RÉSUMÉ DIGEST
HCR 5 2019 Regular Session Barras
Provides for a hospital stabilization formula pursuant to Art. VII, §10.13 of the Constitution
of La., including assessments 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:
(a)The reimbursement rates in effect for dates of service on or after Jan. 1, 2019,
with the exception of certain exclusions.
(b)The reimbursement rates in conformity with HCR 6 of the 2018 R.S.
(c)For dates of service on or after Jan. 1, 2020:
(i)Patient reimbursement rates increased by an amount equal to the four
quarter moving average value for the first quarter of the federal FY
2020 as published by CMS on or before June 30, 2019.
(ii)For inpatient reimbursement rates, long-term acute hospitals indexed
to 45%, separately licensed, Medicare designated, rehabilitation
hospitals indexed to 37%, and distinct part psychiatric units and
freestanding psychiatric hospitals indexed to 32%.
Requires the department to set the catastrophic outlier pool aggregate payment amount to be
at least 50% of total hospital outlier claims submitted with dates of service in state FY 2017-
2018.
Requires LDH to quarterly publish a report 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.
Requires LDH to operate under the current waiver approved by CMS effective Jan. 1, 2017,
until LDH receives approval for waivers seeking exclusion of facilities prohibited from
participating in the Medicare program, in accordance with HCR 6 of the 2018 R.S.