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Program A: Medical Vendor Administration

PROGRAM DESCRIPTION

The mission of the Medical Vendor Administration Program is to develop and implement the administrative and programmatic procedures to provide quality health care to all qualified Louisiana residents enrolled in the Medicaid Program.

The goal of Medical Vendor Administration Program is to administer the Medicaid program to ensure that it operates in an efficient and effective manner according to federal and state statutes, rules and regulations.

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

1. In FY 1998-99, the Medical Vendor Administration Program, through the Medicaid Management Information System, will operate an efficient Medicaid Claims processing system.

1 Error free claims must be processed within 30 days.

2. In FY 1998-99, the Medical Vendor Administration Program, through the Medicaid Eligibility Determinations activity, will provide Medicaid Eligibility Determinations and administer the program within federal regulations, by processing 97% of applications timely.

1 The federal Medically Needy Program is reinstated and the potential of having to do aggressive outreach to eligibles exists.

3. In FY 1998-99, the Medical Vendor Administration Program, through the Program Integrity activity, will ensure that expenditures for Medicaid services are appropriate.

1 DHH has hired additional Program Integrity and legal staff, and as a result, collections increased to $40 million, including $30 million from Psychiatric Hospitals. As these new auditors are hired and working on cases, the Department expects the compliance rate to improve.

4. In FY 1998-99, the Medical Vendor Administration Program, through the Health Standards activity, will enforce licensing standards and certification requirements through licensing, surveying, and certification of health care providers.

1 Survey refers to annual inspection of health care facilities for determining compliance with federal regulations and state standards (for licensing and/or Medicaid). Surveys include a review of the following areas: quality of care (nursing services), quality of life (patients/resident/client rights), pharmaceutical services, dietary services, physician services, professional services, environmental services, quality assurance, administration, admission, transfer/discharges, activities, social services, resident assessment, and life safety code.

2 Out of compliance: Facilities that are determined not to meet conditions of participation, have substandard quality of care or have a limited capacity to furnish services required by Medicare/Medicaid.

3 Sanction: Includes civil monetary penalties, denial of payment for new admissions, state monitoring, directed plans of correction.

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

This program is funded with general fund, fees and self-generated revenues, and federal funds. Fees and self-generated revenue are derived from miscellaneous collections, such as document copies. Federal funds represent the federal share of the cost to administer the Medicaid program. The federal share varies by type of activity, but averages about 60% of the total Medicaid administrative cost.

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

 

DESCRIPTION

 

 

 

 

 

$34,068,049

$94,192,622

1,121

 

ACT 18 FISCAL YEAR 1997-1998

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

 

 

 

 

None

 

 

 

 

 

$34,068,049

$94,192,622

1,121

 

EXISTING OPERATING BUDGET - December 10, 1997

 

 

 

 

 

($401,691)

($803,381)

0

 

Non-recurring Adjustment(s) for the costs of a non-emergency medical transportation scheduling contract in the New Orleans area as this function will be performed by State Staff in FY 1998-'99.

($17,500)

($35,500)

0

 

Non-recurring Adjustment(s) for the contract for the investigation of complaints against nursing homes

($150,000)

($300,000)

0

 

Non-recurring Adjustment(s) for the Medicare buy-in program computer system up-grade to reflect the completion of the contract

($62,500)

($125,000)

0

 

Non-recurring Adjustment(s) for the costs of independent assessment waivers, the scope of which varies every other year

($320,661)

($641,322)

0

 

Equipment/Major Repairs Adjustment(s) (Non-recurring: -$1,032,909; Replacement/New: +$712,248)

$333,327

$666,653

0

 

Annualization of 1997 -'98 Merit Pay Adjustment(s)

$339,994

$679,987

0

 

1998 -'99 Merit Pay Adjustment(s)

$581,733

$1,462,707

0

 

Attrition Adjustment(s)

($95,070)

($190,140)

0

 

Retirement Rate Adjustment(s)

$58,614

$117,227

0

 

Adjustment(s) for Civil Service, Training and Other Statewide Interagency Transfer Activities

($1,047,212)

($2,094,424)

0

 

Reductions in various Expenditure Categories; Including Reductions to fully fund Salaries

($425,000)

$0

0

 

Substitute federal funds for general fund to budget the federal match for the Medicaid managed care demonstration project in the Houma-Thibodeaux area

$3,767,705

$0

0

 

Substitute general fund for federal funds to accurately reflect the State match rate for the Medicaid administration program

$0

$0

(2)

 

Technical adjustment to transfer two authorized positions to the Office of Mental Health, with no associated means of financing, at agency request

$2,206,153

$4,412,305

0

 

Fund the increased costs associated with the re-bidding of the fiscal intermediary contract, including an expansion in the scope of services provided by the contractor

$63,578

$127,155

0

 

Increase in funding for ventilator assisted child case management services

$11,177

$22,354

0

 

Fund an increase in the scope of audits of acute care hospitals, federally qualified and rural health clinics, and mental health and substance abuse outpatient clinics

$12,500

$25,000

0

 

Fund the cost of expert testimony and consultation for court cases brought as a result of increased fraud and abuse detection efforts by the department

($9,273)

($18,545)

0

 

Reduce funding for student labor to the level student employment projected by the department for FY 1998-'99

$1,760,000

$3,520,000

0

 

Fund the cost of enhancements to the computer system for the Welfare Information System to make year 2000 compliant

$0

$1,613,348

2

 

Provide funding and positions to replace the positions transferred to the Office of Mental Health

$340,462

$680,923

0

 

Transfer funding for the Bock nursing home resident assessment contract from management and finance to this appropriation, and substitute matching federal funds for one-half of the general fund

 

 

 

 

 

$41,289,385

$103,862,469

1,121

 

TOTAL RECOMMENDED

 

 

 

 

 

$7,221,336

$9,669,847

0

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 110.3% of the existing operating budget. It represents 97.2% of the total request ($106,918,939) for this program.

Most of the difference between the existing operating budget and the total amount recommended can be accounted for by the addition of $4.4 million ($2.2 million general fund) for an increase in the fiscal intermediary contract, including an increase in the scope of services provided by the contractor in processing claims for payment of providers of covered medical services for Medicaid eligible patients. In addition, $3.5 million ($1.8 million general fund) was provided to upgrade the Welfare information computer system for year 2000 compliance, and $690,923 ($340,462 general fund) was increased by the transfer of the Bock contract to screen nursing home residents for appropriateness of placement from the Office of the Secretary in order to access federal financial participation in the cost of the contract.

PROFESSIONAL SERVICES

$200,000

 

Covington & Burling for litigation costs

$15,555

 

Disability Determinations (medical exams)

$32,833,884

 

Fiscal intermediary contract

$596,341

 

Hospitals, Federally Qualified Health Centers, Rural Health Centers, Home Health Agencies, Mental Health & Substance Abuse Audits

$300,000

 

Hospital Rate Rebasing

$25,000

 

Independent Assessment Waivers

$113,689

 

Computerized Income Tax Matching

$5,036,308

 

Kid-med and Community Care Management

$705,400

 

Long Term Care Audits

$111,090

 

Long Term Care Physicians & Consultants

$262,500

 

Case Management Contractor Audits

$10,130

 

Medical Consultants

$42,534

 

Medical Review Physicians

$608,221

 

Ventilator Assisted Child Case Management

$3,146,182

 

Non-Emergency Medical Transportation

$106,000

 

Nursing Home Board of Administration-Aide Registry

$15,000

 

Nurses Aide Competency Testing

$65,000

 

Drug Utilization Review

$650,250

 

Pharmacy Audits

$65,000

 

Psychiatric Consultants

$17,900

 

CD-Rom Technology Consulting

$15,000

 

IBM Computer System Upgrade for Reimbursement

$25,000

 

Medical Consultants for Surveillance and utilization review

$2,340,188

 

Third Party Liability Collection Contract

$3,520,000

 

Upgrade Computers for year 2000 compliance

 

 

 

$50,826,172

 

TOTAL PROFESSIONAL SERVICES

OTHER CHARGES

$600,000

 

Hepatitis B Vaccine

$310,000

 

Medicaid Enrollment Centers

$15,000

 

Nurse Aide Training Reimbursement

$5,000

 

Supplemental Security Income Field Office Eligibility Determination Information

$135,000

 

Nursing Homes, ICF/MR's, Hospital Home Health Agencies and Dialysis Employee Licensing Training

 

 

 

$1,065,000

 

TOTAL OTHER CHARGES

 

 

 

 

 

Interagency Transfers

$301,793

 

Division of Administration - Rent, Maintenance, Forms Management & Publishing

$2,184,349

 

Department of Social Services - Joint costs of co-housed eligibility staff

$75,934

 

Department of Social Services Warehouse - Supplies

$2,168

 

Department of Social Services - Printing

$195

 

Department of Social Services - Dues and Subscriptions

$226,000

 

Fire Marshall - Life Safety Code Inspections

$72,095

 

Office of Public Health - Flu Vaccine

$117,227

 

Civil Service

$400,000

 

OCDD - Transition Coordinators (Pinecrest Developmental Center and Hammond Developmental Center to Community)

$150,000

 

OCDD - Add more Transition coordinator

$1,500,000

 

University of New Orleans - Computer & computer training services

$457,934

 

LSU School of Dentistry - Contractual Services

 

 

 

$5,487,695

 

TOTAL INTERAGENCY TRANSFERS

 

 

 

ACQUISITIONS AND MAJOR REPAIRS

$1,424,495

 

Funding for replacement of inoperable and obsolete equipment

 

 

 

$1,424,495

 

TOTAL ACQUISITIONS AND MAJOR REPAIRS


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