Louisiana Medicaid is implementing directed payments for acute, psychiatric, LTAC, and rehabilitation hospitals through its five Medicaid managed care plans. The program covers services on and after July 1, 2022. Although no new hospital-MCO contracts are required, each plan has specific informational requirements. As a service to our clients and other Louisiana hospitals, Breazeale, Sachse & Wilson has compiled all of those forms and instructions on a single website.
Written by Gregory D. Frost
On May 31, 2017, the U. S. Department of Justice (DOJ) announced that eClinicalWorks (ECW) agreed to pay a $155 million settlement and enter a corporate integrity agreement with the OIG to resolve allegations that ECW caused its health care provider customers to submit false Medicare and Medicaid claims for meaningful use payments in violation of the False Claims Act (FCA). Under the corporate integrity agreement, ECW agreed to strict compliance and reporting obligations and to provide the latest version of ECW’s EHR software to each of ECW’s current customers free of charge. Continue reading →
In settling allegations of violating the False Claims Act (FCA), healthcare providers often enter into a Corporate Integrity Agreement with the OIG in exchange for the OIG’s agreement not to exclude the provider from participation in Medicare or other federal health care programs. Corporate Integrity Agreements (CIAs) generally require a provider to establish or supplement an existing compliance program, with detailed requirements described in the CIA. Continue reading →
Beginning June 1, 2016, Louisiana residents with a household income below 138 percent of the federal poverty level will be eligible to obtain healthcare coverage through the state’s Medicaid program. On January 12, 2016, Gov. John Bel Edwards signed an executive order to expand the Medicaid program, making Louisiana the 31st state to extend Medicaid.
The U.S. Department of Health & Human Services also approved a new approach to Medicaid enrollment that will allow Louisiana to use information from the Supplemental Nutrition Assistance Program (SNAP) to determine eligibility and enroll individuals in Medicaid. Louisiana is the first state to be approved to use this enrollment strategy through the use of a state plan amendment.
- Enrollment began on June 1
- Coverage will be effective July 1
- The State of Louisiana estimates that 375,000 new adults will enroll in coverage, with about 105,000 people already enrolled in SNAP identified as likely eligible for coverage.
- Through 2016, the coverage for newly enrolled adults of up to 138% of the federal poverty line is completely funded with federal money. However, federal funding rates will decline beginning in 2017 (Federal funding rates will not fall below 90% of costs). 
 U.S. Department of Health & Human Services, HHS Secretary Sylvia M. Burwell Applauds Louisiana Medicaid Expansion Under the Affordable Care Act, (May 31, 2016).
Written by: Catherine Moore
The Office of Inspector General of the United States Department of Health and Human Services is reviewing questionable billing practices related to Medicaid billing for pediatric dental services throughout Louisiana. A description of this state and national initiative can be found here. Continue reading →