For Healthcare, a Subdued Session on Louisiana Medical News

For Healthcare, a Subdued Session

By: TED GRIGGS

Sean Prados

Louisiana’s private healthcare providers head into the regular session of the state Legislature in a different position than in the last two years: a proposed budget that contains no cuts to Medicaid reimbursements.

Sean Prados, executive vice president of the Louisiana Hospital Association, said the state’s budget crisis – the shortfall is estimated at $1.6 billion – and proposed constitutional amendments to give the governor and Legislature more flexibility during tough economic times are expected to dominate the session.

“I think those are going to be real big priorities for healthcare providers this year, and probably for higher education,” Prados said.

In the past two years, Medicaid funding has been cut by $264 million, while higher education has seen state funding slashed by $315 million.

Gov. Bobby Jindal has proposed increasing the amount that can be cut from funding protected by state law during a budget deficit. Currently that amount is 5 percent; Jindal would like to make that 10 percent. Similar efforts have failed in the past.

Still, Prados said the hospital association’s members remain optimistic.

“There always seems to be some hiccups during the session, but that happens in any session,” Prados said. “And while we’d like long-term, sustainable and predictable funding, we kind of have to deal with the budget on an annual basis. So we’re going to be working real hard with the Legislature to keep things whole.”

Prados said there may also be some legislation that revolves around managed care and the state’s planned coordinated care networks.

But the hospitals and two of the state’s largest physician associations have endorsed the Jindal administration’s proposal to make private insurers or third-party administrators responsible for healthcare for two-thirds of the state’s 1.2 million Medicaid enrollees. Critics have said the private insurers will be paid $300 million for overseeing care for the lowest-cost segment of the Medicaid population, women and children. They say the money would be better used for healthcare instead of administrative costs and profit.

Prados said the hospital association hasn’t begun talking to legislators yet because they are occupied with the redistricting session.

But once that is over, the association and its members will be hitting the streets pretty hard, he said.

Gil Dupré, chief executive officer of the Louisiana Association of Health Plans, said he also expects budget issues to consume lawmakers’ attention.

“Many of them have let it be known that they’re not really interested in a lot of controversial issues … besides the budget,” Dupré said. “We think that admonition will have some effect.”

The health plans, for example, are planning on offering very little in the way of bills, Dupré said, and he expects that other organizations will respond in similar fashion.

Although healthcare legislation often requires that issues be revisited and adjustments made to previously passed laws, Dupré said he expects that will be kept to a minimum during the fiscal session.

Joseph Donchess, executive director of the Louisiana Nursing Home Association, said with the nursing homes’ funding taken care of, he expects only a couple of clean-up bills to be offered.

One deals with the number of days a Certified Nursing Assistant must work in a 120-day period to maintain certification, he said. The bill passed two years ago requires a CNA to work 90 days in that period.

“That effectively means they couldn’t be sick or take a vacation day or even two days off on the weekends, almost,” Donchess said.

The calculations were based on an eight-hour workday, but CNAs work seven and a half hours a day, he said. The certification requirement would have gone into effect in August, so there is still time to make the necessary changes.

For now, the association will base the certification requirements on federal law, which requires a CNA to work eight hours in a two-year period, Donchess said. Although that’s “kind of ridiculous” it is still a better alternative than the state’s existing law.

The association will also seek to continue a pilot program under which medical attendants can make medication passes, Donchess said. Under the program, the attendants cannot be called away from that work for other duties.

“We need to have it extended for another three years so the pilot can be fully tested or to have it turned into a permanent program,” Donchess said.

A medical attendant is an employee who is not a nurse but has been trained to give medication, Donchess said. Other states have found that facilities that use medication attendants have fewer medication errors.

Licensed practical nurses who do the medication passes are often called to deal with other situations in a home that arise at the same time, Donchess said. The nurses are only human and if they’re called away enough times, it’s possible they might forget whether they gave a patient medication.

“That can either result in the patient not getting her medication at all or getting a double dose,” Donchess said.