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09-306 Medical Vendor Payments Program

The Medical Vendor Payments Program provides for direct payments to medical vendors (healthcare providers) for essential health care services rendered to Louisiana residents who are eligible for the Title XIX Medicaid Program, are Department of Corrections inmates or are medically indigents. Medical Assistance is extended to individuals eligible for Temporary Assistance to Needy Families, Pregnant Women, and Children through age 6 with income under 133% of the poverty level, Supplemental Security Income, State Supplementation, Foster Care, Refugee Assistance, Medically Needy Assistance and Long Term Care categories of assistance. Preventive health care for children up to age 21 is included as a medically necessary service. Family planning services are covered for all eligibles.

Services provided under the Medical Vendor Program include: (1) inpatient and outpatient hospital services including ambulatory surgical center services (with limitations); (2) nursing facility services; (3) physician services including Podiatrists, Optometrists, Nurse Practitioners and Nurse-Midwife Services (with limitations); (4) independent laboratory and x-ray services; (5) pharmacy services; (6) clinic services (Mental Health, Substance Abuse, Sexually Transmitted Disease Clinics and Tuberculosis Clinics); (7) outpatient services including Hemodialysis Services and Rehabilitation Center Services (with limitations); (8) Family Planning Services; (9) Early and Periodical Screening, Diagnosis and Treatment Services including Basic Screening, Dental Treatment and Eyeglasses, as well as services from other Subprogram Medical Vendors (Kid-Med); (10) Home Health Services; (11) Medical Transportation Services (prior authorized); (12) Durable Medical Equipment (prior authorized); (13) Adult Dental Services; (14) Rural Health Services; (15) Mental Hospital Services for individuals under age 21 or age 65 or older; (16) Waivered services (Adult Day Health, Mentally Retarded/Developmentally Disabled and Managed Care); (17) Optional Targeted Case Management; and (18) Federally Qualified Health Center Services.

It is estimated that approximately 20% of the recipients of Medical Vendor Payments (MVP) program expenditures are children, and consequently it is assumed that 20% of MVP program expenditures represent expenditures for children. Shown below is a compilation of the projected Medical Vendor Payments program expenditures to private providers for children's services that are included in the Governor's Executive Budget Recommendation. It should be noted that only payments to private providers are included in the compilation below. Medical Vendor Payment program expenditures to public providers are counted as revenue by the public providers, and consequently services for children that are provided by publicly funded healthcare entities are shown in the specific public sector descriptions that follow this section.

RESOURCE ALLOCATION FOR CHILDREN

 

 

1998-1999

 

 

(MILLIONS $)

MEANS OF FINANCING:

 

 

 

 

 

STATE GENERAL FUND

 

$92.6

   Interagency Transfers

 

0.4

   Self-Generated Revenues

 

1.0

   Statutory Dedications

 

20.7

FEDERAL FUNDS

 

  273.6

 

 

 

TOTAL

 

$388.3

 

 

 

EXPENDITURES:

 

 

 

 

 

Medical Vendor Payments to Private Providers

 

$388.3

 

 

 

TOTAL

 

$388.3


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