Louisiana’s DSH Flexibility Plan Presentation to Regional Consortium by rux99038

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									Louisiana’s Plan for DSH Flexibility:
Expanding Access to Health Care for
the Uninsured

Madeline W. McAndrew
Senior Health Care Advisor
Department of Health and Hospitals
May 2005
Background

 Louisiana has a high number of
 uninsured.
 Louisiana ranks 50th in health status.
 There is limited access to preventive and
 primary care across the state.
 Care for the uninsured tends to be
 hospital-based.
Health Care Reform Activities to
Reduce the Number of Uninsured

 Increasing enrollment in existing Medicaid
 programs i.e. LAChip, LAMoms, etc.
 Expanding eligibility through submittal of a HIFA
 Waiver
 Maximizing utilization of federal programs –
 Pharmacy 340B Program
 Collaborating with regional and local efforts to
 reduce the number of uninsured.
What is DSH Funding?

 The DSH program is a state-federal program
 that pays for care for the uninsured.
 Currently DSH funding is utilized to pay for
 hospital-based inpatient and out-patient
 services.
 DSH funding does not pay for physician
 services, except in rural health clinics
 operated by a hospitals.
What is DSH Funding?

 The state must put up “match” in order to
 draw down federal DSH dollars.

 Louisiana has a DSH cap that it cannot
 exceed.
 In fiscal year 2005/06, Louisiana does not
 have sufficient state funds identified to draw
 the entire DSH allotment available to our
 state.
What is DSH Funding?

The state’s match can come from:
  – State appropriations;
  – Local funds; and/or
  – Certified Public Expenditures - the
    expenditure of local public funds that are
    then certified (CPEs).
The Plan


 Improve the health status and reduce
 the number of uninsured by amending
  the pending HIFA waiver to create a
  funding pool using disproportionate
         share (DSH) funding.
Health Insurance Flexibility and
Accountability Waiver (HIFA)
  Federal Waiver Opportunity which allows
  states to expand to health insurance
  coverage. Submitted to CMS November,
  2004
  Four components:
  – LaHIPP
  – LaChoice
  – Federalization of the Louisiana Health
    Plan
The Plan

 Under the amended HIFA waiver, the state’s
 entire DSH allotment will be placed in a
 flexible funding pool.
 The funding pool will:
  – Continue to support hospitals that serve a
    disproportionate share of Medicaid and
    the uninsured;
  – Reimburse some infrastructure
    expenditures;
The Plan

 The funding pool will (continued):
 – Reimburse physician service and certain
   other medical services expenditures for
   the uninsured population; and
 – Support regional and local efforts to
   provide health care to low-income (under
   200% FPL) uninsured adults by
   expanding access to preventive and
   primary care as well as coverage.
The Plan


 How will this plan assist regional
  and/or local efforts to increase
   access and coverage to the
             Uninsured?
The Plan

 Part of the unused portion under the DSH
 cap will be used for the regional/local
 efforts.
 The required match for the regional/local
 efforts can be provided through local funds
 and/or certified public expenditures.
The Plan

 The regional/local efforts portion of
 the waiver will provide an opportunity
 to:
 – Expanding the availability of primary &
   preventive care to the uninsured;
 – Providing health insurance coverage to
   the uninsured; and
 – Meeting the state’s disease management
   goals.
The Plan - Increasing Access to
Primary and Preventive Care

 Funds from the pool shall be used for
 activities that increase the amount of
 primary and preventive care for the
 uninsured.
 Examples include but are not limited to:
  – Developing new or expanded FQHC and RHC
    sites;
  – Expanding the services in other public or private
    community-based primary care clinics or
    physician offices;
The Plan - Increasing Access to
Primary and Preventive Care

 Examples: (continued)
  – Expanding the services of parish health
    units to include a full range of primary
    care services; and/or

  – Expanding primary care services at LSU
    clinics.
The Plan - Increasing Coverage

 Regional/local efforts may want to
 provide health insurance coverage to
 the low-income uninsured in their
 communities.
 Examples:
 – Expand the LaChoice program
 – Three-Share
 – Public HMO
The Plan - Disease Management

 Any regional/local approach (access or
 coverage) must address Louisiana’s disease
 management goals.
 Strategies for meeting Disease Management
 goals include:
 –   Implementing electronic medical records;
 –   Tracking individuals with chronic diseases;
 –   Implementing performance measures; and/or
 –   Monitoring and reporting on quality outcomes.
Funding – Allowable Sources for Match

Acceptable                            Not Acceptable
Certified Public Expenditures Federal Dollars
 Medicaid Provider                     New or recycled
 Public Entity
 Covered Eligible within DSH Waiver   Provider Donations
 Covered Benefit within DSH Waiver

Transfer of Local Funds
 Governmental Entity
 Tax/Millage
 Tax/Millage generated

Foundation Grant Money
The Plan

 Each parish within a region will be allotted a
 capped amount of available DSH allotment
 to be matched with local funds.
 Interested applicants must submit
 applications to DHH for funding.
 – Applications must demonstrate a legitimate
   source of match, community need and impact,
   and fulfill other requirements as outlined by
   DHH.
The Plan

 How much of the local match will
 return to the local entity?
 – The local entity will receive their
   contribution plus the federal match to be
   used for health care services under the
   waiver less DSH funds for administrative
   costs on the state level.
Next Steps

 Short-term
 – Passage of the Framework for Health
   Care bill (H.B. 565 by Representative
   Durand)
 – Obtain regional/local input
 – Submit an updated, more detailed
   concept to CMS
Next Steps

 Long-term
 – Gain waiver approval from CMS
 – Obtain additional regional/local input and
   provide technical assistance
 – Develop the details and move toward
   implementation
 – Gain CMS approval for regional/local
   applications
          Questions?

Email your consortium chair with additional
                 comments.

								
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