§976. Children's Health Insurance Program; criteria for implementation

A. In accordance with the authority granted the Louisiana Department of Health pursuant to R.S. 36:254(A)(6) and (D)(1)(a)(i) and pursuant to the restrictions contained in Subsection B of this Section, the department shall avail itself of federal funding under the Children's Health Insurance Program (Title XXI of the Social Security Act) only if the following criteria are met:

(1) If sufficient funds are appropriated, at a minimum, the department shall grant a reasonable fee increase of at least ten percent for physician's reimbursement codes 99212, 99213, and 99214. The department shall investigate the need for other adjustments to physician's reimbursement codes in order to increase the number of participating providers serving the Medicaid population.

(2) The department shall make recommendations to the legislature in regard to policy issues involved in reducing the number of primary care health professional shortage areas in the state.

(3) The department shall take the following steps to simplify the enrollment process for children:

(a) Significantly reduce the size of the application form for children who seek to qualify for Medicaid on the basis of family income level.

(b) Distribute the application form at various strategic locations, including but not limited to hospitals and other health facilities.

(c) Distribute information as to how to apply for Medicaid services and where to obtain an application form at various strategic locations, including but not limited to healthcare facilities, schools, community centers, churches, and grocery stores.

(d) Authorize an application to be mailed to the department.

(4) The department shall authorize one-year continuous eligibility for children, birth until age nineteen, in accordance with federal guidelines.

(5)(a) The department shall expand Medicaid eligibility for children, birth until age nineteen, in families whose income does not exceed one hundred thirty-three percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services.

(b) After July 1, 1999, the department shall expand Medicaid eligibility for children, birth until age nineteen, in families whose income does not exceed one hundred fifty percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services.

(c) After July 1, 2000, the department shall expand eligibility for children, birth until age nineteen, in families whose income does not exceed two hundred percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services.

(d)(i) After July 1, 2001, the department shall apply to the Centers for Medicare and Medicaid Services, United States Department of Health and Human Services, for authority to implement appropriate waivers or demonstration projects to expand eligibility under the Children's Health Insurance Program for parents of children who are enrolled in the state's Children's Health Insurance Program or Medicaid whose family income does not exceed one hundred percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services, and for pregnant women whose family income is greater than one hundred eighty-five percent of the applicable federal poverty guideline but does not exceed two hundred percent of the applicable federal poverty guideline.

(ii) As used in this Subparagraph, the term "parent" shall mean the child's mother and legal father with whom the child resides and who exercise daily responsibility for care and control of the child, and shall include adoptive parents who have been legally granted a decree of adoption, but shall not include step-parents or parents who share custody but do not reside with the child the majority of the time.

(iii) However, the provisions of this Subparagraph shall not be implemented by the department until such time as funding and performance standards, including a specified target for enrollment, for the program are specifically provided for in the General Appropriation Act for any fiscal year. The date for such implementation shall be as provided by the General Appropriation Act, or if no date is specified, no later than the first day of January in the fiscal year for which the appropriation is made, contingent upon approval of the waivers or demonstration projects by the Centers for Medicare and Medicaid Services, United States Department of Health and Human Services. In addition, the initial implementation of this Subparagraph shall be contingent upon approval of an implementation plan containing cost projections for at least three years which shall be submitted by the department to the Senate Committee on Health and Welfare, the House Committee on Health and Welfare, and the Joint Legislative Committee on the Budget.

B.(1)(a) Subparagraph (A)(5)(a) of this Section shall not be implemented by the department unless funding and performance standards, including a specified target for enrollment, for the state's Children's Health Insurance Program, hereafter referred to as "LaCHIP", are specifically included in the General Appropriation Act enacted during the 1998 Regular Session of the Louisiana Legislature. The department shall implement LaCHIP on the date set forth in the General Appropriation Act or if no date is specified, no later than October 1, 1998.

(b) Subparagraph (A)(5)(b) of this Section shall not be implemented by the department unless funding and performance standards, including a specified target for enrollment, for the program are specifically included in the General Appropriation Act enacted during the 1999 Regular Session of the Louisiana Legislature. The department shall implement Subparagraph (A)(5)(b) of this Section on the date set forth in the General Appropriation Act enacted during the 1999 Regular Session of the Louisiana Legislature or, if no date is specified, not later than October 1, 1999.

(c) Subparagraph (A)(5)(c) of this Section shall not be implemented by the department unless funding and performance standards, including a specified target for enrollment, for the program are specifically included in the General Appropriation Act enacted during the 2000 Regular Session of the Louisiana Legislature. The department shall implement Subparagraph (A)(5)(c) of this Section on the date set forth in the General Appropriation Act enacted during the 2000 Regular Session of the Louisiana Legislature or, if no date is specified, not later than October 1, 2000. The Senate Committee on Health and Welfare, the Senate Committee on Finance, the House Committee on Health and Welfare, and the House Committee on Appropriations, in consultation with the department, the Department of Insurance, and the Louisiana Children's Health Insurance Program Task Force shall determine whether Subparagraph (A)(5)(c) of this Section shall be implemented through an expansion of Medicaid eligibility or through the use of a private health insurance model.

(2) No later than December 1, 1999, the department shall establish an interagency agreement with the Department of Insurance regarding the Department of Insurance's responsibilities should a private health insurance model be included under the Louisiana Children's Health Insurance Program. The interagency agreement shall include at a minimum, the following:

(a) A provision authorizing the Department of Insurance to administer all regulatory requirements related to insurance companies who participate in the private insurance model as it relates to LaCHIP.

(b) A provision authorizing the Department of Insurance to develop the necessary criteria for participation by insurance companies in the private insurance model in accordance with state and federal insurance laws and regulations.

(c) A provision authorizing the Department of Insurance to establish an insurance credentialing process for use in the private insurance model.

(d) A provision authorizing the Department of Insurance to create the necessary monitoring procedures for insurance companies and administer them.

(e) A provision authorizing the Department of Insurance to administer sanctions against insurance companies who are found to be in violation of any state and federal insurance laws and regulations.

(f) A provision authorizing the Department of Insurance to administer a statewide standardized grievance and appeals process for the private insurance model.

(g) A provision authorizing the Department of Insurance to review and provide oversight in any grievance procedure between the insurance company and the applicants and participants in the private insurance model.

(3) Any private health insurance model implemented pursuant to the State Children's Health Insurance Program (Title XXI of the Social Security Act) shall at a minimum include the following features:

(a) Organize school children's groups to formulate the provision of preventive health services and comprehensive health coverage to children under the private insurance model, and where practicable, establish cooperative agreements with the Department of Education to facilitate school based enrollment of eligible children into the private insurance model.

(b) Require all insurance providers participating in the private insurance model to collect payments or premiums from participants on a sliding scale basis and in accordance with any applicable state and federal regulations in order to provide for payment for healthcare services or premiums for comprehensive insurance coverage.

(c) Establish, with consultation from appropriate professional organizations, standards for preventive health services and providers, and comprehensive insurance benefits appropriate to children and their family members.

(d) Establish eligibility criteria which children and their family members must meet in order to participate in the private insurance model.

(e) Establish procedures under which applicants to and participants in the private insurance model may have grievances reviewed by the commissioner of insurance.

(f) Establish participation criteria and, if appropriate, contract with an authorized insurer, health maintenance organization, or insurance administrator to provide administrative services to the private insurance model.

(g) Develop and implement a plan to publicize the private insurance model, the eligibility requirements of the private insurance model, and to maintain public awareness of the private insurance model.

C. Beginning January 1, 1999, and semiannually thereafter, the department shall submit the following information to the Joint Legislative Committee on the Budget and to the Senate and House committees on health and welfare:

(1) A status on LaCHIP implementation, including the number of new enrollees, the estimated cost of the Medicaid expansion due to LaCHIP, the cost reduction to the state as a result of instituting LaCHIP as opposed to a Medicaid expansion under Title XIX, and any other information the department deems pertinent to LaCHIP.

(2) A report relative to the impact of the physician fee increase required by Paragraph (A)(1) of this Section, including both the fiscal impact to the state and the effect on the number of participating providers.

(3) Recommendations for expanding LaCHIP or any other recommendations relative to the requirements of this Section.

D. The provisions of this Section shall not prohibit the department from exercising any and all authorities and responsibilities granted to the department under the Medical Assistance Program (Title XIX of the Social Security Act) in the event such authorities and responsibilities are concurrent with the provisions of this Section.

E. Any rules or regulations adopted under the provisions of this Section shall be promulgated under the Administrative Procedure Act. Any rules or regulations adopted pursuant to the private health insurance model shall be subject to review by the House Committee on Health and Welfare, the Senate Committee on Health and Welfare, the House Committee on Insurance, and the Senate Committee on Insurance.

Acts 1998, 1st Ex. Sess., No. 128, §2, eff. May 5, 1998; Acts 1999, No. 1197, §§1, 2, eff. July 9, 1999; Acts 2001, No. 1027, §1, eff. June 27, 2001; Acts 2018, No. 206, §5.