HLS 20RS-1083 REENGROSSED
2020 Regular Session
HOUSE BILL NO. 817
BY REPRESENTATIVE DUSTIN MILLER
MEDICAID MANAGED CARE: Provides relative to nonemergency medical transportation
services in Medicaid managed care
1 AN ACT
2To amend and reenact R.S. 46:460.51(7) and to enact R.S. 46:460.54(G) and 460.91(C)(5)
3 and (F), relative to the state medical assistance program known commonly as
4 Medicaid; to stipulate that providers of nonemergency, non-ambulance medical
5 transportation services shall be deemed as healthcare providers for purposes of laws
6 pertaining to the Medicaid managed care program; to provide for review of contracts,
7 policies, and procedures for Medicaid nonemergency, non-ambulance transportation
8 brokers; to require disclosure of claims payment data associated with Medicaid
9 nonemergency, non-ambulance medical transportation; to provide for reports to
10 certain legislative committees of information on claims processing in the Medicaid
11 managed care program; to specify data and other material to be included in such
12 reports; to provide for definitions; and to provide for related matters.
13Be it enacted by the Legislature of Louisiana:
14 Section 1. R.S. 46:460.51(7) is hereby amended and reenacted and R.S.
1546:460.54(G) and 460.91(C)(5) and (F) are hereby enacted to read as follows:
16 §460.51. Definitions
17 As used in this Part, the following terms have the meaning ascribed in this
18 Section unless the context clearly indicates otherwise:
19 * * *
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1 (7) "Healthcare provider" or "provider" means a person, partnership, limited
2 liability partnership, limited liability company, corporation, facility, or institution
3 that provides healthcare or professional services to individuals enrolled in the
4 Medicaid program. The terms "healthcare provider" and "provider", as used in this
5 Part, shall include providers of nonemergency, non-ambulance medical
6 transportation services.
7 * * *
8 §460.54. Medicaid policies and procedures; procedure for adoption
9 * * *
10 G. On an annual basis, the department shall review the contracts, policies,
11 and procedures of all nonemergency, non-ambulance medical transportation brokers
12 operating within this state and ensure that those brokers are not providing
13 preferences to non-Louisiana-based, nonemergency, non-ambulance medical
14 transportation operators.
15 * * *
16 §460.91. Claims processing data; reports to legislative committees
17 * * *
18 C. The report shall feature a narrative which includes, at minimum, the
19 action steps which the department plans to take in order to address all of the
20 following:
21 * * *
22 (5) Timeliness of claims payments to providers by each managed care
23 organization.
24 * * *
25 F.(1) The quarterly reports shall feature data on timeliness of claims
26 payments by each managed care organization; and, in the case of nonemergency,
27 non-ambulance medical transportation, data on timeliness of claims payments by
28 each managed care organization and its transportation brokers. If a claim for
29 payment is denied by a managed care organization, or a fiscal agent or intermediary
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1 of the managed care organization, and the provider resubmits the identical claim
2 information and the claim is paid, then the days-to-payment metric for that claim
3 shall be based upon the date of submission of the original claim.
4 (2) The department shall itemize the data on provider claims required by this
5 Subsection by claims from nonemergency, non-ambulance medical transportation
6 providers versus claims from all other healthcare providers, collectively.
7 (3) The department shall take a random sampling from paid and denied
8 claims for nonemergency, non-ambulance medical transportation providers that are
9 adjudicated beyond the thirty-day timeliness requirement for additional analysis.The
10 department shall include in the report common trends in underlying causes for the
11 timeliness outlier sampling and outreach efforts by the department or Medicaid
12 managed care organizations to providers and transportation brokers for resolution.
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
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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.
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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.
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