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 817 Original 2020 Regular Session Dustin Miller
Abstract: Stipulates that providers of nonemergency medical transportation (NEMT) services shall
be deemed healthcare providers for purposes of Medicaid managed care laws and requires
that data on financing of NEMT services be included in Medicaid managed care transparency
reports issued by the La. Department of Health.
Present law provides conditions, limitations, requirements, and standards for the Medicaid managed
care program of this state, including rights and protections for healthcare providers. Defines
"healthcare provider" and "provider", for purposes of present law, as a person, partnership, limited
liability partnership, limited liability company, corporation, facility, or institution that provides
healthcare or professional services to individuals enrolled in the Medicaid program.
Proposed law retains present law and specifies that, for purposes of present law and proposed law
relative to Medicaid managed care, the terms "healthcare provider" and "provider" shall include
providers of nonemergency medical transportation (NEMT) services.
Present law requires the La. Department of Health (LDH) to submit an annual report concerning the
Medicaid managed care program, known commonly as the "managed care transparency report", to
the legislative committees on health and welfare. Provides requirements for the content of the report.
Proposed law retains present law and adds thereto a requirement that the annual managed care
transparency report include the total amount of payments by each Medicaid managed care
organization (MCO) for NEMT services. Requires LDH to provide an itemization of each MCO's
total payments to NEMT providers showing the proportions, respectively, of its payments to NEMT
providers that are Louisiana-based companies and NEMT providers that are based outside of
Louisiana.
Present law requires LDH to produce and submit to the Joint Legislative Committee on the Budget
and the House and Senate committees on health and welfare a quarterly report entitled the "Healthy
Louisiana Claims Report". Specifies the data on healthcare provider claims submitted to MCOs to
be included in the report.
Proposed law retains present law and adds thereto a requirement that the report feature data on
timeliness of claims payments by each MCO; and, in the case of nonemergency medical
transportation, data on timeliness of claims payments by each MCO, its transportation brokers, and
its third-party administrators. Proposed law requires that the data to be reported, at minimum, shall include an average and a
median days-to-payment metric for all claims reflecting the number of calendar days elapsed from
the date of claim submission by the provider to the date of claim payment by the MCO,
transportation broker, or third-party administrator. Provides that if a claim for payment is denied in
whole or in part, the provider resubmits the claim, and the claim is paid in full or in part, then the
days-to-payment metrics for that claim shall be based upon the date of submission of the original
claim.
Proposed law requires LDH to itemize the data on provider claims by claims from NEMT providers
versus claims from all other healthcare providers collectively.
Present law provides that the Healthy Louisiana Claims Report shall feature a narrative which
includes, at minimum, the action steps which LDH plans to take in order to address certain issues
in Medicaid managed care.
Proposed law retains present law and adds timeliness of claims payments by MCOs as an issue to
be addressed in the report.
(Amends R.S. 46:460.51(7); Adds R.S. 40:1253.2(A)(1)(m) and R.S. 46:460.91(C)(5) and (F))