John Bel Edwards Dr. Courtney N. Phillips GOVERNOR SECRETARY State of Louisiana Louisiana Department of Health Office of the Secretary January 29, 2021 The Honorable John Bel Edwards, Governor State of Louisiana P.O. Box 94004 Baton Rouge, LA 70804 The Honorable Patrick Page Cortez, President Louisiana State Senate P.O. Box 94183, Capitol Station Baton Rouge, LA 70804-9183 The Honorable Clay Schexnayder, Speaker Louisiana State House of Representatives P.O. Box 94062, Capitol Station Baton Rouge, LA 70804-9062 Re: HCR 2 Quarterly Report SFY 21 Q1 - Medicaid Assessment Report In response to House Concurrent Resolution 2 (HCR 2) of the 2020 First Extraordinary Session, the Louisiana Department of Health (LDH) submits the enclosed report. This report can be viewed on LDH’s website at https://ldh.la.gov/index.cfm/newsroom/detail/5892 the resolution requires LDH to publish on a quarterly basis a report containing data directly related to payment for health care services through the implementation of a health coverage expansion of the Louisiana medical assistance program. The report includes the following: (a) Total Medicaid Expansion enrollment on a monthly basis from July 2020 through September 2020. (b) The average monthly Expansion premium paid to managed care organizations providing benefits and services to eligible Medicaid enrollees and the portion of the premium related to hospital payments for the July 1, 2020 rates. (c) The aggregate Medicaid Expansion claims payment by provider type for July 2020 through September 2020. (d) The total amount of inpatient and outpatient Medicaid Expansion claims paid to hospitals delineated by individual hospital for July Bienville Building ▪ 628 N. Fourth St. ▪ P.O. Box 629 ▪ Baton Rouge, Louisiana 70821-0629 Phone: (225) 342-9500 ▪ Fax: (225) 342-5568 ▪ www.dhh.la.gov An Equal Opportunity Employer The Honorable John Bel Edwards The Honorable Patrick “Page” Cortez The Honorable Clay Schexnayder HCR 2 Quarterly Report January 19, 2021 Page 2 2020 through September 2020 separated into two attachments by inpatient and outpatient. Please feel free to contact me at (225) 342-6726 with any questions or comments that you may have regarding the enclosed report. Sincerely, Ruth Johnson Undersecretary Enclosure cc: The Honorable Senator Fred H. Mills, Senator The Honorable Mack “Bodi” White, Senator The Honorable Larry Bagley, Representative The Honorable Jerome “Zee” Zeringue, Representative Mr. David R. Poynter, Legislative Research Library (A) Total Medicaid Expansion enrollment on a monthly basis. Month Enrollees July 2020 538,114 August 2020 550,576 September 2020 562,374 Source: LAMEDS, Enrollment Trends Report http://www.ldh.la.gov/index.cfm/page/1275. Data is extracted on or near the 1st day following the end of each month. Monthly data is not updated in subsequent months to reflect retro eligibility determinations made after the end of each month. HCR2_SFY2021_Q1 Business Analytics 1 of 43 (B) Average Per Member Per Month and Portion of the Per Member Per Month Associated with Hospitals Expansion Rate Estimate -- Rate Floor Expansion Adult (Rate Floor) Hospital Portion of Expansion Rate Full Rate $590.74 $254.91 • Hospital records are identified by CLQ_Claim_Type 01 and 03. • The PMPM above does not include claims related to maternity kick payments. • The PMPM above is the aggregate rate for regular Expansion rate cells (which do not include SBH/NEMT-only and High Needs rate cells). HCR2_SFY2021_Q1 Mercer Report 2 of 43 (C) The aggregate M edicaid claims payment by provider type (for Expansion only). NOTE: 1) Data are based on service provider types. 2) Data extracted by DOP and on 10/14/2020. 3) Error Providers are made up of those providers that are enrolled in the Managed Care Program but not enrolled in the Fee For Service Program (FFS). 4) Methodology change effective 7/1/19 for HCR 5 removing PMPM payments to MCOs and MCNA (Provider Types 05 & AY) to eliminate duplication of total dollars reported. 5) Provider Types 60, 64 & 69 include $653,175 in payments for Non-Inpatient/Non-Outpatient claim types. Provider Type Description for Provider Type Total (= FFS + Encounters) Provider Jul-2020 Aug-2020 Sep-2020 SFY Sum Type Total $ 247,222,166 $ 248,418,800 $ 229,152,618 $ 724,793,584 Total 03 CHILDREN'S CHOICE (WVR)(IN-ST) 1,105 1,079 5,955 8,139 03 04 PEDI DAY HLTH CARE (IN-ST) 3,188 107 3,295 04 06 NOW PROFESSIONAL SERVICES 12,081 13,503 11,353 36,937 06 07 CASE MGMT-INFT & TODD (IN-ST) 42,691 92,613 31,795 167,099 07 08 OAAS CASE MGMT (IN-ST) 2,159 1,847 4,007 08 09 HOSPICE SERVICES (IN-ST) 276,144 178,578 270,799 725,521 09 12 MULTI-SYSTEMIC THER (IN-ST) 2,217 1,416 1,520 5,154 12 13 PREVOC REHAB (WVR) (IN-ST) 89 540 379 1,008 13 16 PERS EMERG RESP SYS (WVR) 4,545 4,732 5,822 15,099 16 18 COMM MENTAL HLTH CTR/PART HOSP 329,905 70,725 22,904 423,533 18 19 DR OF OSTEOPATH MED (IND & GP) 820,895 1,010,575 750,496 2,581,966 19 20 PHYSICIAN (IND & GP) 28,201,736 33,631,693 25,819,934 87,653,363 20 23 INDEPENDENT LAB 4,417,012 5,483,103 3,790,879 13,690,994 23 24 PERSONAL CARE SERVICES (IN-ST) 279,199 302,783 355,741 937,722 24 25 MOBILE XRAY/RADIATION THRPY CT 15,420 18,859 14,338 48,618 25 26 PHARMACY 79,227,642 72,138,567 78,669,611 230,035,820 26 27 DENTIST (IND & GP) 2,454,491 2,044,557 1,778,495 6,277,544 27 28 OPTOMETRIST (IND & GP) 1,264,799 1,202,442 1,151,115 3,618,356 28 29 EARLYSTEPS (IND & GP) (IN-ST) 5 6 11 29 30 CHIROPRACTOR (IND & GP) 37,680 39,587 30,026 107,292 30 31 PSYCHOLOGIST (LIC/MED) (IN-ST) 135,345 133,680 81,265 350,291 31 32 PODIATRIST (IND & GP) 178,470 236,889 204,476 619,835 32 33 PRESCRIBING ONLY PROVIDER 161,207 120,218 38,237 319,662 33 34 AUDIOLOGIST (IN-ST) 14,733 14,131 13,903 42,768 34 35 PHYSICAL THERAPIST (IN-ST) 430,591 520,755 414,082 1,365,428 35 37 OCCUPATIONAL THERAPIST (IN-ST) 41,795 47,954 34,025 123,774 37 38 SCHOOL BSED HEALTH CTR (IN-ST) 363 88 58 509 38 39 SPEECH/LANGUAGE THERAP (IN-ST) 10,868 7,735 7,395 25,998 39 40 DME 2,485,374 2,472,921 2,320,557 7,278,851 40 41 REGISTERED DIETICIAN (IN-ST) 5,885 7,529 4,975 18,389 41 HCR2_SFY2021_Q1 Business Analytics 3 of 43 Provider Type Description for Provider Type Total (= FFS + Encounters) Provider Jul-2020 Aug-2020 Sep-2020 SFY Sum Type 42 NON-EMER MED TRANSPORT (IN-ST) 587,367 536,053 331,669 1,455,090 42 43 CASE MGT - NHV/FTM (IN-ST) 2,774 6,028 5,441 14,244 43 44 HOME HEALTH AGENCY (IN-ST) 708,122 1,007,568 827,681 2,543,372 44 45 CASE MGMT - CONTRACTOR (IN-ST) 1,459 1,761 570 3,791 45 47 CASE MGMT - CMI 18,065 15,830 11,034 44,929 47 51 AMBULANCE TRANSPORTATION 2,620,022 2,303,420 2,023,196 6,946,637 51 54 AMBULATORY SURGI CTR (IN-ST) 110,872 133,260 104,222 348,353 54 55 EMERG ACCESS HOSPITAL (IN-ST) 7,395 11,531 14,628 33,555 55 56 PRESCRIBER ONLY FOR MCO 4,164 3,813 3,742 11,719 56 57 OPH REGISTERED NURSE (IN-ST) 7,968 14,428 16,379 38,775 57 59 NEURO REHAB HOSPITAL (IN-ST) 128,851 118,348 203,018 450,217 59 60 HOSPITAL 89,057,034 89,556,871 79,342,800 257,956,704 60 61 VENERIAL DISEASE CL (IN-ST) 10,260 10,588 3,058 23,905 61 62 TUBERCULOSIS CLINIC 446 430 876 62 64 MENTAL HLTH HOSP (FREE-STAND) 7,637,505 8,225,441 7,184,293 23,047,238 64 65 REHABILITATION CENTER (IN-ST) 49,193 47,338 12,584 109,115 65 66 KIDMED SCREENING CLINIC 16,231 12,682 1,468 30,381 66 67 PRENATAL HLTH CARE CL (IN-ST) 2,800 2,420 5,442 10,662 67 68 SUBS/ALCOH ABSE CTR (X-OVERS) 1,165,723 1,318,826 1,316,985 3,801,534 68 69 DIST PART PSYCH HOSP (IN-ST) 2,996,048 2,585,946 2,315,690 7,897,684 69 70 EPSDT HEALTH SERVICES (IN-ST) 27,020 10,868 10 37,898 70 71 FMLY PLANNING CLINIC (IN-ST) 12,265 5,221 11 17,497 71 72 FED QUALIFIED HLTH CTR (IN-ST) 256,005 337,772 183,692 777,470 72 73 LIC CL SOCIAL WORKER (IN-ST) 860,286 928,771 614,165 2,403,221 73 74 MENTAL HEALTH CLINIC (IN-ST) 92,848 41,757 35,448 170,053 74 75 OPTICAL SUPPLIER 44,038 50,781 48,552 143,371 75 76 HEMODIALYSIS CENTER (IN-ST) 647,020 644,692 598,288 1,890,000 76 77 MENTAL REHAB AGENCY (IN-ST) 399,558 438,911 413,908 1,252,377 77 78 NURSE PRACTITIONER (IND & GP) 6,183,381 7,565,048 5,716,048 19,464,476 78 79 RURAL HLTH CL(PROV-BSE)(IN-ST) 142,722 133,330 70,510 346,562 79 80 NURSING FACILITY (IN-ST) 718,433 504,482 753,074 1,975,989 80 81 CASE MGMT - VENT ASSTD CARE 1,703 1,703 81 82 PERS CARE ATTEND (WVR) (IN-ST) 43 43 82 84 SUBSTIT FMLY CARE (WVR)(IN-ST) 864 1,283 1,241 3,387 84 87 RURAL HLTH CL(INDEPEND)(IN-ST) 36,381 53,744 21,879 112,005 87 90 CERTIFIED NURSE MIDWIFE 48,610 60,420 45,048 154,079 90 91 CERT REG NURS ANEST (IND & GP) 851,155 930,641 879,592 2,661,388 91 93 CLINICAL NURSE SPECIALIST 26,101 32,168 31,065 89,333 93 94 PHYSICIAN ASSISTANT 1,002,666 1,177,772 896,984 3,077,422 94 HCR2_SFY2021_Q1 Business Analytics 4 of 43 Provider Type Description for Provider Type Total (= FFS + Encounters) Provider Jul-2020 Aug-2020 Sep-2020 SFY Sum Type 96 PSYCH RESID TREAT FACILITY 91,362 17,709 3,417 112,488 96 AA ASSERTIVE COMM TREAT TEAM 222,354 192,315 174,675 589,344 AA AD TRANSITION COORDINATION 125 125 AD AF CRISIS RECEIVING CENTER 4,496 2,540 6,140 13,175 AF AG BEHAVIORAL HLTH REHAB AGENCY 503,694 349,849 554,067 1,407,610 AG AH LIC MARRIAGE & FAMILY THERAPY 23,157 27,365 21,833 72,355 AH AJ LICENSED ADDICTION COUNSELOR 68,461 85,565 52,188 206,215 AJ AK LICENSED PROFESSION COUNSELOR 958,874 1,072,773 801,552 2,833,199 AK AL COMMUNITY CHOICE WAIVER-NURS 1,226 528 1,754 AL AS OPH CLINIC 2,458 7,985 6,207 16,650 AS AT THERAPEUTIC GROUP HOME 60,082 45,054 76,847 181,983 AT AU OPH REGISTERED DIETITIAN 9 9 AU AW PERMANENT SUPPOR HOUSING AGENT 42,900 6,367 4,400 53,667 AW AZ SUBST USE RESIDENT TX FAC 4,941,177 5,178,206 4,952,059 15,071,441 AZ MW LICENSED MID-WIFE 11,564 17,397 14,436 43,397 MW NB NON-LICENSED BEHAVIORAL HEALTH STAFF 2,243,747 2,197,423 1,862,886 6,304,056 NB PO OPR (ORDERING, PRESCRIBING, AND REFERRING) 24,158 21,451 7,636 53,245 PO TM TRANSPORTATION MANAGEMENT CONTRACTOR 669 883 1,983 3,535 TM TS TRANSPORTATION SUBCONTRACTOR 55,749 1,559 18 57,326 TS WA WRAP AROUND AGENCY 1,338 4,845 1,121 7,304 WA XX ERROR PROVIDER 625,293 557,774 747,606 1,930,673 XX HCR2_SFY2021_Q1 Business Analytics 5 of 43 (D.1) The total amount of inpatient M edicaid claims paid to hospitals delineated by individual hospital (for Expansion only).