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 Reengrossed 2020 Regular Session Dustin Miller
Abstract: Stipulates that providers of nonemergency, non-ambulance medical transportation
(NEMT) services shall be deemed healthcare providers for purposes of Medicaid managed
care laws and requires that data on payment of claims for NEMT services be included in
Healthy Louisiana Claims Report.
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, non-ambulance medical transportation (NEMT) services.
Proposed law requires the La. Department of Health (LDH), on an annual basis, to review the
contracts, policies, and procedures of all NEMT brokers operating in La. and ensure that those
brokers are not providing preferences to non-La.-based NEMT operators.
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 Medicaid
managed care organizations (MCOs) to be included in the report.
Proposed law retains present law and adds thereto a requirement that the Healthy Louisiana Claims
Report feature data on timeliness of claims payments by each MCO; and, in the case of NEMT
services, data on timeliness of claims payments by each MCO and its transportation brokers.
Provides that if a claim for payment for NEMT services is denied by an MCO and the provider
resubmits the identical claim information and the claim is paid, then the days-to-payment metric
reported 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.
Proposed law requires LDH to take a random sampling from paid and denied claims for NEMT
providers that are adjudicated beyond the 30-day timeliness requirement for additional analysis, and to include in the quarterly Healthy Louisiana Claims Report the following:
(1)Common trends in underlying causes for the timeliness outlier sampling.
(2)Outreach efforts by LDH or MCOs to providers and transportation brokers for resolution.
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. 46:460.54(G) and 460.91(C)(5) and (F))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Health and Welfare to the
original bill:
1. Specify that proposed law applies to nonemergency, non-ambulance medical
transportation providers and services.
The House Floor Amendments to the engrossed bill:
1. Delete proposed law which would have required that the annual Medicaid managed care
transparency report produced by the La. Department of Health (LDH) include the total
amount of payments made by each Medicaid managed care organization (MCO) for
nonemergency, non-ambulance medical transportation (NEMT) services.
2. Delete proposed law which would have required 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 La.-based companies and to NEMT providers that
are based outside of La.
3. Require LDH, on an annual basis, to review the contracts, policies, and procedures of all
NEMT brokers operating in La. and ensure that those brokers are not providing
preferences to non-La.-based NEMT operators.
4. Delete proposed law which would have required LDH to include in the quarterly Healthy
Louisiana Claims Report data on timeliness of claims payments by each MCO's
third-party administrators for NEMT services.
5. Delete proposed law which would have required LDH to include in the quarterly Healthy
Louisiana Claims Report data on timeliness of claims payments by MCOs for NEMT services that encompasses 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.
6 With respect to information to be included in the quarterly Healthy Louisiana Claims
Report, provide that if a claim for payment for NEMT services is denied by an MCO and
the provider resubmits the identical claim information and the claim is paid, then the
days-to-payment metric reported for that claim shall be based upon the date of
submission of the original claim.
7. Require LDH to take a random sampling from paid and denied claims for NEMT
providers that are adjudicated beyond the 30-day timeliness requirement for additional
analysis, and to include in the quarterly Healthy Louisiana Claims Report the following:
a. Common trends in underlying causes for the timeliness outlier sampling.
b. Outreach efforts by LDH or MCOs to providers and transportation brokers for
resolution.
8. Make technical changes.