing or advocating on behalf
18 of providers, recipients, or parents or guardians of recipients.
19 SUBPART B. RATE DESIGN AND METHODOL OGY
20 §1250.11. Rate design
21 A. The department shall design all rate-setting processes and methodologies
22 to ensure that recipients have adequate access to services that satisfy all applicable
23 standards and requirements of federal and state law for efficiency, economy, and
24 quality of care. Such rate-setting processes and methodologies shall comply with the
25 procedures, standards, and requirements provided in this Part.
26 B. The department shall consider innovative rate and payment structures
27 designed to promote improvements in quality, adequacy, access, and sufficiency, and
28 shall develop measures to assess the effectiveness of such rate and payment
29 structures.
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1 §1250.12. Rate methodology
2 A. The department shall establish all rates by a methodology that specifies
3 and describes all factors, procedures, methods, and data used or considered in
4 developing the respective rates, including but not limited to sources and methods of
5 data collection, staff-to-recipient ratios, standards of reliability, formulas,
6 calculations, assumptions, and variables.
7 B. The department shall design the methodology to ensure that all rates meet
8 the sufficiency standards provided in R.S. 40:1250.14.
9 C. All data used or relied on in the methodology shall be reliable in
10 accordance with standard principles of data reliability. No cost data that is more than
11 two years old shall be deemed reliable.
12 D. The department shall ensure that its methodology results in rates that
13 satisfy all of the following conditions:
14 (1) The rates allow for all recipients to have a choice of quality providers for
15 each service offered.
16 (2) The rates allow all recipients to access services in a timely manner.
17 (3) The rates allow services to be provided in the most integrated setting for
18 recipients, consistent with the holdings of the Supreme Court in Olmstead v. L.C.,
19 527 U.S. 581 (1999), and the Americans with Disabilities Act of 1990, as amended
20 (42 U.S.C. 12101 et seq.).
21 (4) The rates can be incorporated consistently in both fee-for-service
22 Medicaid and Medicaid managed care programs, and under both Medicaid waiver
23 and Medicaid state plan authorities.
24 (5) The rates are sufficient to enlist a range of willing providers who are able
25 to retain a qualified and stable workforce and take into account all other applicable
26 workforce measures provided in R.S. 40:1250.14(4).
27 (6) The rates are subject to a review process that includes input from
28 stakeholders and assesses the adequacy of access to services financed by the rates.
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1 E. The department shall consider payment structures that ensure quality and
2 value and improve adequacy, access, and sufficiency.
3 F. In connection with its design and implementation of the rate methodology
4 required in this Section, the department shall develop a reporting system that
5 disaggregates data by geography and demography and features specific information
6 on access to services for population subgroups including, without limitation, people
7 with developmental, intellectual, age-related, or physical disabilities.
8 §1250.13. Cost data; requirements
9 All rates shall be set based on reliable data of the actual or reasonably
10 estimated costs of providing the service to be reimbursed. Such costs shall include,
11 as applicable to the rate, all employee wages, benefits, qualifications, and training
12 costs; staff-to-recipient ratios; equipment and vehicle costs; and costs of operating,
13 maintaining, and managing a residential setting including taxes, administrative costs,
14 and overhead costs, but excluding unreimbursed room and board costs.
15 §1250.14. Rate uniformity
16 Rates for similar services and supports shall be uniform in order to ensure
17 that all providers receive the same rate for the same service for individuals with the
18 same or similar needs, subject to reasonable adjustments for documented geographic
19 variations in cost data.
20 SUBPART C. MONITORING AND RATE ADJUSTMENT
21 §1250.21. Monitoring for adequacy and quality of services
22 A. The department shall maintain reliable data in a form that permits
23 ongoing monitoring of factors that may be indicators of the adequacy of access to
24 and quality of services that are subject to reimbursement rates. Such factors shall
25 include all of the following:
26 (1) The numbers of individuals on wait lists who are eligible for services.
27 (2) The frequency and duration of delays in recipient placement with
28 providers.
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1 (3) The number and suitability of vendor responses to calls for recipient
2 placements.
3 (4) The compiled number and character of unmet needs documented by
4 personal planning processes for all recipients.
5 (5) The frequency and levels of crisis service usage and critical incident
6 reporting.
7 (6) The frequency and character of recipient grievances and complaints filed.
8 (7) The levels of provider enrollment and participation.
9 (8) The turnover and vacancy rates of direct support professionals.
10 (9) The frequency and character of provider appeals and complaints filed.
11 B. The department shall maintain reliable data in a form that permits ongoing
12 monitoring of trending factors that may affect the sufficiency of rates. Such factors
13 shall include, without limitation, trends in cost of living and other economic indexes,
14 wage rates, and changes in regulatory and policy requirements affecting provider
15 costs.
16 C. The department may require reasonable, periodic financial reports from
17 providers as needed to ensure the availability of reliable cost data. The department
18 shall consult and collaborate with providers to develop reasonable financial reporting
19 requirements.
20 §1250.22. Annual review of rates
21 The department shall conduct annual reviews of all rates by service category
22 and shall make a determination of the level of sufficiency of each rate based on a
23 review of all pertinent data including the factors identified in R.S. 40:1250.21(A) and
24 (B).
25 §1250.23. Rate adjustment; procedures
26 A. The department shall follow all procedures provided in this Section when
27 adjusting rates.
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1 B. The department shall rebase rates at least once every two years using the
2 most recent audited cost report data available per the prescribed reimbursement
3 methodology calculations for each covered service.
4 C. The department shall trend reimbursement rates forward annually for all
5 years between rate rebasing using the appropriate health market basket inflation
6 index.
7 SUBPART D. REPORT TO LEGISLATURE
8 §1250.31. Annual report to the legislature
9 A. The department shall provide an annual report concerning disability
10 service provider rates to the House Committee on Appropriations, the Senate
11 Committee on Finance, and the legislative committees on health and welfare no later
12 than forty-five days prior to the convening of each regular session of the legislature.
13 The report shall encompass all determinations of sufficiency or insufficiency of rates
14 made under the most recent annual review conducted by the department.
15 B. Upon request of any legislative committee identified in Subsection A of
16 this Section, the secretary of the department or his designee shall appear in person
17 before the committee to present the report required by this Section.
18 SUBPART E. RULEMAKING
19 §1250.41. Administrative rulemaking; limitation on emergency rules
20 A. The department shall promulgate all such rules in accordance with the
21 Administrative Procedure Act as are necessary to implement the provisions of this
22 Part.
23 B. Except in cases in which the conditions for adoption of an emergency rule
24 provided in R.S. 49:953(B)(1)(a) are satisfied, the department shall promulgate all
25 rules for implementation of the provisions of this Part through the notice process
26 provided for in R.S. 49:953(A).
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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 390 Original 2019 Regular Session White
Abstract: Requires the La. Department of Health to Relative to develop Medicaid
reimbursement rates paid to providers of disability services according to certain
guidelines.
Proposed law provides that its purpose is to provide for a reliable legal framework to guide
the La. Department of Health (LDH) in setting reimbursement rates for providers of
disability services for persons with developmental, intellectual, age-related, or physical
disabilities.
Proposed law requires LDH to design all processes and methodologies for setting Medicaid
reimbursement rates for providers of disability services to ensure that service recipients have
adequate access to services that satisfy all applicable standards and requirements of federal
and state law for efficiency, economy, and quality of care. Requires LDH to consider
innovative rate and payment structures designed to promote improvements in quality,
adequacy, access, and sufficiency, and to develop measures to assess the effectiveness of
such rate and payment structures.
Proposed law requires LDH to establish all rates by a methodology that specifies and
describes all factors, procedures, methods, and data used or considered in developing the
respective rates, including but not limited to sources and methods of data collection,
staff-to-recipient ratios, standards of reliability, formulas, calculations, assumptions, and
variables. Stipulates that all data used or relied on in the methodology shall be reliable in
accordance with standard principles of data reliability, and that no cost data that is more than
two years old shall be deemed reliable.
Proposed law requires LDH to ensure that its methodology results in rates that satisfy all of
the following conditions:
(1)The rates allow for all recipients to have a choice of quality providers for each
service offered.
(2)The rates allow all recipients to access services in a timely manner.
(3)The rates allow services to be provided in the most integrated setting for recipients,
consistent with the holdings of the Supreme Court in Olmstead v. L.C. and the
Americans with Disabilities Act.
(4)The rates can be incorporated consistently in both fee-for-service Medicaid and
Medicaid managed care programs, and under both Medicaid waiver and Medicaid
state plan authorities.
(5)The rates are sufficient to enlist a range of willing providers who are able to retain
a qualified and stable workforce.
(6)The rates are subject to a review process that includes input from stakeholders and
assesses the adequacy of access to services financed by the rates.
Proposed law provides that in connection with its design and implementation of the rate
methodology required in proposed law, LDH shall develop a reporting system that
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disaggregates data by geography and demography and features specific information on
access to services for population subgroups including, without limitation, people with
developmental, intellectual, age-related, or physical disabilities.
Proposed law requires all rates to be set based on reliable data of the actual or reasonably
estimated costs of providing the service to be reimbursed. Provides that such costs shall
include, as applicable to the rate, all employee wages, benefits, qualifications, and training
costs; staff-to-recipient ratios; equipment and vehicle costs; and costs of operating,
maintaining, and managing a residential setting including taxes, administrative costs, and
overhead costs, but excluding unreimbursed room and board costs.
Proposed law provides that rates for similar services and supports shall be uniform in order
to ensure that all providers receive the same rate for the same service for individuals with
the same or similar needs, subject to reasonable adjustments for documented geographic
variations in cost data.
Proposed law requires LDH to maintain reliable data in a form that permits ongoing
monitoring of factors that may be indicators of the adequacy of access to and quality of
services that are subject to reimbursement rates. Provides that such factors shall include all
of the following:
(1)The numbers of individuals on wait lists who are eligible for services.
(2)The frequency and duration of delays in recipient placement with providers.
(3)The number and suitability of vendor responses to calls for recipient placements.
(4)The compiled number and character of unmet needs documented by personal
planning processes for all recipients.
(5)The frequency and levels of crisis service usage and critical incident reporting.
(6)The frequency and character of recipient grievances and complaints filed.
(7)The levels of provider enrollment and participation.
(8)The turnover and vacancy rates of direct support professionals.
(9)The frequency and character of provider appeals and complaints filed.
Proposed law requires LDH to maintain reliable data in a form that permits ongoing
monitoring of trending factors that may affect the sufficiency of rates such as trends in cost
of living and other economic indexes, wage rates, and changes in regulatory and policy
requirements affecting provider costs.
Proposed law authorizes LDH to require reasonable, periodic financial reports from
providers as needed to ensure the availability of reliable cost data. Requires LDH to consult
and collaborate with providers to develop reasonable financial reporting requirements.
Proposed law requires LDH to conduct annual reviews of all rates by service category and
make a determination of the level of sufficiency of each rate based on a review of all
pertinent data.
Proposed law requires LDH to rebase rates at least once every two years using the most
recent audited cost report data available per the prescribed reimbursement methodology
calculations for each covered service. Requires LDH to trend reimbursement rates forward
annually for all years between rate rebasing using the appropriate health market basket
inflation index.
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Proposed law requires LDH to provide an annual report to the House Committee on
Appropriations, the Senate Committee on Finance, and the legislative committees on health
and welfare which encompasses all determinations of sufficiency or insufficiency of rates
made under its most recent annual review.
(Adds R.S. 40:1250.1-1250.41)
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