2013

Louisiana Primary Care Association

5/13/2013

State Legislative Proposal

P a g e | 2

State of Louisiana 2013 Facts

Louisiana population 4,601,893 (2012 U.S. Census Bureau) State Jobs, Notables and the National Economy - FY2013

All across the country state governments have been struggling with their budgets as revenues have failed to meet the demands of spending. According to a survey produced by the National Governor’s Association and National Association of State Budget Officers (Spring 2012), state fiscal conditions continue to improve as we transition into fiscal year 2013. However, despite any improvements, revenues have not been enough to meet the rise in demand for state services. Gaps between spending and revenue collections decreased slightly from $78.2 billion in fiscal year 2011 to $68.1 billion in fiscal year 2012. Nevertheless, gaps or budget shortfalls persist. However, there is an opportunity made available to states to expand Medicaid according to the provisions of the Affordable Care Act that would positively impact their economies.

Louisiana is facing a $1.3 billion dollar state general fund shortfall. The Governor’s Executive Budget seeks to address this with a budget proposal that is $990 million dollars less than the FY 2012-2013 budget and provides for the use of $424 million dollars in one-time monies to fill budget gaps.

The FY 2013-2014 Governor’s Executive Budget reflects further reductions in the number of fulltime appropriated positions in the executive branch by 10,088. Following prior reductions of 16,140 through budgetary actions, approval of this year’s budget recommendation would mean a total reduction of 26,228 fulltime appropriated positions since the beginning of the Jindal administration. Over 5,900 of the positions cut from this year’s budget proposal in the LSU Health Care Services Division is designed to prepare for the privatization of the same services.

FQHC Network

Louisiana’s FQHCs – 28 organizations and 100+ total sites with satellites, 223,095 people served, 39% uninsured, 41% Medicaid/SCHIP (2011 HRSA Uniform Data Systems Report)

State Health Facts

In 2012, Louisiana was ranked 49th in the nation for health. Louisiana was ranked 47th in 2009 (America’s Health Rankings).

Uninsured Ranges - 653,000 Uninsured (14.2% of the Population) (2011 LA Health Insurance Survey) Kaiser Family Foundation states that Louisiana has 877,000 uninsured residents (19.1%). Challenges to Health Status: (According to 2012 Health Rankings)

Louisiana has a high prevalence of obesity at 33.4 percent of the population.

Louisiana has a high incidence of infectious disease at 16.9 cases per 100,000 populations.

Louisiana has a high rate of preventable hospitalizations with 92.1 discharges per 1,000 Medicare

enrollees.

P a g e | 3

Policy Agenda

Policy Goal: Support Medicaid Expansion as Sponsored by the Patient Protection and Affordable

Care Act (PPACA)

The Louisiana Primary Care Association (LPCA) is the state trade association of federally qualified health

centers (FQHCs). At the Association’s core is the fundamental value of providing affordable, accessible,

high quality, culturally competent access to health care for all Louisianan’s. This will remain a value of

the LPCA and Louisiana’s federally qualified health centers whether Louisiana chooses to expand

Medicaid or not.

However, Louisiana with the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010

has been provided an unprecedented opportunity to afford approximately 400,000 projected new

Medicaid enrollees with health care coverage fully paid for by the federal government until the year

2017. From the year 2017 and beyond, the state would incrementally increase its federal medical

assistance percentage rate up to 10% of their cost by 2020. This opportunity would not only cut

Louisiana’s uninsured rate nearly in half, but is also projected to inject an estimated $15.7 billion

dollars into Louisiana’s economy between the years 2013-2022 according to the Kaiser Family

Foundation with a trickledown effect of job creation, supporting businesses, and financially supporting

the state’s local hospital system and safety net providers.

In addition, according to the provisions of PPACA, due to the expectation that less people would be

uninsured due to health insurance exchanges and Medicaid expansion, federal Disproportionate

Share Hospital (DSH) funding will diminish whether the state chooses to accept Medicaid

Expansion or not. As a result of diminishing DSH revenues, Louisiana would leave hospitals that

currently care for the indigent and uninsured populations in an even more precarious state that may

result in service reductions, closers and necessitate the need public/private partnerships and

consolidations without the significant influx of federal dollars afforded through accepting Medicaid

Expansion. Hospitals and safety-net providers such as FQHCs need the revenues afforded through

Medicaid expansion to effectively care for uncompensated care patients.

Louisiana’s FQHCs would directly benefit from Medicaid Expansion through an economic

impact of approximately $140 million dollars. FQHCs then would in turn inject $84.5 million dollars

of operating expenditures directly into local economies. FQHCs would also be impacted through the

creation of 951 jobs while returning $13.7 million dollars to the state in new tax revenues. Currently,

39% of Louisiana’s FQHC patients are uninsured, and through Medicaid expansion, many of these

patients would be afforded health care coverage which would aid in supporting the safety net system.

P a g e | 4

Policy Goal: Support HB 392 by Reps Stuart, Bishop and Anders which provides for the

Standardization of Credentialing and the Provision of Information with Claims Paid

In an effort to bring efficiency and add more predictability to the annual expenditures of the Medicaid

program, Louisiana endeavored to engage in the improbable venture of transitioning Medicaid from a

fee-for-service system to Medicaid Managed Care. The result of the transition is formally referred to as

Bayou Health. As expected with a venture to transition and manage the health care of over 900,000

Louisiana residents, managing provider contracts, multiple health plans, and the varied other nuances

and mechanisms, there were changes that would need to be made to streamline and improve program

operations. A few of the challenges that have been noted among Louisiana’s network of FQHCs include,

delayed prior authorization for pharmaceutical drugs, long turnaround times in claims payment, and the

denial of claims, all of which can be contributed to the “newness” of the system. HB 393 standardizes

the credentialing process and provides information on the claims paid along with standardizing other

processes, which will aid in bring more efficiencies to Bayou Health.

Some of the benefits of HB 392 include:

Completion of credentialing process in 90 days.

Provides for standardizing the credentialing hard copy application (Louisiana Standardized

Credentialing Application Form or the form utilized by the Council for Affordable Quality Health Care

or its successor).

Provides that claims paid be accompanied with the patient’s name, Medicaid health insurance

number, date of service, patient account number, the Current Procedural Terminology Code, amount

do from the patient, reimbursement amount, and the identification of the plan that made the payment.

Provides for claims to be paid for all primary care services rendered to newborns in the first 30 days

to be paid regardless if the Medicaid provider is contracted with the managed care organization.

Policy Goal: Support SB55 by Senators, John, Alario, Allain, and others which provides for

Medicaid Transparency

With the implementation of Bayou Health, the state of Louisiana had several expectations including:

Improved health care coordination with patient centered medical homes

Improved health outcomes measured by Health Effectiveness Data and Information Set (HEDIS)

Improved emphasis on disease prevention and chronic disease management

Improved access to Medicaid services with the implementation of best practices and other benefits

SB 55 provides for public accountability to evaluate the efficiencies of Bayou Health and all specified

encompassing processes. LPCA supports SB55, because any improvements to Bayou Health will

directly benefit FQHCs. Thirty-seven percent (37%) of FQHC revenues come from the Medicaid

program.

P a g e | 5

Policy Goal: Support HB 281 by Rep. Simon which provides for a standard Behavioral Health

License

The prevalent mental health care shortages/gaps in Louisiana have been well documented by the

Department of Health and Hospitals. However, despites the shortages, Louisiana has made significant

strides to incorporate better system coordination, improve access, and develop efficiencies. Some of

the state’s efforts include the creation of the Louisiana Behavioral Health Partnership, a collaborative

effort of the fairly new Coordinated System of Care (CSOC), Non-Coordinated System of Care (Non-

CSOC) organizations and the Adult Behavioral Health Program.

With the filing of HB281, the Department of Health and Hospitals Office of Behavioral Health along with

Representative Simon are seeking for increased service coordination and efficiencies with the creation

of a single behavioral health license. Currently, any organization seeking to provide mental health

services must have a mental health clinic license and likewise facilities seeking to treat substance abuse

patients must have a substance abuse clinic license. As a result, institutions will have one license or

the other, or both licenses. However, with the creation of a single license, a facility can see both mental

health and substance abuse patients at one location, under the authority of a single license. LPCA

supports this streamlined license approach, which will aid in assuring better service integration and

coordination.

Policy Goal: Support HB 111 by Rep. Hoffman which prohibits smoking within 25 feet of a state

building

Research has well documented the adverse effects of smoking and second-hand smoke on society. For

example, the American Cancer Society has noted the following about second hand smoking (SHS):

There is an estimated 46,000 deaths from heart disease in people who are current non-smokers due

to the exposure to second-hand smoke.

Children exposed to secondhand smoke are much more likely to be put into intensive care when they

have the flu; they are in the hospital longer; and are more likely to need breathing tubes than kids who

aren’t exposed to SHS.

In the United States the costs of extra medical care, illness, and death caused by SHS are over $10

billion per year.

In the interest of public safety, the LPCA commends Rep. Hoffman and HB 111 for its efforts to

reduce the effects of smoking at public state owned facilities.