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) and to administer the Medicaid Program to ensure operations are in accordance with federal and state statues regarding medically necessary services to eligible recipients. Additionally, the Medical Vendor Payments Program assures that reimbursements to providers of medical services to Medicaid recipients are appropriate.
The goals of the Payments to Private Providers are:
1. To develop alternatives to institutional care.
2. To implement disease management programs in the Pharmacy Program.
The Payments to Private Providers Program provides 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
Unless otherwise indicated, all objectives are to be accomplished during or by the end of FY 1999-2000. Performance indicators are made up of two parts: name and value. The indicator name describes what is being measured. The indicator value is the numeric value or level achieved within a given measurement period. For budgeting purposes, performance indicator values are shown for the prior fiscal year, the current fiscal year, and alternative funding scenarios (continuation budget level and Executive Budget recommendation level) for the ensuing fiscal year (the fiscal year of the budget document).
RESOURCE ALLOCATION FOR THE PROGRAM
The Total Recommended amount includes $91,253,565 of Supplementary Recommendations, of which $27,074,933 is Statutory Dedications, for the expansion of the MR/DD Waiver Program and pro-rata funding for all providers excluding only LaCHIP and family planning initiatives. Funding of this Supplementary Recommendation is payable out of funding received pursuant to the Master Settlement Agreement reached between certain states and participating tobacco product manufacturers in November, 1998.
The Total Recommended amount includes $150,556,117 of Supplementary Recommendations, of which $44,670,000 is Statutory Dedications, for pro-rata funding for all providers excluding only LaCHIP and family planning initiatives. Funding of this Supplementary Recommendation is payable out of the Casino Gaming Proceeds Fund pursuant to enactment of legislation amending existing law to permit expenditures for this purpose.
This program is funded with General Fund, Interagency Transfers, Fees and Self-generated Revenues, Statutory Dedications, and Federal Funds. Interagency Transfers originate from the Department of Social Services, Office of Family Support for Refugee Medical Vendor payments and Office of Community Services for the processing and all state funded payment of Non-Title XIX Foster Care Medical Vendor claims. Self-generated Revenues derived from the recovery of payments made when Third Party Insurance can be accessed. The Statutory Dedications are the Louisiana Medical Assistance Trust Fund which derives its funding source from the collection of provider fees from varying medical providers in the state based on corresponding per bed per day rates, the Tobacco Settlement Fund payable out of funding received pursuant to the Master Settlement Agreement reached between certain states and participating tobacco products manufacturers in November, 1998, and the Casino Gaming Proceeds Fund payable out of revenue generated by the land based casino pursuant to enactment of legislative amending existing law to permit expenditures for this purpose. (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' revenues included interagency transfers of pool funds from Medicaid collections and excess provider fees collected.
The total means of financing for this program is recommended at 98.2% of the existing operating budget. It represents 86.1% of the total request ($2,285,508,595) for this program. The major changes include the following adjustments: the annualizations of the costs of expanding to various degrees certain waiver programs in FY 1999; the annualization of FY 1999 and the subsequent expansion of the MR/DD Waiver Program; the annualization of FY 1999 expenditures and the subsequent expansion of LaCHIP; and the downsizing of the program in response to anticipated revenue collections by the State. The effect of not funding the supplementary recommendations may be determined by a review of the description above.
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This program does not have funding for Professional Services for Fiscal Year 1999-2000. |
OTHER CHARGES
ACQUISITIONS AND MAJOR REPAIRS
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This program does not have funding for Acquisitions and Major Repairs for Fiscal Year 1999-2000. |