HLS 201ES-42 ORIGINAL
2020 First Extraordinary Session
HOUSE BILL NO. 20
BY REPRESENTATIVES VILLIO AND BACALA
MEDICAID: Provides for the implementation of a Medicaid managed long-term services
and supports system (Item #38)
1 AN ACT
2To enact Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of 1950, to be
3 comprised of R.S. 46:460.101, relative to Medicaid-funded long-term services and
4 supports; to provide for delivery of such services through a managed care program;
5 to provide for duties of the Louisiana Department of Health in administering the
6 Medicaid managed care program; to provide for submission of an application to the
7 Centers for Medicare and Medicaid Services by a certain date; to provide for
8 minimum application criteria; to provide for a request for proposals process; to
9 provide for sources of funding; to provide for audits; to establish deadlines for
10 program implementation; to provide for rulemaking; and to provide for related
11 matters.
12Be it enacted by the Legislature of Louisiana:
13 Section 1. Part XIV of Chapter 3 of Title 46 of the Louisiana Revised Statutes of
141950, comprised of R.S. 46:460.101, is hereby enacted to read as follows:
15 PART XIV. MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS
16 ยง460.101. Medicaid managed long-term services and supports; findings; minimum
17 requirements
18 A. The Legislature of Louisiana finds and declares the following:
19 (1) Managed long-term services and supports, referred to hereafter in this
20 Part as "MLTSS", refers to the delivery of Medicaid services for individuals
Page 1 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
1 receiving home- and community-based services or institutional-based services and
2 individuals at highest risk of needing those services through capitated Medicaid
3 managed care programs that coordinate the provision of all physical, behavioral, and
4 long-term health services.
5 (2) States utilize MLTSS programs as a strategy for improving access to
6 home- and community-based services, promoting community inclusion, ensuring
7 quality, and increasing efficiency and fiscal sustainability of their Medicaid
8 programs.
9 (3) Senior citizens represent the largest population receiving Medicaid
10 long-term care services, and this state would best serve its seniors by implementing
11 programs that have an emphasis on choice, consumer-driven care, and services that
12 actively promote community-based alternatives.
13 (4) Individuals receiving Medicaid funded long-term services and supports
14 are the only beneficiary group currently excluded from Medicaid managed care,
15 leaving them ineligible for new types of services that could better integrate care
16 management, promote independence, employment, wellness, and recovery, or detect
17 and delay the increased risks associated with chronic disease.
18 (5) The Centers for Medicare and Medicaid Services referred to hereafter in
19 this Part as "CMS", has given states great flexibility in selecting an approved
20 managed care authority, including demonstrations or waivers, that best apply to the
21 MLTSS program developed by each state.
22 B.(1) The secretary of the Louisiana Department of Health shall develop and
23 implement a Louisiana MLTSS program and submit an application for the program,
24 based on the most appropriate managed care authority, to CMS. The secretary may
25 use in the application existing materials, including waiver drafts and stakeholder
26 input, if the materials comply with the requirements of this Section.
27 (2) The Louisiana MLTSS program shall apply to the following populations:
28 (a) Medicaid recipients who are elderly or who have adult-onset disabilities
29 and who meet the eligibility requirements for and are receiving long-term services
Page 2 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
1 and supports through a Medicaid state plan or waiver program designed specifically
2 for the population, including but not limited to nursing facilities, home- and
3 community-based waivers, or state plan personal care programs.
4 (b) Recipients who are receiving both Medicaid and Medicare benefits and
5 are not otherwise receiving long-term services and supports.
6 (c) The provisions of this Section shall not apply to Medicaid recipients
7 eligible for and receiving services due to an intellectual or developmental disability.
8 C. The secretary of the Louisiana Department of Health shall ensure that the
9 MLTSS program application includes and expounds upon the following elements
10 that have been set forth by CMS in guidance to the states as minimum components
11 that will increase the likelihood of a high quality MLTSS program:
12 (1) Demonstration of adequate planning and design.
13 (2) Formal process for ongoing education of stakeholders.
14 (3) Enhanced provision of home- and community-based services, consistent
15 with the Americans with Disabilities Act and Olmstead v. L.C., 527 U.S. 581 (1999),
16 that deliver long-term services and supports in the most integrated fashion, in the
17 most integrated setting, and in a way that offers the greatest opportunity for active
18 community and workforce participation.
19 (4) Alignment of payment structures and goals to hold providers accountable
20 through performance-based incentives or penalties.
21 (5) Beneficiary support such that MLTSS participants have access to
22 conflict-free education and assistance that is accessible, ongoing, and consumer
23 friendly.
24 (6) Person-centered processes that include needs assessments, service
25 planning, and service coordination policies and protocols.
26 (7) Comprehensive, integrated service packages that require a MLTSS
27 managed care organization to provide or coordinate the provision of all physical,
28 behavioral, and long-term health services.
Page 3 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
1 (8) A qualified MLTSS managed care organization provider network to
2 ensure long-term service and support providers sufficient enough in amount to
3 provide adequate access to all individuals covered by the program.
4 (9) Participant protections to ensure that participant health and welfare is
5 protected in the MLTSS program.
6 (10) A quality improvement strategy that is transparent and appropriately
7 tailored to address the unique needs of the MLTSS population.
8 D.(1) The secretary of the Louisiana Department of Health shall ensure that
9 a request for proposals is issued no later than sixty days after the application
10 submitted to CMS pursuant to Paragraph (B)(1) of this Section. MLTSS managed
11 care plans shall be selected through a competitive request for proposals process in
12 accordance with the Louisiana Procurement Code, R.S. 39:1551 et seq.
13 (2) The secretary may utilize an existing request for proposals to satisfy the
14 provisions of this Subsection if it complies with mandatory minimum qualifications,
15 including but not limited to the following:
16 (a) Demonstrated successful MLTSS plan coverage and operation in another
17 state Medicaid MLTSS program.
18 (b) Provision of all physical, behavioral, pharmacy, facility-based, and
19 community-based healthcare services and supports, in addition to any other services
20 required by the secretary. If there is a separate single Medicaid contract for the
21 provision of any service listed in this Subsection, such service may be excluded from
22 the MLTSS contract.
23 (c) Appointment of an independent ombudsman to assist recipients with any
24 questions or concerns regarding coverage in the MLTSS program.
25 (d) Establish a provider reimbursement rate floor at the Medicaid
26 fee-for-service rate in effect on September 1, 2020.
27 (e) Establish requirements for timely payments to providers and penalties for
28 failure to remit timely payments.
Page 4 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
1 (f) The office of aging and adult services of the Louisiana Department of
2 Health shall retain authority for determining recipient eligibility for Medicaid-funded
3 long-term services and supports for the population covered by this Section, including
4 all initial assessments and recertifications.
5 (3) The secretary shall select at least two, but no more than three, capitated
6 managed care plans to implement the MLTSS program.
7 E. Sources of funding for the implementation and administration of the
8 MLTSS program may include monies dedicated in accordance with R.S. 46:2623,
9 R.S. 22:842(C), and any other monies allowed by law.
10 F. One year prior to the expiration of any contract entered into to implement
11 the provisions of this Section, the legislative auditor shall conduct and issue a fiscal
12 and performance audit of the program, including an audit of the contractor and an
13 audit of oversight of the contract by the Louisiana Department of Health. The
14 legislative auditor shall have access to all information in the custody and control of
15 the contractor needed to conduct the audit.
16 G. The secretary of the Louisiana Department of Health shall promulgate
17 rules and regulations in accordance with the Administrative Procedure Act as are
18 necessary to implement the provisions of this Section.
19 Section 2. The secretary of the Louisiana Department of Health shall submit to the
20Centers for Medicare and Medicaid Services the application required by the provisions of
21R.S. 46:460.101(B)(1), as enacted by Section 1 of this Act, no later than January 1, 2021.
22 Section 3. The secretary of the Louisiana Department of Health shall take all such
23actions as are necessary to ensure that the Medicaid managed long-term services and
24supports program provided for in R.S. 46:460.101, as enacted by Section 1 of this Act, is
25fully implemented, and participant coverage by a managed long-term services and supports
26managed care plan or plans is available, no later than July 1, 2022.
Page 5 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
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 20 Original 2020 First Extraordinary Session Villio
Abstract: Provides for implementation of a Medicaid managed long-term services and
supports system for the elderly and certain persons with disabilities.
Proposed law provides for implementation of a managed long-term services and supports
(MLTSS) program within Medicaid. Provides that MLTSS refers to the delivery of
Medicaid services for individuals receiving home- and community-based services or
institutional-based services and individuals at highest risk of needing those services through
capitated Medicaid managed care programs that coordinate the provision of all physical,
behavioral, and long-term health services.
Proposed law requires the secretary of the La. Department of Health (LDH) to develop and
implement an MLTSS program and submit an application for the program to the federal
Centers for Medicare and Medicaid Services (CMS) no later than Jan. 1, 2021. Provides that
the secretary may use in the application existing materials, including waiver drafts and
stakeholder input, if the materials comply with the requirements of proposed law.
Proposed law provides that the La. MLTSS program shall apply to the following
populations:
(1)Medicaid recipients who are elderly or who have adult-onset disabilities and who
meet the eligibility requirements for and are receiving long-term services and
supports through a Medicaid state plan or waiver program designed specifically for
the population, including but not limited to nursing facilities, home- and
community-based waivers, or state plan personal care programs.
(2)Recipients who are receiving both Medicaid and Medicare benefits and are not
otherwise receiving long-term services and supports.
(3)The provisions of this Section shall not apply to Medicaid recipients eligible for and
receiving services due to an intellectual or developmental disability.
Proposed law requires the secretary of LDH to ensure that the MLTSS program application
includes the following elements that have been set forth by CMS as minimum components
that will increase the likelihood of a high-quality program:
(1)Demonstration of adequate planning and design.
(2)Formal process for ongoing education of stakeholders.
(3)Enhanced provision of home- and community-based services, consistent with the
Americans with Disabilities Act and Olmstead v. L.C., 527 U.S. 581 (1999), that
deliver long-term services and supports in the most integrated fashion, in the most
integrated setting, and in a way that offers the greatest opportunity for active
community and workforce participation.
(4)Alignment of payment structures and goals to hold providers accountable through
performance-based incentives or penalties.
Page 6 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 201ES-42 ORIGINAL
HB NO. 20
(5)Beneficiary support such that MLTSS participants have access to conflict-free
education and assistance that is accessible, ongoing, and consumer friendly.
(6)Person-centered processes that include needs assessments, service planning, and
service coordination policies and protocols.
(7)Comprehensive, integrated service packages that require a MLTSS managed care
organization to provide or coordinate the provision of all physical, behavioral, and
long-term health services.
(8)A qualified MLTSS managed care organization provider network to ensure
long-term service and support providers sufficient enough in amount to provide
adequate access to all individuals covered by the program.
(9)Participant protections to ensure that participant health and welfare is protected in
the MLTSS program.
(10)A quality improvement strategy that is transparent and appropriately tailored to
address the unique needs of the MLTSS population.
Proposed law requires the secretary of LDH to ensure that a request for proposals is issued
no later than 60 days after the MLTSS program application is submitted to CMS. Provides
that MLTSS managed care plans shall be selected through a competitive request for
proposals process in accordance with present law.
Proposed law authorizes the secretary of LDH to utilize an existing request for proposals to
satisfy the provisions of proposed law if it complies with mandatory minimum
qualifications.
Proposed law provides that the secretary of LDH shall select at least two, but no more than
three, capitated managed care plans to implement the MLTSS program.
Proposed law provides that sources of funding for the implementation and administration
of the MLTSS program may include any monies dedicated or otherwise provided in
accordance with present law.
Proposed law stipulates that one year prior to the expiration of any contract entered into to
implement the provisions of proposed law, the legislative auditor shall conduct and issue a
fiscal and performance audit of the program, including an audit of the contractor and an audit
of oversight of the contract by LDH. Authorizes the legislative auditor to have access to all
information in the custody and control of the contractor needed to conduct the audit.
Proposed law requires the secretary of LDH to take all such actions as are necessary to
ensure that the MLTSS program is fully implemented, and participant coverage by a
managed long-term services and supports managed care plan or plans is available no later
than July 1, 2022.
(Adds R.S. 46:460.101)
Page 7 of 7
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.