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OVERVIEW: Historically, Louisiana has provided for hospital safety net services for low-income and uninsured residents through a statewide, state-run Charity Hospital System. In 1997, the Legislature ceded operation of this important public safety net to the Louisiana State University (LSU) Health Care Services Division. In so doing, the Legislature required LSU to “establish an overall role, scope, and mission statement for hospitals [in the newly created Health Care Services Division] consistent with state law and the historical mission of the hospitals of providing medical care to any resident of the state of Louisiana, including the medically indigent and uninsured population.” There is no other mandated free care for individuals who are ineligible for Medicaid. It should be noted that, in 2008, the Legislature amended reporting requirements for hospitals and other medical providers that receive reimbursements for the provision of uncompensated care.
Admission Criteria to State-Supported Charity Hospitals
Louisiana Revised Statutes § 46.6
Charity Hospitals (General Provisions)
Louisiana Revised Statutes §§ 46:921 to 46:924
LSU Health Sciences Center – Health Care Services Division
Louisiana Revised Statutes §§ 17:1519.1 to 1519.17
Uncompensated Care Hospital Payments
Louisiana Revised Statutes § 46:2761
The Louisiana State University Health Care Services Division (hereinafter “the Division”) and its component hospitals shall be under the immediate direction and control of the Louisiana State University Health Sciences Center at New Orleans, subject to the overall supervision and direction of the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College (hereinafter “the Board”). La. Rev. Stat. §§ 17:1519.3(A); see La. Rev. Stat. §§ 17:1519.1 and 17:1519.2.
The Department of Health and Hospitals (hereinafter “the Department”) shall specify how to define and calculate uncompensated care in its Medicaid State Plan. La. Rev. Stat. § 46:2761. The Department shall determine what facilities qualify for uncompensated care payments and the amount of these payments. Id.
DEFINITIONS AND DISTINCTIONS:
“Medically indigent,” for purposes of the Health Care Services Division Act, is defined as any person whose income is at or below 200 percent FPL and who is uninsured. La. Rev. Stat. § 17:1519.1(12).
FREE CARE AS A COMMUNITY BENEFIT: N/A
The Health Care Services Division Act, which turned control of the public safety net hospital system to LSU, states that providing access to uninsured and medically indigent patients shall be a primary objective of hospitals operating under the rubric of the Health Care Services Division. La. Rev. Stat. § 17:1519.4(A), (B)(1). Under the Health Care Services Division Act, any bona fide resident of Louisiana in need of medical services, including but not limited to the uninsured, shall be eligible for treatment at a state-supported hospital owned or operated by the Board in accordance with policy adopted by the LSU Board of Supervisors (i.e. the Charity Hospital System). La. Rev. Stat. § 46:6. However, persons with income greater than 200 percent FPL may be denied access to non-emergency care under the following circumstances:
- The person refuses to pay any appropriately adopted reasonable charges for treatment or service received, unless the patient's clinical condition requires immediate treatment as determined by the patient's treating physician; or
- The person has been treated in the past, billed based upon his or her ability to pay, and has refused to pay for previous medical services without justifiable excuse or to make arrangements for periodic partial payments, unless the patient's clinical condition requires immediate treatment as determined by the patient's treating physician or medical director. La. Rev. Stat. § 46:6.
As stated previously, the Department of Health and Hospitals determines which health care facilities qualify to receive uncompensated care reimbursements. La. Rev. Stat. § 46:2761. In determining reimbursements to qualified facilities, the Department shall distribute funds in proportion to the type and amount of uncompensated care reported and as allocated to the Medical Vendor Payments Program. Id.
Police juries may appropriate annually and use from parish funds no more than $1,000 to aid charity hospitals or other institutions that treat indigent patients without cost. La. Rev. Stat. § 46:4. Police juries may appropriate up to $300 to aid charity hospitals or other similar institutions of adjoining states that treat indigent patients of the parish without cost. La. Rev. Stat. § 46:5.
SERVICES COVERED: N/A
NOTIFICATION REQUIREMENTS: N/A
APPLICATION PROCESS: N/A
GRIEVANCE/APPEAL PROCESS: N/A
The Health Care Services Division shall report quarterly on its projected expenses and revenues to the Joint Legislative Committee on the Budget, the Department of Health and Hospitals, and the Senate and House Committees on Health and Welfare. La. Rev. Stat. § 17:1519.8(C); La. Rev. Stat. § 17:1519.3(E). The report must include the following information for each hospital, executive administration, and general support program:
- A complete and detailed accounting on a cash basis of all revenues by source, including but not limited to, state general fund, Medicaid, Medicaid-Uncompensated Care, Medicare, self-pay and commercial insurance, federal grants, and receipts from any other public or private entity;
- All expenditures for the prior quarter in a form and manner approved by the Joint Legislative Committee on the Budget; and
- Projections of costs eligible for reimbursement from Medicaid payments or uncompensated care payments to be made by the Department of Health and Hospitals for the current quarter and next three quarters. La. Rev. Stat. § 17:1519.8(C).
The Louisiana State University Health Sciences Center at New Orleans shall jointly furnish reports to the Board and to the Senate and House Committees on Health and Welfare that include a fiscal year overview and any planned reductions at division hospitals. La. Rev. Stat. § 17:1519.3(F).
In order to receive reimbursements for uncompensated care, all state hospitals, non-state hospitals, and other facilities must report patient-specific data on the amount and type of uncompensated care provided, using the universal billing revenue code format established by Louisiana Medicaid. La. Rev. Stat. § 46:2761. The Department may request other data on the amount and type of other services and activities financed by these uncompensated care payments. Id. These reports must be filed electronically with the Department on a quarterly schedule. Id. At the close of each quarter, the Department Secretary shall issue a detailed summary of these reports to the Governor and State Legislature. Id.
Hospitals defined under the Rural Hospital Preservation Act shall report data collected on the Department’s “Schedule of Uncompensated Care Costs” in keeping with the state’s Medicaid Plan, as approved by CMS. La. Rev. Stat. § 46:2761. The Department Secretary shall provide annual reports of the submitted information and related payments to the Governor and State Legislature. Id. The Secretary shall make this data available to the public on the Department’s website. Id.
PENALTIES FOR NONCOMPLIANCE:
If a hospital or health care facility fails to comply with the state’s reporting requirements by withholding patient-specific data, the Department may withhold up to five percent of the Medicaid payments due to that provider. La. Rev. Stat. § 46:2761. This withholding shall increase by five percent for every successive month the information is not received until the twenty-five percent threshold is reached. Id. Once the hospital or health care facility complies, the payment will be released. Id.
To guarantee that the newly-created LSU Health Care Services Division would retain the old Charity Hospital System’s historic focus on providing care to the medically indigent and uninsured, the Legislature included a provision that prohibited LSU from closing a hospital or emergency room within the system without prior legislative approval. La. Rev. Stat. § 17:1519.3(B). In 2005, LSU ignored this mandate and permanently closed Charity Hospital without legislative approval, citing structural damages caused by Hurricane Katrina. As of this writing, Charity’s closure is being challenged in court.