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 Reengrossed 2019 Regular Session White
Abstract: Requires the La. Department of Health to monitor and report to the legislature on
Medicaid reimbursement rates paid to providers of Medicaid-funded services for people with
disabilities.
Proposed law requires the La. Department of Health (LDH) to maintain reliable data in a form that
permits ongoing monitoring of trending factors that may affect the sufficiency of reimbursement
rates paid to providers of Medicaid-funded services for people with disabilities.
Proposed law allows LDH to require reasonable, periodic financial reports from providers as needed
to ensure the availability of reliable cost data. Requires the department to consult and collaborate
with providers to develop reasonable financial reporting requirements.
Proposed law authorizes LDH to conduct annual reviews of all Medicaid reimbursement rates by
disability service category and make a determination of sufficiency of each rate based on a review
of all pertinent data.
Proposed law requires LDH to provide a written report concerning Medicaid reimbursement rates
for disability service providers to the House Committee on Appropriations, the Senate Committee
on Finance, and the legislative committees on health and welfare no later than 45 days prior to the
convening of each regular session of the legislature. Specifies content that the department shall
include in the report.
(Adds R.S. 40:1250.1-1250.21)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill:
1. Revise the short title of proposed law to provide that it shall be known as the "Disability
Services Medicaid Reimbursement Rate Act".
2. Delete legislative finding from proposed law indicating that, historically, instabilities in
provider networks and systems of services in various states resulted in decades of
litigation in federal courts challenging reimbursement rates set by state Medicaid
agencies for providers of disability services. 3. Delete proposed law providing that its intent is to supplement the requirements of
Medicaid law applicable to reimbursement rates for services provided to persons with
disabilities.
4. Delete provisions relative to construction of proposed law.
5. Replace all instances of "age-related disability" with "adult-onset disability".
6. Replace all instances of "direct support professional" with "direct service worker".
7. Replace all instances of "personal planning" with "person-centered planning".
8. Specify that certain services and reimbursement rates referred to in proposed law are
Medicaid services and reimbursement rates.
9. Delete proposed law requiring the La. Department of Health (LDH) to consider
innovative rate and payment structures designed to promote improvements in quality,
adequacy, access, and sufficiency, and develop measures to assess the effectiveness of
such rate and payment structures.
10.Revise proposed law relative to establishment of rate methodologies to require that LDH
establish all new rates or changes to rates by a methodology that specifies and describes
all factors, procedures, methods, and data used or considered in developing the respective
rates.
11.Delete proposed law stipulating that no cost data that is more than two years old shall be
deemed reliable.
12.Delete proposed law requiring LDH to ensure that its rates for disability services satisfy
the following conditions:
(a)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.,
527 U.S. 581 (1999), and the Americans with Disabilities Act.
(b)The rates are sufficient to enlist a range of willing providers who are able to
retain a qualified and stable workforce and take into account all other applicable
workforce measures provided in proposed law.
(c)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.
13.Stipulate that the LDH rates for disability services be developed such that they can be
incorporated consistently in Medicaid 1915(c) waivers and Medicaid managed care
programs. 14.Stipulate that implementation of any new Medicaid reimbursement methodology shall
be contingent upon approval by the Centers for Medicare and Medicaid Services and the
Joint Legislative Committee on the Budget.
15.Prohibit LDH from implementing any new Medicaid reimbursement rate pursuant to
proposed law unless the legislature makes a specific appropriation for such purpose.
16.Delete requirement that LDH maintain reliable data in a form that permits ongoing
monitoring of certain factors that may be indicators of the adequacy of access to and
quality of services that are subject to reimbursement rates.
17.Delete a requirement that LDH conduct annual review of all rates by service category and
instead authorize the department to conduct such reviews.
18.Delete requirements that LDH do the following:
(a)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.
(b)Trend reimbursement rates forward annually for all years between rate rebasing
using the appropriate health market basket inflation index.
19.Revise reporting requirements provided in proposed law to require that LDH provide a
written report concerning disability service provider rates to the House Committee on
Appropriations, the Senate Committee on Finance, and the legislative committees on
health and welfare no later than 45 days prior to the convening of the 2020 R.S., and to
specify the content of the report.
20.Make technical changes.
The House Floor Amendments to the engrossed bill:
1. Change the short title of proposed law from the "Disability Services Medicaid
Reimbursement Rate Act" to the "Disability Services Sustainability Act".
2. Delete proposed law indicating that its purpose is to provide for a reliable legal
framework to guide the La. Department of Health (LDH), or any successor state
Medicaid agency, in setting reimbursement rates for providers of disability services for
persons with developmental, intellectual, adult-onset, or physical disabilities.
3. Delete the defined terms "direct service worker", "person-centered planning process",
"recipient", "restructure", "service plan", "staff-to-recipient ratio", and "stakeholder" and
their corresponding definitions. 4. Delete all provisions of proposed law relative to the design and establishment of a
reimbursement rate methodology.
5. Revise proposed law relative to reporting to require that LDH submit an annual report
concerning disability service provider rates to the House Committee on Appropriations,
the Senate Committee on Finance, and the legislative committees on health and welfare
no later than 45 days prior to the convening of each regular session of the legislature.