Louisiana Revised Statutes 49:1403 – Reports
Terms Used In Louisiana Revised Statutes 49:1403
- Agency: means any of the following state departments:
(a) Department of Children and Family Services. See Louisiana Revised Statutes 49:1402
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Fraud: Intentional deception resulting in injury to another.
- Program: means any of the following:
(a) Medicaid. See Louisiana Revised Statutes 49:1402
Beginning in 2023, any agency that administers a program shall, no later than February fifteenth of each year, submit a report to the legislature, providing, at a minimum, the following information:
(1) For the current fiscal year, the total dollar amount and percentage of the agency’s budget for the program allocated for program integrity and eliminating fraud, waste, and abuse.
(2) A description of the agency’s current policies and practices that reduce fraud, waste, and abuse of program benefits.
(3) For the preceding calendar year, the total number of individuals determined by the agency or legislative auditor to have improperly received benefits through the program and the total dollar amount of benefits improperly received.
(4) The type and amount of improper payments.
(5) The type and amount of any improper payments prevented, if known.
(6) The dollar amount the state saved in preventing improper payments, and if any, in recouping improper payments.
(7) A description of all policies, processes, and procedures in place at the agency to determine eligibility for the program. The description shall include details about what information the agency verifies or cross-checks through databases and data exchanges with other agencies, including national databases, and the frequency of that verification or cross-checking.
(8) A description of all policies, processes, and procedures in place at the agency to identify individuals receiving benefits under the program who are no longer eligible to receive benefits and what steps, if any, are taken, and under what timeline, to remove identified individuals from program participation.
(9) A detailed description of all policies, processes, and procedures in place at the agency to verify federal or state work or work search requirements for benefit eligibility, if applicable.
(10) The frequency with which the agency performs the verification.
(11) A description of any barriers the agency identifies to implementing additional program integrity measures, including privacy or data sharing impediments, administrative burden, and any increase in financial cost.
(12) A description of all metrics and data points used by the agency to measure success of the program, including all metrics and data points related to program integrity and fraud.
(13) For the preceding calendar year, measures of access in the program, including:
(a) For each month, the number of applications received, the percentage of applications denied, and the percentage of applications denied for procedural reasons.
(b) Monthly call center performance metrics for call centers serving clients and applicants, including the average number of calls and the average and maximum call wait times.
(c) The average caseload per caseworker.
(14) A detailed description of the program’s administrative appeals process for clients, including but not limited to the number of hearings requested by clients and the number of hearings waived by clients.
Acts 2022, No. 542, §1, eff. June 17, 2022.