2006 Louisiana Laws - RS 46:979 — Department responsibility

§979.  Department responsibility

A.(1)  The department shall apply to the Center for Medicare and Medicaid Services, Department of Health and Human Services, for authority and funding to implement a Health Insurance Flexibility and Accountability demonstration or other Section 1115 demonstration initiative for uninsured persons in families below two hundred percent of the federal poverty level, which provides for placing all of the state's disproportionate share payment allotment into a pool which provides the flexibility to:

(a)  Continue to support hospitals that serve a disproportionate number of Medicaid and uninsured patients.

(b)  Expand the availability of primary and preventive care for Medicaid and uninsured patients.

(c)  Provide health insurance coverage to the uninsured, through such approaches as, but not limited to, expansion of LaChoice, Medicaid, a public managed care organization or other strategies to accomplish the stated goals.

(d)  Meet the state's disease management goals.

(2)(a)  The priority for use of the funding pool, subject to appropriation by the legislature, shall be in the following order:

(i)  To provide for the annual federal disproportionate share hospital payments to state hospitals which are referred to as public state-operated hospitals in rules promulgated by the Department of Health and Hospitals.

(ii)  To provide for the annual federal disproportionate share hospital payments to hospitals defined by the Rural Hospital Preservation Act.

(iii)  To provide for the annual federal disproportionate share hospital payments to any other hospital receiving disproportionate share hospital funding in the 2004-2005 fiscal year, providing the hospital continues to meet disproportionate share hospital funding requirements.

(iv)  To provide for annual federal disproportionate share hospital payments for services under the Health Insurance Flexibility and Accountability demonstration or other Section 1115 demonstration initiative approved by the Centers for Medicare and Medicaid Services. Entities eligible for disproportionate share hospital payments may include, but are not limited to, the following:  federally qualified health centers, as defined by rule adopted by the Department of Health and Hospitals, parish health units, Louisiana State University clinics, and public or private community-based primary care clinics.

(v)  To provide for annual federal disproportionate share hospital payments to hospitals that pay hospital provider fees and that meet disproportionate share hospital funding requirements.

(b)  The amount of funding allocated to each of the above priority categories shall be determined by the specific annual appropriations for that category by the legislature or by budget adjustments approved by the Joint Legislative Committee on the Budget.

(c)  Such payments shall be made utilizing current disproportionate share hospital payment methodologies and local initiatives payment methodologies to be developed pursuant to this Section.

(d)  In addition to the foregoing, public state-operated hospitals and rural hospitals shall be permitted to participate in waivers provided for in this Section and to receive additional reimbursement from the funding pool for services and costs that are eligible for reimbursement under such waivers.

(3)  Any changes to the local application process as outlined in the original Health Insurance Flexibility and Accountability or Section 1115 waiver approved by the Centers for Medicare and Medicaid Services must be approved by the Joint Committee on Health and Welfare.

B.(1)  Upon completion of the waiver application, the department shall submit the waiver plan, including cost estimates for a minimum of three years to the Joint Legislative Committee on the Budget for its review and approval.  If the plan is approved by the committee, the department shall submit the waiver application to the Center for Medicare and Medicaid Services for approval.

(2)  Upon approval of the waiver application by the Center for Medicare and Medicaid Services, the department may implement the waiver only to the extent that appropriations to the department specifically include funds for this purpose.

C.  The department shall adopt and promulgate rules and regulations in accordance with the Administrative Procedure Act that provide for maximizing Medicaid funding and rates for those hospitals that provide either of the following:

(1)  Inpatient services to fragile newborns or critically ill children in either a Level III Regional Neonatal Intensive Care Unit or a Level I Pediatric Intensive Care Unit, which units have been in operation on or before January 1, 2003.

(2)  A Medicaid utilization rate of twenty-five percent of total inpatient days or greater.

Acts 2003, No. 813, §1; Acts 2005, No. 154, §2, eff. June 28, 2005.