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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).

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

GENERAL FUND

TOTAL

T.O.

 

DESCRIPTION

 

 

 

 

 

$429,983,388

$1,987,123,438

0

 

ACT 18 FISCAL YEAR 1997-1998

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

($82,893)

($279,666)

0

 

Transfer between Private Providers and Uncompensated Care Costs to budget for Villa Feliciana's BA-7 (#282)

 

 

 

 

 

$429,900,495

$1,986,843,772

0

 

EXISTING OPERATING BUDGET - December 10, 1997

 

 

 

 

 

$3,961,333

$13,333,333

0

 

Annualization of the newly reinstated Medically Needy Program to provide funding for the final third of the year not in existing operating budget

$990,543

$3,334,040

0

 

Annualization of the costs associated with the increase in the number of MR/DD waiver slots partially filled in FY98

$0

$1,339,450

0

 

Annualization of the rate increase for EPSDT services

$0

$367,574

0

 

Annualization of the costs associated with the most recently filled Elderly Waiver slots

$1,116,981

$3,759,614

0

 

Workload - Increase in the utilization of physicians crossover

$0

$2,154,316

0

 

Workload - Increase in the utilization of available leave days by ICF/MR facilities and nursing homes

$0

$2,347,887

0

 

Workload - Increase in the utilization of outpatient hospitalization services

$84,000,000

$0

0

 

Means of Financing Substitution(s) - Replace interagency transfers with general fund to eliminate the carryforward of overcollections from FY97 to FY98 for recurring expenses

$1,390,790

$0

0

 

Means of Financing Substitution(s) - Replace federal funds with general fund for the Federal Medical Assistance Percentage (FMAP) change in the state match rate from 29.64% to 29.71%

($574,430)

$0

0

 

Means of Financing Substitution(s) - Replace general fund with statutory dedications for the War Veterans Home to pay provider fees

($18,152,705)

$0

0

 

Means of Financing Substitution(s) - Replace general fund with statutory dedications to budget for statutory dedications that have already been collected

($4,767,570)

$0

0

 

Means of Financing Substitution(s) - Replace general fund with statutory dedications to adjust budget for additional requests made by the Department of Health and Hospitals

($9,960,440)

$0

0

 

Means of Financing Substitution(s) - Replace general fund with statutory dedications to balance to the most recent revenue projections

$0

$9,246,953

0

 

Adjustment(s) to compensate for the high rate of inflation associated with pharmaceutical goods and services

$0

$1,200,000

0

 

Adjustment(s) to create the Assisted Living Waiver program as legislated by Act 1185 of 1997

$0

$1,317,554

0

 

Adjustment(s) to return the KIDMED program to the 1995 level of service

($3,960,604)

($13,330,878)

0

 

Adjustment(s) due to an existing operating budget surplus

($5,942,000)

($20,000,000)

0

 

Adjustment(s) to remove excess private hospitalization audit payments

($15,000,000)

($50,488,051)

0

 

Adjustment(s) to reduce payments for inpatient hospitalization services, long term care facilities, and physicians services

 

 

 

 

 

$463,002,393

$1,941,425,564

0

 

TOTAL RECOMMENDED

 

 

 

 

 

$33,101,898

($45,418,208)

0

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

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.

PROFESSIONAL SERVICES

This program does not have funding for Professional Services for Fiscal Year 1998-1999.

OTHER CHARGES

$1,941,425,564

 

Medicaid payments for the following:

$387,055,377

 

Non-discretionary inpatient hospital services

$115,912,300

 

Non-discretionary outpatient hospital services

$463,468,752

 

Non-discretionary long term care facilities

$170,325,723

 

Discretionary private ICF/MR facilities (community homes for the mentally retarded)

$59,815,652

 

Discretionary MR/DD home and community based waiver services

$17,916,711

 

Non-discretionary private inpatient mental health hospital services for patients under the age of 22

$14,688,816

 

Discretionary Psychiatric Rehabilitation program services

$1,684,607

 

Discretionary Adult Day Health waiver services

$186,740,318

 

Non-discretionary private physician services

$287,958,601

 

Discretionary and non-discretionary pharmaceutical products and services

$37,410,144

 

Non-discretionary laboratory and X-ray services

$14,910,957

 

Non-discretionary emergency medical transportation services

$11,808,431

 

Non-discretionary non-emergency medical transportation services

$719,444

 

Discretionary chiropractic services

$3,641,123

 

Discretionary Certified Registered Nurse Anesthetists services

$3,949,735

 

Discretionary adult dentures

$25,366,117

 

Discretionary appliances (durable medical equipment)

$23,279,288

 

Non-discretionary home health services

$18,209,711

 

Discretionary Hemodialysis services

$52,915,993

 

Non-discretionary EPSDT screening and related services

$3,417,775

 

Discretionary case management services

$4,581,572

 

Discretionary Elderly Waiver services

$3,386,155

 

Non-discretionary Federally Qualified Health Center services

$4,864,034

 

Non-discretionary private family planning services

$5,654,230

 

Discretionary private rehabilitation services

$4,887,632

 

Non-discretionary rural health clinics

$10,790,948

 

Discretionary private substance abuse clinics

$4,865,418

 

Non-discretionary other private provider services

$1,200,000

 

Discretionary Assisted Living Waiver

 

 

 

$1,941,425,564

 

TOTAL OTHER CHARGES

ACQUISITIONS AND MAJOR REPAIRS

This program does not have funding for Acquisitions and Major Repairs for Fiscal Year 1998-1999.


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