Louisiana Revised Statutes 46:979.4 – Administration of the Louisiana First America Next Freedom and Empowerment Plan
Terms Used In Louisiana Revised Statutes 46:979.4
- Cost-sharing: means the portion of the cost of a covered medical service that must be paid by or on behalf of eligible individuals, consisting of copayments or coinsurance, but not deductibles. See Louisiana Revised Statutes 46:979.2
- Department: means the Louisiana Department of Health. See Louisiana Revised Statutes 46:979.2
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
- Fraud: Intentional deception resulting in injury to another.
- Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
- Medicaid: means the medical assistance program provided for in Title XIX of the Social Security Act. See Louisiana Revised Statutes 46:979.2
- Plan: means the Louisiana First America Next Freedom and Empowerment Plan established by this Chapter. See Louisiana Revised Statutes 46:979.2
A. The Louisiana Department of Health shall create and administer the plan within the department. The department shall promulgate rules to implement this Chapter in accordance with the Administrative Procedure Act.
B. In keeping with the plan’s purposes set forth in La. Rev. Stat. 46:979.3, the department shall on or before September 1, 2014, submit to the House and Senate committees on health and welfare and to the governor an outline specifying how it will seek to implement the following health care access reforms in Louisiana beginning January 1, 2015:
(1) Lowering the cost of health care in Louisiana, including but not limited to actions furthering the following goals:
(a) Tax equity: Giving all Louisiana consumers the same standard deduction for health insurance, regardless of whether they obtain that health insurance from an employer or on their own, and without raising taxes.
(b) A Louisiana health insurance program: Seeking any available federal funds, including but not limited to the use of federal waivers or Medicaid state plan amendments, so as to create an innovative and cost-effective state health insurance program that would reduce health insurance premiums to make coverage more affordable, guarantee access for individuals with pre-existing conditions, and allow the state the option of using such funds to subsidize health insurance coverage for individuals with pre-existing conditions and low-income individuals who may not receive tax savings from a health insurance deduction.
(c) Health savings accounts: Further increasing participation in the plan’s innovative insurance model and enhancing the ability to contain the growth of health costs by allowing individuals to create personal health savings accounts and use those funds to pay health insurance premiums, allowing for additional flexibility in benefit design.
(d) Greater incentives for wellness: Providing insurers and employers with additional flexibility to offer incentives for healthy behaviors, and the ability to provide those incentives on a tax-free basis, in order to accelerate efforts at changing behaviors in a way that can slow health cost growth.
(e) Focus on eliminating fraud: Moving away from the existing “pay and chase” model of eliminating fraud, and seeking to target those who profit from trafficking in personal health information.
(f) Price and quality transparency: Increasing online posting of health care services price and quality data in order to empower Louisiana patients with trusted information and provide Louisiana health care providers with a greater incentive to improve their quality practices.
(2) Protecting the most vulnerable Louisiana citizens, including but not limited to actions furthering the following goals:
(a) Guaranteed access for pre-existing conditions: Demonstrating in requests to federal funding sources that, as a condition of participation in the plan, Louisiana will guarantee access for individuals with pre-existing conditions through a high-risk pool, reinsurance, or some other method ensuring those with chronic conditions can obtain needed care.
(b) Premium support: Providing cost subsidies or premium assistance so that Louisiana’s senior citizens are offered more health insurance choices, while seeking to make Medicare more financially solvent and sustainable for future generations.
(c) Medicaid reforms: Seeking to work with the federal government through existing or new grant programs to demonstrate that, in exchange for a fixed funding allotment from the federal government and accountability standards, Louisiana will demonstrate flexibility in designing solutions to meet the health care needs of Louisiana citizens.
(d) Life protections: Seeking to strengthen conscience protections for businesses and medical providers.
(3) Portability and choice, including but not limited to actions furthering the following goals:
(a) Louisiana-based reforms to expand access: Reforming laws that govern medical licensure and construction of new medical facilities, in order to increase the supply of medical providers, including new options that may lower health care costs.
(b) Better access for individuals changing employers: Ending the requirement that individuals leaving their employer must exhaust COBRA continuation coverage before gaining access to the individual health insurance market, in order to alleviate a costly mandate on businesses and ease the transition into individual health coverage for those changing jobs.
(c) Pooling mechanisms: Allowing small businesses, fraternal organizations, civic groups, alumni associations, and other similar organizations to band together and offer health insurance to their members in order to provide new options for individuals to purchase coverage that travels with them from job to job.
(d) Cross-state insurance purchasing: Seeking to work with the federal government and other state governments to allow purchasing of health insurance across state lines, so as to allow Louisianians to buy the customized health insurance plan that best meets their needs.
(e) Lawsuit reform: Enacting common sense reforms to crack down on frivolous lawsuits in seeking to expand patient access and lower costs.
(f) Freedom for senior citizens to choose: Enhancing choice and competition by eliminating the arbitrary restrictions on senior citizens’ choice of medical providers imposed by bureaucratic mandates, and seeking to restore the doctor-patient relationship by working with the federal government to see those onerous requirements repealed.
C. The department may work with any other state department in order to seek to effect the plan’s purposes, and shall do so with all deliberate speed so as to effect these health care reforms in a timely manner.
D.(1) The department may utilize any federal or state funding, or any other source of revenue, available to implement this plan.
(2) Prior to implementation, the department shall develop the plan, including a determination of the cost, and submit the plan with the cost estimate to the Joint Legislative Committee on the Budget for approval.
E. The plan may include premium support or insurance premium subsidies for eligible individuals to enable their enrollment in a health insurance plan.
F. The department shall be specifically authorized to pay supplemental cost-sharing subsidies directly to health insurance plans or health savings accounts for participants in the plan.
G. An eligible individual offered health insurance access, enrolled in health insurance coverage or allowed to create a health savings account, shall affirmatively acknowledge the existence of all of the following facts:
(1) The plan shall not be a perpetual federal or state right or guaranteed entitlement.
(2) The plan shall be subject to cancellation upon appropriate notice.
(3) The plan shall not be an entitlement program.
H. The state may implement cost-sharing and copays, as a condition of participation in the plan, for plan participants whose earning shall exceed fifty percent of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services.
I. The department shall recommend appropriate adjustments in funding to the legislature. Adjustments shall be made by the legislature as appropriate.
J. On a quarterly basis, the department shall report to the Joint Legislative Committee on the Budget, within two weeks of the end of each quarter, information regarding the following aspects of the plan:
(1) Plan enrollment.
(2) Patient experience.
(3) Economic impact.
(4) Carrier competition.
(5) Success in avoiding uncompensated care.
Acts 2014, No. 783, §1, eff. June 19, 2014; Acts 2018, No. 206, §5.