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2024 Regular Session
HOUSE CONCURRENT RESOL UTION NO. 3
BY REPRESENTATIVE MCFARLAND
A CONCURRENT RESOL UTION
To provide for a hospital stabilization formula pursuant to Article VII, Section 10.13 of the
Constitution of Louisiana; to establish the level and basis of hospital assessments;
to establish certain reimbursement enhancements for inpatient and outpatient hospital
services; to establish certain criteria for the implementation of the formula; and to
provide for related matters.
WHEREAS, through the adoption of this Resolution, the Legislature of Louisiana
hereby seeks to:
(1) Preserve and enhance the availability of inpatient and outpatient hospital services
for the citizens of Louisiana.
(2) Preserve and protect rural hospitals as provided in the Rural Hospital
Preservation Act, pursuant to R.S. 40:1189.1 et seq.
(3) Enhance the stability of hospital funding by utilizing a fiscally prudent healthcare
driven solution that does not rely on the use of state general funds and provides a reliable
and recurring source of funding for healthcare services.
(4) Minimize the effects of shifting the cost of caring for those Louisiana residents
who are uninsured to those who are able to obtain health insurance.
(5) Create flexibility to design a plan to provide for more efficient and effective
ways to maximize the state's use of monies currently expended for the provision of
healthcare services to the state's low income and uninsured residents.
(6) Enhance the financial sustainability of the Medicaid hospital program by
pursuing a hospital directed payment model that is in conformance with the
recommendations contained in Senate Concurrent Resolution No. 27 of the 2020 First
Extraordinary Session of the Louisiana Legislature and the federal rules and regulations
promulgated by the Centers for Medicaid and Medicare Services.
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THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby
enact the annual hospital stabilization formula pursuant to Article VII, Section 10.13 of the
Constitution of Louisiana:
I. Hospital Stabilization Assessment.
A.(1) Upon approval by the Centers for Medicare and Medicaid Services of
a directed payment arrangement pursuant to 42 C.F.R. 438.6, the Louisiana
Department of Health shall be authorized to levy and collect an assessment upon
those hospitals subject to the approved directed payment arrangement that is in
accordance with the provisions of this Subsection.
(2) Any hospital assessment levied and collected pursuant to this Resolution
shall be levied and collected on a quarterly basis. Prior to the levy of any assessment
pursuant to the provisions of this Resolution, the Louisiana Department of Health
shall submit a Medicaid assessment report to the Joint Legislative Committee on the
Budget. The Medicaid assessment report shall include a description of the proposed
assessment, the basis for the calculation of the assessment, and a listing of each
hospital included in the proposed assessment.
B.(1) The hospital assessment for state Fiscal Year 2024-2025 shall be
calculated as the product of the rates set forth as follows and the respective hospitals'
inpatient net patient revenue and outpatient net patient revenue as reported in the
Medicare cost report ending in state fiscal year 2019:
(a) Long-term acute care, psychiatric and rehabilitation hospitals: 1.38% of
inpatient net patient revenue, and 1.38% of outpatient net patient revenue.
(b) Hospital Service Districts not included in R.S. 40:1189.1 et seq: 2.48%
of inpatient net patient revenue up to one hundred twenty-five million dollars, and
2.48% of outpatient net patient revenue up to one hundred twenty-five million
dollars.
(c) All other acute care hospitals: 3.23% of inpatient net patient revenue up
to one hundred twenty-five million dollars, and 3.35% of outpatient net patient
revenue up to one hundred twenty-five million dollars.
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(d) Hospital Service Districts not included in R.S. 40:1189.1 et seq, and all
other acute care hospitals: 1.38% of inpatient net patient revenue exceeding one
hundred twenty-five million dollars, and 1.38% of outpatient net patient revenue
exceeding one hundred twenty-five million dollars.
(2) Non-rural, small urban private acute hospitals with forty licensed beds or
less, either as reported in the Medicare cost report ending in state fiscal year 2019
or as licensed by the Louisiana Department of Health, freestanding psychiatric
Medicaid disproportionate share hospitals, and rural hospitals as defined in
R.S.40:1189.1, et seq., shall be exempt and excluded from the levy of any
assessment implemented pursuant to this Subsection.
C. In the event the Centers for Medicare and Medicaid Services approves an
assessment that is different from the provisions set forth in this Section, the
Louisiana Department of Health shall seek ratification of such changes from the Joint
Legislative Committee on the Budget prior to the levy of an approved assessment.
D. An assessment levied pursuant to Subsection B or C of this Section shall
be levied only for the quarters that directed payments are actually paid to hospitals
pursuant to 42 C.F.R. 438.6 directed payment arrangements as approved by the
Centers for Medicare and Medicaid Services.
II. Reimbursement Enhancements.
A. Upon the implementation of an assessment pursuant to Subsection A of
Section I of this Resolution, the Louisiana Department of Health shall provide for
reimbursement enhancements as follows:
(1) Implementation of directed payments pursuant to 42 C.F.R. 438.6
utilizing a uniform percentage increase methodology for both acute and post-acute
hospitals.
(a) For acute care hospitals, the methodology shall be implemented in the
manner set forth in the directed payment arrangement submitted to the Centers for
Medicaid and Medicare Services on or before April 30, 2024.
(b) For post-acute care hospitals, the methodology shall be implemented in
the manner set forth in the directed payment arrangement submitted to the Centers
for Medicaid and Medicare Services on or before April 30, 2024.
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(2) Payment for healthcare services through the implementation of a health
coverage expansion of the Louisiana medical assistance program that meets all the
requirements necessary for the state to maximize federal matching funds as set forth
in 42 U.S.C. 1396d(y) of Title XIX of the Social Security Act.
(3) For any hospital subject to the assessment levied pursuant to this
Resolution, the payment of hospital reimbursement rates in an amount no less than
the reimbursement rates in effect for dates of service on or after January 1, 2024.
B. The Louisiana Department of Health shall publish, on a publicly
accessible website of the department, the approved Centers for Medicare and
Medicaid Services directed payment arrangements within ten days of receiving
approval. In the event the Centers for Medicare and Medicaid Services approves
either the acute care hospital or the post-acute care hospital preprint in a manner that
is different from the provisions contained in the initial 42 C.F.R. 438.6 preprint
submitted on or before April, 30, 2024, the department shall seek ratification of the
changes from the Joint Legislative Committee on the Budget prior to
implementation.
C. The Louisiana Department of Health shall publish on a quarterly basis, no
later than thirty days after the end of each quarter, a report containing data directly
related to the reimbursement enhancements provided for in this Resolution. The
report shall include the following:
(1) The total amount of inpatient and outpatient Medicaid claims paid to
hospitals delineated by each individual hospital Medicaid provider number.
(2) The amount of directed payments received by each hospital.
(3) Other supplemental payments received by each hospital.
III. Administration.
The Louisiana Department of Health shall submit any necessary state plan
amendment that may be required in order to implement the provisions of this Resolution to
the Centers for Medicare and Medicaid Services no later than one hundred and twenty days
from the date this Resolution is adopted. In addition, the Louisiana Department of Health
may promulgate any rules and regulations that are necessary and proper to implement the
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provisions of this Resolution; however, the final adoption thereof shall not be required in
order to implement and carry out the provisions of this Resolution.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
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