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).
The goal of the Payments to Private Providers Program is to provide 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
1. In FY 1998-99, the Payments to Private Providers Program will decrease by 24.9% the use of child and adolescent in-patient hospitalizations by increasing the use of quality Community Mental Health Rehabilitation and Mental Health Clinic services.
1 Statistics on diverted cases were not compiled for SFYs 1995-97.
2. In FY 1998-99, the Payments to Private Providers Program will utilize the Pharmacy Benefit Management Program (PBM) to convert 8.7% of eligibles with gastrointestinal disorders from an acute level of therapy to a maintenance level which will reduce pharmacy expenditures.
Note: Disease management was initiated in SFY 1997. Disease Management programs for other disease states will be implemented in the future. The order of program implementation is as follows: Lipids and Diabetes, Hyperkinetics, Arthritis, Asthma and Depression.
3. In FY 1998-99, the Payments to Private Providers Program will offer Medicaid recipients alternatives to institutionalization where appropriate by providing alternative quality care for services to clients in MR/DD waiver and Mental Health Rehabilitation Program.
1 Institutional Care: Inpatient Hospital, Long Term care, ICF/MR, Inpatient Mental Health.
2 Institutional Alternatives: Outpatient Hospital, MR/DD Waiver, Psychiatric Rehabilitation, Adult Day health, Home Health, and Elderly and disabled Adult Waiver.
3 December forecast.
RESOURCE ALLOCATION FOR THE PROGRAM
SOURCE OF FUNDING
This program is funded with general fund, fees and self-generated revenues, statutory dedications, and federal funds. Self-generated revenues are derived from recoveries of payments made when Third Party Insurance funds can be accessed. The statutory dedication is the Louisiana Medical Assistance Trust Fund that is funded from provider fees. (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' revenue included interagency transfers of pool funds from Medicaid overcollections.
ANALYSIS OF RECOMMENDATION
The total means of financing for this program is recommended at 97.7% of the existing operating budget. It represents 93.3% of the total request ($2,079,981,168) for this program. The major changes include the following adjustments: a non-recurring adjustment to remove a portion of the private hospitalization audit payments; annualizations for the medically needy program, the increase in the MR/DD waiver slots, existing Elderly Waiver slots, and the rate increase for EPSDT services; workload adjustments for the increased utilization of physicians crossover, the increased use by ICF/MR facilities and nursing homes of available leave days, and the increased need for the performance of outpatient hospitalization services; and other adjustments for an existing operating budget surplus, inflation associated with pharmaceutical goods and services, the new Assisted Living Waiver program, the funding increase for the KIDMED program, and reductions in inpatient hospitalization services, long term care facilities, and physician services. Overall, general fund increased by $33 million due mainly to means of financing substitutions of general fund to cover recurring expenses that were financed by non-recurring funds in the current fiscal year.
ACQUISITIONS AND MAJOR REPAIRS
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