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Program A: Medical Vendor Administration

PROGRAM DESCRIPTION

The mission of the Medical Vendor Administration Program is to administer the Medicaid Program and ensure operations are in accordance with federal and state statues, rules and regulation.

The goals of Medical Vendor Administration Program are:

1. Process claims from Medicaid providers within the state and federal regulations.

2. Process Medicaid applications within state and federal regulations.

3. Ensure that Medicaid expenditures are accurate and to reduce fraud and abuse.

The Medical Vendor Administration Program includes the following activities: Medicaid Management Information System, Medicaid Eligibility Determinations, Program Integrity, and Health Standards.

OBJECTIVES AND PERFORMANCE INDICATORS

Unless otherwise indicated, all objectives are to be accomplished during or by the end of FY 1999-2000. Performance indictors are made up of two parts: name and value. The indicator name describes what is being measured. The indicator value is the numeric value or level achieved within a given measurement period. For budgeting purposes, performance indicator values are shown for the prior fiscal year, the current fiscal year, and alternative funding scenarios (continuation budget level and Executive Budget recommendation level) for the ensuing fiscal year (the fiscal year of the budget document).

 

 

RESOURCE ALLOCATION FOR THE PROGRAM

The Total Recommended amount includes $1,435,726 of Supplementary Recommendations of which $603,005 is Statutory Dedications for expansion of MR/DD Waiver program. Funding this Supplementary Recommendation is payable out of funding received pursuant to the Master Settlement Agreement reached between certain states and participating tobacco product manufacturers in November 20, 1998.

 

SOURCE OF FUNDING

This program is funded with General Fund, Fees and Self-generated Revenues, Statutory Dedications, and Federal Funds. Fees and Self-generated Revenue are derived from licensing and certification fees, third party liability collections and miscellaneous collections, such as document copies. Federal Funds represent the federal share of the cost to administer the Medicaid program. The Statutory Dedication is the Tobacco Settlement Fund payable out of funding received pursuant to the Master Settlement Agreement reached between certain states and participating tobacco products manufacturers in November 20, 1998 (R.S. 39:32B (8), see table below for a listing of expenditures out of each Statutory Dedication fund). The Federal Share varies by type of activity, but averages about 58% of the total Medicaid administrative cost. Existing Operating Budget includes interagency transfers from Y2K Funding Pool.

 

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

DESCRIPTION

 

 

 

 

 

$42,483,174

$107,303,491

1,180

 

ACT 19 FISCAL YEAR 1998-1999

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

$0

$278,200

0

 

Y2K Funding Pool Award

$0

$0

(2)

 

Transfer of positions to the Office of the Secretary for the centralization of the Information Services activities in Mainframe Maintenance

$0

$110,896

2

 

Acceptance of a federal award to defer the state’s costs for the Outcome and Assessment Information Set (OASIS) program which encompasses the new electronic reporting process and database all state Medicaid administrative agencies must develop and participate

$0

$0

10

 

Transfer of positions to correctly align the Table of Organization within the entire department

 

 

 

 

 

$42,483,174

$107,692,587

1,190

 

EXISTING OPERATING BUDGET – November 20, 1998

 

 

 

 

 

$236,244

$562,485

0

 

Annualization of FY 1998 –1999 Classified State Employees Merit Increase

$275,386

$655,680

0

 

Classified State Employees Merit Increases for FY 1999 -2000

$193,236

$460,086

0

 

Risk Management Adjustment

$470,400

$1,120,000

0

 

Acquisitions and Major Repairs

($567,985)

($1,663,413)

0

 

Nonrecurring Acquisitions and Major Repairs

$2,528

$5,056

0

 

Rent in State-owned Buildings

$1,431

$2,862

0

 

Maintenance of State-owned Buildings

$430,343

$1,024,627

0

 

Salary Base Adjustment

($776,817)

($1,849,564)

0

 

Attrition Adjustment

($61,143)

($145,580)

(4)

 

Personnel Reductions

($104,013)

($247,648)

0

 

Salary Funding from Other Line Items

$7,302

$17,386

0

 

Civil Service Fees

$0

$237,872

0

 

Workload – An adjustment to forward federal funds to the Office for Citizens with Developmental Disabilities to financially offset their increased role in the monitoring of the MR/DD Waiver slots on behalf of Medicaid Administration

($108,119)

($302,009)

0

 

Other Annualizations – Adjustment to annualize the expenditures of the LaChip administrative amendment

$244,930

$583,168

0

 

Other Annualizations – An adjustment to annualize the expenditures of the administrative costs associated with the 700 slots added by amendment to the MR/DD Waiver Program

$224,209

$448,418

0

 

Other Annualizations – An adjustment to annualize the expenditures associated with the forced relocation of two parish eligibility offices

$0

$365,864

0

 

Other Adjustments – An adjustment to match general fund transferred from the Office of the Secretary to consolidate the Case Management Services Staff activities into one (1) unit located within this agency with federal funds by which placement in this agency now qualifies this activity for collecting

$526,648

$1,053,297

0

 

Other Adjustments – An adjustment to provide funding for the increase in the costs of shared office space with the Department of Social Services statewide

$365,864

$365,864

14

 

Other Technical Adjustments – An adjustment to receive funding and positions from the Office of the Secretary to create one (1) Case Management Unit in this agency

$659,806

$0

0

 

Means of Financing Substitutions – Replace federal funds with general fund due to the termination of the Managed Care Pilot Program

$167,286

$796,600

18

 

New and Expanded Adjustments – An adjustment to fund and staff the administrative activities associated with the expansion of LaCHIP to extend Medicaid eligibility to children living at or below 150% federal poverty level

$0

$1,435,726

28

 

New and Expanded Adjustments – An adjustment to fund and staff the administrative activities associated with the expansion of the MR/DD Waiver Program due to the addition of 800 new waiver slots

 

 

 

 

 

$44,670,710

$112,619,364

1,246

 

SUBTOTAL

         

$0

($1,435,726)

(28)

 

LESS SUPPLEMENTARY RECOMMENDATIONS

         

$44,670,710

$111,183,638

1,218

 

EXECUTIVE BUDGET FISCAL YEAR 1999-2000

         
       

SUPPLEMENTARY RECOMMENDATIONS:

$0

$1,435,726

28

 

An Adjustment to fund and staff the administrative activities associated with the expansion of the MR/DD Waiver Program through the addition of 800 new waiver slots

         

$0

$1,435,726

28

 

TOTAL SUPPLEMENTARY RECOMMENDATIONS

         

$44,670,710

$112,619,364

1,246

 

GRAND TOTAL RECOMMENDED

         

$2,187,536

$4,926,777

56

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

         

$2,187,536

$3,491,051

28

 

DIFFERENCE (TOTAL BASE RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 104.9% of the existing operating budget. It represents 87.9% of the total request ($127,989,157) for this program. The major changes include the increased cost of co-housing staff with DSS, the various annualizations of actions taken in FY 1999, the creation of the one (1) Case Management Unit, and the expansions of LaCHIP and the MR/DD Waiver Program. The effect of not funding the supplementary recommendations may be determined by a review of the description above.

PROFESSIONAL SERVICES

$596,341

Audits of Title XIX Reimbursement to Hospitals

$967,900

Audits of Title XIX Reimbursement to Long-term Care Facilities

$650,250

Audits of Title XIX Reimbursement to Pharmacy Providers

$680,923

Bock Psychiatric Evaluations

$17,900

CD-ROM Document Storage System

$200,000

Covington & Burling Litigation Costs

$457,934

Dental Claim Review and Authorization by the LSU School of Dentistry

$15,555

Eligibility Medical Examinations to Determine Disability of Applicants

$33,014,170

Fiscal Intermediary Contract

$300,000

Hospital Reimbursement Rate Re-basing Study Contract

$30,000

IBM Programmer Contract to maintain the Licensing and Certification programs on the Health Standards Section’s Miniframe

$25,000

Independent Assessments performed under contract on Waiver programs approved under Section 1915 (b)(c) of the Social Security Act

$113,689

Internal Revenue Service Computer Matching of Personal Tax Information utilized in determining Applicant Eligibility for the Medicaid program

$3,909,551

KID-MED Management Contract

$91,220

Long Term Care Quality of Care Assessment Consultants

$56,534

Medical Eligibility Determination Team

$608,221

 

New Orleans Children’s Hospital provides case management services for Ventilator-Assisted Children’s Program (VACP)

$3,146,182

Non-Emergency Medical Transportation

$65,000

Northeast Louisiana University's School of Pharmacy serves as a reference point on drug utilization reviews

$106,000

Nurses Aide Registry

$15,000

Nurses Aide Competency Testing

$80,000

Psychiatric Consultants

$25,000

Surveillance and Utilization Review Statistical Consultants

$2,328,088

Third Party Liability Collection Contract

$3,550,000

Welfare Information System (WIS) Conversion Contract to create new Medicaid Eligibility Determination System (MEDS)

 

 

 

$51,050,458

 

TOTAL PROFESSIONAL SERVICES

OTHER CHARGES

$1,816,894

 

Administrative Costs of LaCHIP

$1,600,000

 

Contract with the University of New Orleans for Information Systems Services, Assessment and Training

$160,000

 

Employee Licensing Training for Nursing Homes, ICF/MRs, Hospital Homes Health Agencies and Dialysis Facilities

$300,000

Hepatitis B Vaccine

$1,800

OASIS grant

$15,000

Reimbursement of Nurse Aide Training

$617,691

Reimbursement to varying organizations serving as Medicaid Enrollment Centers

$5,000

Supplemental Security Income Field Office eligibility Determination Information

 

 

 

$4,516,385

 

TOTAL OTHER CHARGES

 

 

 

 

 

Interagency Transfers

$134,613

Civil Service Fees

$72,095

Influenza Vaccine from Office of Public Health

$203,580

Life Safety Code Inspections by the State Fire Marshall

$32,814

Maintenance of State-Owned Buildings

$47,000

Payments to the Governor's Office of Women's Services for Medicaid applications processed while serving as a Medicaid Enrollment Center

$761,585

Payments to the Office for Citizens with Developmental Disabilities for Regional Transition Coordinators for clientele enrolling in the MR/DD Waiver program

$237,872

Reimbursement to the Office for Citizens with Developmental Disabilities for costs associated with the monitoring of clientele enrolled in the MR/DD Waiver program

$110,055

Rent in State-Owned Buildings

$3,237,646

Statewide Co-Housing of Staff with the Department of Social Services/Office of Family Support Staff

$80,797

Supplies from the Department of Social Services Warehouse

 

 

 

$4,918,057

 

TOTAL INTERAGENCY TRANSFERS

 

 

 

ACQUISITIONS AND MAJOR REPAIRS

$1,606,992

 

Funding for replacement of inoperable and obsolete equipment

 

 

 

$1,606,992

 

TOTAL ACQUISITIONS AND MAJOR REPAIRS


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