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Program A: Payments to Private Providers

PROGRAM DESCRIPTION

The mission of the Payments to Private Providers Program is to provide payments to private providers of health services to Louisiana residents who are eligible for Title XIX (Medicaid) and to administer the Medicaid Program to ensure operations are in accordance with federal and state statues regarding medically necessary services to eligible recipients. Additionally, the Medical Vendor Payments Program assures that reimbursements to providers of medical services to Medicaid recipients are appropriate.

The goals of the Payments to Private Providers are:

1. To develop alternatives to institutional care.

2. To implement disease management programs in the Pharmacy Program.

The Payments to Private Providers Program provides payments to the following providers/services: Inpatient Hospital Services, Outpatient Hospital Services, Long Term Care Facilities, ICF-MR (MR/DD Community Homes), MR/DD Waiver (Community Services), Assisted Living Waiver, Inpatient Mental Health, Psychiatric Rehabilitation, Adult Day Health, Physicians Services, Pharmaceutical Products and Services, Laboratory and X-ray Services, Emergency Transportation, Non-Emergency Transportation, Chiropractic Services, Certified RN Anesthetists, Adult Dentures, Appliances and Medical Devices, Home Health Services, Hemodialysis Services, EPSDT (Screening and Early Diagnosis), Case Management Services, Elderly Waiver, Federally Qualified Health Centers, Private Family Planning, Rehabilitation Services, Rural Health Clinics, Substance Abuse Clinics, and Other Private Providers.

OBJECTIVES AND PERFORMANCE INDICATORS

Unless otherwise indicated, all objectives are to be accomplished during or by the end of FY 1999-2000. Performance indicators 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 $91,253,565 of Supplementary Recommendations, of which $27,074,933 is Statutory Dedications, for the expansion of the MR/DD Waiver Program and pro-rata funding for all providers excluding only LaCHIP and family planning initiatives. Funding of 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, 1998.

The Total Recommended amount includes $150,556,117 of Supplementary Recommendations, of which $44,670,000 is Statutory Dedications, for pro-rata funding for all providers excluding only LaCHIP and family planning initiatives. Funding of this Supplementary Recommendation is payable out of the Casino Gaming Proceeds Fund pursuant to enactment of legislation amending existing law to permit expenditures for this purpose.

SOURCE OF FUNDING

This program is funded with General Fund, Interagency Transfers, Fees and Self-generated Revenues, Statutory Dedications, and Federal Funds. Interagency Transfers originate from the Department of Social Services, Office of Family Support for Refugee Medical Vendor payments and Office of Community Services for the processing and all state funded payment of Non-Title XIX Foster Care Medical Vendor claims. Self-generated Revenues derived from the recovery of payments made when Third Party Insurance can be accessed. The Statutory Dedications are the Louisiana Medical Assistance Trust Fund which derives its funding source from the collection of provider fees from varying medical providers in the state based on corresponding per bed per day rates, 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, 1998, and the Casino Gaming Proceeds Fund payable out of revenue generated by the land based casino pursuant to enactment of legislative amending existing law to permit expenditures for this purpose. (Per R.S. 39:32B.(8), see table below for a listing of expenditures out of each statutory dedicated fund.) Federal Funds represent federal financial participation in the Medicaid program. Prior years' revenues included interagency transfers of pool funds from Medicaid collections and excess provider fees collected.

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

DESCRIPTION

 

 

 

 

 

$475,482,323

$1,986,160,056

0

 

ACT 19 FISCAL YEAR 1998-1999

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

$0

$17,971,807

0

 

This BA-7 increased the reimbursement rate paid to nursing homes across the state. The state match was provided by an increase in the provider fees all nursing homes pay per bed day to the Department of Health and Hospitals.

 $0

 $0

 0

 

This BA-7 properly aligned the means of financing in this program by increasing statutory dedications and decreasing interagency transfers by $2,104,784. This increase in anticipated statutory dedications is not related to the previous BA-7. 

         

$475,482,323

$2,004,131,863

0

 

EXISTING OPERATING BUDGET - November 20, 1998

 

 

 

 

 

$4,714,688

$18,419,677

0

Other Annualizations - An adjustment to fully fund the costs of the new Louisiana Children's Health Insurance Program (LaCHIP) begun in FY 1999

$5,741,713

$19,353,870

0

Other Annualizations - An adjustment to fully fund the MR/DD Waiver slots filled in FY 1999

$455,391

$1,534,852

0

 

Other Annualizations - An adjustment to fully fund the Adult Day Health Waiver slots added in FY 1999

$758,025

$2,554,852

0

Other Annualizations - An adjustment to fully fund the 200 Elderly and Disabled Waiver slots added in FY 1999

$347,649

$1,171,718

0

Other Annualizations - An adjustment to fully fund the costs of the new Assisted Living Waiver program begun in FY 1999

$366,361

$1,234,785

0

Other Annualizations - An adjustment to fully fund the Case Management services associated with the 700 MR/DD Waiver slots added in FY 1999

$44,505

$150,000

0

Other Adjustments - An adjustment to fund a warranty program on eyeglasses provided via the Early and Periodic Screening, Diagnosis and Testing program

($30,000,000)

($101,112,234)

0

Other Adjustments - An adjustment to reduce the Medicaid budget

$1,001,637

$0

0

Means of Financing Substitution(s) - Replace federal funds with general fund in response to the change in the Federal Medical Assistance Percentage from 29.71% in FY 1999 to 29.67% in FY 2000 and the need to properly align the revenue base in the program

($720,089)

$0

0

Means of Financing Substitution(s) - Replace interagency transfers with general fund to correctly align of the means of financing across the four programs

$32,692,269

$0

0

Means of Financing Substitution - Replace statutory dedications with general fund to remove all nonrecurring revenue from the means of financing base

($68,320,000)

$0

0

 

Means of Financing Substitution – Replace general fund with statutory dedications to associated pro-rata funding with the Supplemental Recommendations

$1,826,505

$8,697,645

0

New and Expanded Adjustments - An adjustment to expand LaCHIP to provide medical coverage to all children under the age of 19 living within 150% of the federal poverty level

$0

$11,543,420

0

 

New and Expanded Adjustments – An adjustment to expand the MR/DD Waiver Program through the addition of 800 new Waiver slots

         

$424,390,977

$1,967,680,448

0

 

SUBTOTAL

         

$0

($241,809,682)

0

 

LESS SUPPLEMENTARY RECOMMENDATIONS

 

 

 

 

 

$424,390,977

$1,725,870,766

0

 

EXECUTIVE BUDGET FISCAL YEAR 1999-2000

         
       

SUPPLEMENTARY RECOMMENDATIONS

$0

$11,543,420

0

 

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

$0

$79,710,145

0

 

Pro-rata funding of all providers excluding only LaCHIP and family planning initiatives

$0

$150,556,117

0

 

Pro-rata funding of all providers excluding only LaCHIP and family planning initiatives

         

$0

$241,809,682

0

 

TOTAL SUPPLEMENTARY RECOMMENDATIONS

         

$424,390,977

$1,967,680,448

0

 

GRAND TOTAL RECOMMENDED

 

 

 

 

 

($51,091,346)

($36,451,415)

0

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

         

($51,091,346)

($278,261,097)

0

DIFFERENCE (TOTAL BASE RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 98.2% of the existing operating budget. It represents 86.1% of the total request ($2,285,508,595) for this program. The major changes include the following adjustments: the annualizations of the costs of expanding to various degrees certain waiver programs in FY 1999; the annualization of FY 1999 and the subsequent expansion of the MR/DD Waiver Program; the annualization of FY 1999 expenditures and the subsequent expansion of LaCHIP; and the downsizing of the program in response to anticipated revenue collections by the State. The effect of not funding the supplementary recommendations may be determined by a review of the description above.

PROFESSIONAL SERVICES

This program does not have funding for Professional Services for Fiscal Year 1999-2000.

OTHER CHARGES

   

Payments to private medical providers for the provision of the following medical services to patients enrolled in the State’s Medicaid program:

$4,077,987

Adult Day Health Waiver

$3,031,444

Adult Dentures

$25,470,847

Appliances and Medical Devices

$2,219,129

Assisted Living Waiver

$5,443,969

Case Management

$3,732,118

Certified Registered Nurse Anesthetists (CRNA’s)

$335,928

Chiropractic

$41,062,586

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

$5,709,932

Elderly & Disabled Adult Waiver

$15,673,996

Emergency Medical Transportation

$4,727,416

Family Planning

$2,068,621

Federally Qualified Health Centers

$16,737,418

Hemodialysis

$15,191,041

Home Health

$392,647,298

Inpatient Hospital

$8,312,676

Inpatient Mental Health

$165,069,887

Intermediate Care Facilities – Mental Retardation (Community Homes for the Mentally Retarded/Developmentally Disabled)

$35,568,823

Laboratory and X-Ray

$459,189,445

Long Term Care Facilities

$48,956,881

Louisiana Children’s Health Insurance Program (LaCHIP)

$93,528,548

Mentally Retarded/Developmentally Disabled Waiver (Home Based Services)

$4,933,632

Miscellaneous

$11,350,584

Non-Emergency Medical Transportation

$108,699,608

Outpatient Hospital

$292,140,812

Pharmaceutical Products

$175,537,877

Physicians

$12,461,810

Psychiatric Rehabilitation

$3,028,012

Rehabilitation

$5,818,173

Rural Health Clinics

$4,953,950

Substance Abuse Clinics

 

 

 

$1,967,680,448

 

TOTAL OTHER CHARGES

ACQUISITIONS AND MAJOR REPAIRS

This program does not have funding for Acquisitions and Major Repairs for Fiscal Year 1999-2000.


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