Louisiana Medical Group Management Association

 


(Capitol building photo courtesy Louisiana Office of Tourism)

 

2017 Louisiana Legislature

Greg Ivey

MGMA-LA State Legislative Chair

With 17 days left in the legislative session it appears there is still plenty of work to be done. Governor Edwards has hinted that another special session may be in order. Below is an update from Elizabeth Crisp with the Advocate.

Elizabeth Crisp

May 22, 2017 - 12:09 am

The Rundown: Merits of the death penalty mulled; Clock winds down on the budget; Gas tax faces critical test; and everything else you need to know about Louisiana politics today.

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Countdown…

Story Continued Below

Days until the regular session ends: 17

The News

Death penalty: The debate over capital punishment wages in Louisiana, as lawmakers vet the merits of continuing to excitute people for crimes. http://bit.ly/2qMUDqV

Budget: The Senate expects to reveal its budget plan next week. http://bit.ly/2qNgkY4

Gas tax: The drive to raise Louisiana’s gasoline tax has suddenly flickered to life, but backers now face the daunting task of rounding up a two-thirds majority in the state House amid anti-tax cries inside and outside the Legislature. http://bit.ly/2qMOScG

Abortion: One of Louisiana's three remaining abortion clinics is blaming a 2015 rewrite of the state's abortion facility regulations for the dwindling number of such clinics in the state. http://bit.ly/2qMOniS

LSU: Gov. John Bel Edwards and some legislators toured LSU's library to see the impact of deferred maintenance first hand. http://bit.ly/2q1EL1K

Flood: Residents paying into the yet-to-be built Comite River Diversion Canal have expressed deep disappointment in the failure to build the canal and have begun to talk about taking action. http://bit.ly/2qMPHlN

Recovery: The floods of 2016 didn't just swamp houses and businesses across swaths of Louisiana, but also hurt many people who lost income because of job disruptions. http://bit.ly/2qMWWdz

Katrina: Al Ater, who as interim secretary of state was instrumental in ensuring voters evacuated to other states after Hurricane Katrina were able to participate in local elections, passed away in Houston Sunday. http://bit.ly/2qMLM8T

Happening today

The Senate convenes at 4 p.m. View the agenda here: bit.ly/LASenateDigest. Watch online here: bit.ly/LASenateChamber

The House comes in at 4 p.m. View the agenda here: bit.ly/LAHouseOrder. Watch online here: bit.ly/LAHouseFloor

House Committees

·         Appropriations meets at 1:30 p.m. Room 5.

·         Transportation, Highways and Public Works meets at 1:30 p.m. Room 3.

·         Ways and Means meets at 1:30 p.m. Room 6.

·         Civil Law and Procedure meets at 2:00 p.m. Room 4.

·         Commerce meets at 3:00 p.m. Room 1.

Senate Committees

·         Finance meets at 9:30 a.m. Room A-B.

·         Revenue and Fiscal Affairs meets at 2:30 p.m. John J. Hainkel, Jr. Room.

Joint Committee

·         Joint Legislative Committee on the Budget meets at 3:30 p.m. Room 5.

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Tips, comments or suggestions? Send your feedback to ecrisp@theadvocate.com or @elizabethcrisp on Twitter. 

 

 

 

 

2016 Louisiana Legislature

Greg Ivey
MGMA-Louisiana State Legislative Chair

 

Click here to view SFY 2017 Reductions to the Executive Budget dated 4-12-16. The legislature has already given permission for LSU to close two of the public/private hospital partnerships. WO moss in Lake Charles and Huey P. Long in Alexandria (see items 12 and 14). If any practice receives an incentive payments from any MCO (Bayou Health Plan), they should pay special attention to item #11. The plans will not be able to cut fee for service reimbursement but if they are hit with a $38.9 million dollar reduction those reductions will most likely be passed on to providers in the form of reduced or eliminated PMPM incentive payments. Time is running out so contact your senator today to voice your opinion. 

SB 291 by Sen. Fred Mills (R-Parks) would allow physical therapists to see patients directly and indefinitely, without ever receiving an assessment or diagnosis from a physician.

Physical therapists do not have adequate training to support this expanded scope of practice. And with all other attempts at expanding scope of practice, access to care is not an adequate argument. This legislation would jeopardize patient safety by eliminating physician-led medicine.

SB 291 could be heard as early as Monday by the full Senate. Please ask your Senator to vote NO on SB 291; if you don't then who will?!

Joint Legislative Committee on the Budget     Saturday, February 13, 2016  3:00 pm

 

Department of Health and Hospitals outlines $131 million in cuts to meet anticipated budget shortfall

Wednesday, January 27, 2016  |  Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov

Today, the Department of Health and Hospitals (DHH) submitted a plan to the Division of Administration that outlines how $131 million in cuts would be spread across the Medicaid program to address the current budget shortfall. DHH Secretary Rebekah E. Gee, MD, MPH said cuts of this magnitude are a worst-case scenario and would only be implemented if the Legislature failed to find additional revenues to address this year's anticipated shortfall.

"We have outlined two options that will reduce Medicaid spending," Gee said. "The reality is both plans will have a catastrophic impact to those served by Medicaid; insurance companies who administer the Bayou Health Plan, hospitals and other providers, and to the patients and people with disabilities who rely on Medicaid for their health care."

DHH developed two reduction plans, one that targets seven specific programs and a second option that eliminates all optional Medicaid programs. Both plans cut $131 million in state funds. In addition, because these state funds attract federal matching dollars, the total impact of both plans are $346.5 million.

Under Option One, the proposed reductions are as follows:

  • Public-Private Partnerships - Reduce spending on the Public-Private Partnerships by $119.1 million in state funding. This equals a $315 million total reduction when federal matching funds are lost. The reductions will be as follows:
    - Eliminate $45 million in state funding ($119.1 million total) in supplemental payments to the partner hospitals that were included in the 2016 Appropriations Act.
    - Eliminate an additional reduction of $9.5 million ($25 million total) to the New Orleans partner hospital in its supplemental payments that were included in the 2016 Appropriations Act.
    - Further reduce the payments to partner hospitals by 12.7 percent. This reduction is $64.6 million in state dollars, $170.9 million total.
  • Reduce Payments to Bayou Health Insurers - This represents a reduction in the per member per month payments to Bayou Health. The reduction is $10.4 million in state funds, $27.4 million total.
  • Eliminate the Pediatric Day Health Care Program - This program serves 612 medically fragile children between the ages of birth to their 21st birthday. It is anticipated that these services could be continued by other Medicaid providers or by school districts. The reduction is $1.6 million in state funds, $4.2 million total.

Under Option Two, the following programs would be eliminated:

  • Reduce Payments to Bayou Health Insurers - This is the same reduction outlined in Option One; $10.4 million in state funds, $27.4 million total.
  • Pediatric Day Health Care Program - This is the same reduction discussed under Option One; is $1.6 million in state funds, $4.2 million total.
  • Hospice Program - Impacts 6,282 hospice recipients. State savings of $200,000, total reduction of $600,000.
  • Children's Choice Waiver - Impacts 1,227 children with developmental disabilities who receive community-based services. State savings of $1.2 million, total reduction of $3.2 million.
  • Adult Day Health Care Waiver - Impacts 900 people who currently receive community-based services as an alternative to nursing home care, and another 4,000 people who are on the waiting list for these services. State savings of $700,000, total reduction of $1.8 million.
  • Residential Options Waiver - This is a program that serves 26 people who are former long-time residents of adult foster care but who now receive home-based care. State savings of $100,000, total reduction of $300,000.
  • PACE Program - PACE is the Program for All-Inclusive Care for the Elderly. PACE offers health care and social services to nursing home-eligible seniors in an adult day care environment. The program currently serves 235 seniors and has a maximum capacity of 600 participants. State savings of $1.2 million, total reduction of $3.1 million.
  • Supports Waiver - This program provides specific, activity-focused services to individuals with disabilities in their homes. The program will impact 1,739 people currently receiving services as of January 2016. State savings of $1.2 million, total reduction of $3.2 million.
  • Long Term Personal Care Services - This service provides hands-on assistance with basic self-care tasks such as eating, bathing, dressing, grooming, and toileting to low-income elders and people with adult-onset disabilities. Elimination of this program will impact more than 17,300 recipients. State savings of $16.6 million, total reduction of $44 million.
  • Community Choices Waiver - This is the primary home and community-based waiver program serving as an alternative to nursing facility care for seniors and people with adult onset disabilities. As of November 2015, there were 5,581 people in the program and another 33,000 individuals on the waiting list. State savings of $10.8 million, total reduction of $28.7 million.
  • Intermediate Care Facilities - These are institutions that serve people with developmental disabilities in a 24-hour managed care environment. Elimination of this program will impact 4,914 recipients currently receiving services. State savings of $24.9 million, total reduction of $66 million.
  • NOW Waiver - The New Opportunities Waiver (NOW) allows people with developmental disabilities to be served in community and home based settings instead of an institution. Elimination of this program will impact 8,686 people currently receiving services. State savings of $42.7 million, total reduction of $113 million.
  • Ambulatory Surgical Center Program - Provides day surgery procedures to an estimated 16,172 recipients. State savings of $200,000, total reduction of $500,000.
  • Hemodialysis Program - Provides free-standing End Stage Renal Disease services to 5,904 recipients. State savings of $3.3 million, total reduction of $8.82 million.
  • Prescription Limits in Adult Pharmacy Program - Medicaid pays for prescription drugs for Medicaid beneficiaries with a limit of four prescriptions per patient (recipient) per calendar month. But, there is an option to get more prescriptions under the "medically necessary override" provision. Eliminating this provision is expected to save $15.9 million in state funds, and $42.1 million total.

In addition to these two options, the Department might also consider a combination of some reductions and program eliminations to achieve the necessary savings.

"Both of these options are worst-case scenarios that we hope will not have to be implemented. The Department has always worked to address the yearly budget shortfalls without cutting provider fees and by minimizing program impacts by using various internal solutions. However, this year's budget reality is monumental, and the potential cuts and their results are staggering," said Gee. "If this reduction plan becomes a reality, its impact will be felt by almost all residents. Vital health care services across Louisiana will be completely eliminated or diminished if additional revenue is not identified in the upcoming special session." 

To learn more about DHH, visit http://www.dhh.louisiana.gov

 


MID-YEAR LEGISLATIVE DEFICIT UPDATE - 11/24/15   See the deficit plan from the Joint Legislative Comittee for the Budget here.

 

Learn more about the Legislature with This Legislative Guide

 

 2015 LEGISLATIVE REGULAR SESSION NEWS 

The Louisiana Chapter of the American Academy of Pediatrics is following bills and taken positions on some of them:


See full
list here
              
Healthcare Bills             Tobacco               Finance/Revenue/Taxes              Sexual Assault

UPDATE 04-15-15: Louisiana lawmakers now at Capitol pondering money sources, cutbacks, tax credits, and more

The 2015 regular session commenced on Monday April 13 at 12 noon and will remain in session until June 11th at 6pm. On Feb. 27,  Commissioner of Administration Kristy Nichols presented the governor’s proposed budget. Some of the highlights from the presentation are listed below.

Lawmakers have a $1.6 billion deficit to deal with this session and are  looking to reform refundable tax credits. The governor’s office wants to reduce expenses by $526 million without increasing taxes; it would also eliminate 727 state jobs/positions.

Healthcare cuts and protection from cuts

The DHH budget would be reduced by $15 million net.  Items that would not be cut include Medicaid provider rates, medical schools, Bayou Health plans, current funding levels for LSU public-private partnership hospitals and clinics, and individuals receiving home and community based waiver services. Of course, all budget proposals are subject to changes as the legislative session moves through its paces these next few months. But the February budget briefing listed these items:

The list of Healthcare expenditures that are being cut or eliminated would include:

  •  Eliminate hospital outlier pool $2.7 million
  • Reduction of $7.7 million through the elimination Greater New Orleans Community Health Connection Program
  • Elimination of Developmental Neuropsychiatric Program $338,107
  • Eliminate state general fund in the LSU+UPL Program $9.6 million
  • Eliminate inpatient teaching hospital program $100,000
  • Eliminate the LAHIPP program $2.3 million

Lawmakers filed more than 1,000 bills (proposed laws) prior to the start of the session and these have been assigned to various committees for hearing. Several of the bills may affect scope of practice, licensure and reimbursement. We encourage everyone to follow the bills of interest to their practice.


KEEPING UP:  See  Legislative Guide above and visit the Legislature's Home Page for scheduled meetings and live streaming of meetings.

PAR Releases Guide to the State Budget Crisis  (04-10-15)   

The Public Affairs Research Council of Louisiana has released an in-depth examination of the state's budget crisis. PAR's Guide to the State Budget Crisis  examines the fiscal condition of the state, including the historical factors that lead us to the current situation.

Louisiana is facing its toughest state budget challenge since the 1980s oil industry depression. Required by law to construct a balanced budget, the Legislature is seeking ways to close a $1.6 billion gap between expected general fund revenue and the initial estimate for spending in the 2016 fiscal year. This report reviews the decisions and circumstances that created Louisiana's chronic and compounding budget sustain-ability problem. It serves as an educational primer on state budgeting and it investigates the familiar as well as the obscure but critical elements of state taxing and spending. 

The wide-ranging report covers many content areas including healthcare, higher education, transportation, and state support of local government, among others. There are also a series of in-depth sections. The section on the state pension systems shows that this is not some future crisis in waiting, but is already having a substantial impact on the budget. The section that reviews dedicated funding demonstrates that while fixes can be made, change is not as straight forward as some might think. This report also contains an analysis of the state's tax exemptions including a special section devoted to tax on inventory. The inventory tax section examines the nature and history of this peculiar tax structure and reviews the various proposed solutions. 

"This report is designed to serve citizens as an owner's manual to the budget," notes PAR President Robert Scott. "The $1.6 billion budget shortfall has rightfully caused a great deal of concern and interest. This will help people navigate the often complex fiscal waters. Our hope is that readers will come away with a different, more informed perspective on the budget issues facing the state."

 To simply access the report,  click here.

 

03-18-15 - Legislative veteran Jim Fannin worried about state financial situation

Monroe news reporter Greg Hilburn shares his interview with Rep. Jim Fannin who has "crafted seven budgets during his tenure as House Appropriations Chair" but this year he is espcially concerned and is making no predictions. More here.

In Hilburn's  late February news story, Fannin was said to be "combing through virtually every Legislature-controlled state fund both within the treasury and outside it to find excess balances that could be siphoned to fill a gaping $1.6 billion budget hole... Conventional wisdom is that the Legislature and Gov. Bobby Jindal have already drained all of the available pools to plug previous budget gaps, but Fannin believes there could be more than $100 million — perhaps hundreds of millions — still to be harvested." Read more.

02-24-15  Message from Greg Ivey, Legislative Chair

State lawmakers convene April 13


While lawmakers are slated to return to the capitol on April 13th, there are already committee meetings in progress. I observed part of the  Feb. 20 hearing by the Joint Legislative Committee on the Budget.  The committee is proposing over $103 million in cuts. Included in these cuts are $13.05 million to healthcare, not including the federal match. If you include the federal match that number moves to about 21 million dollars. There will be additional discussions about cuts to DHH and higher education once the session starts.

We are gearing up for our own work and invite you to join our committee: If you are interested in joining the MGMA-Louisiana legislative committee, please contact us—you can reply to this email. Committee members generally meet weekly during the session by teleconference to discuss bills and their impact on medical practices. We have just compiled a legislative guide and other useful information  for all members which you can access here on this page.

I would like to say thank you to those who take the time to participate on the legislative committee. They are:  Bruce Anzalone, Stefanie Ardoin, Tim Barrett, Laurie Bergeron, Thomas Cochran, Lafe Jones, Leigh Anne Hunter, Janet Krane and Ed Silvey.  Once again this year, we are glad to report that Berkley Durbin and Ashley Politz will join us as committee members, reporting from the capitol as their schedules permit. Berkley is with  Medicine Louisiana, and Ashley is with the Louisiana chapter/American Academy of Pediatrics .

I encourage everyone to participate in the process in any way you can.  You will notice in our new guide (top of this screen) a link to the legislature’s website where their home page always lists upcoming committee  meetings.  

I was at a recent conference where this comment was made about politics, “If you are not at the table, you are on the menu”. Please join us at the table and have your voices heard.  Contact me or Suzie Smith if you want to help us out this year with the legislative agenda.

 

Political Blogs from the Baton Rouge Advocate newspaper

 

 


 


 

 

 

 

 

 

 

 

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