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Session Information

2008 Session Highlights

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Health & Hospitals

By: Greg Waddell
(225) 342-9675

HEALTH CARE TRANSPARENCY

In an effort to equip consumers with more information with which to make health care choices Senate Bill 287 by Senator Mount (Act 537) provides for the Louisiana Health Care Consumers Right To Know Law. This legislation requires certain health care providers to submit to the Department of Health and Hospitals information which relates to health care cost, quality and performance. The legislation creates the Health Data Panel which represents all interests involved in the collection and dissemination of the information collected. The information gathered by the Department of Health and Hospitals will then be presented to consumers through a user-friendly web site where consumers can easily access the information when making their health care choices.

MENTAL HEALTH

There were several pieces of legislation which tried to address the growing issues surrounding mental health especially in areas which were affected by hurricanes Katrina and Rita. One of the most prominent of pieces of legislation was Senate Bill 182 by Senator Gray (Act 407). This legislation provides a procedure whereby the courts may order a person to obtain civil involuntary outpatient treatment if the person satisfies eight detailed criteria and the court finds that a written treatment plan is in place and there is no less restrictive alternative. If civil involuntary outpatient treatment is ordered by a court the initial treatment period may not exceed six months. Additional treatment period of one hundred eighty day can be ordered by the court if the procedure detailed in the legislation is followed and the person still satisfies all of the original criteria.

The second substantial mental health piece of legislation establishes crisis receiving centers. The appropriate crisis identification and stabilization services, including a coordinated system of entry into the crisis system, is critical to successful recovery for people in behavioral crisis. Successful crisis identification and stabilization services will most successfully be developed and maintained through collaboration between the state, local communities and stakeholders of the crisis system. Senate Bill 228 by Senator Heitmeier (Act 447) creates a crisis receiving network to be administered by the Department of Health and Hospitals in conjunction with human service districts and local collaboratives. The legislation additionally establishes a licensing framework for crisis receiving centers. These centers, subject to appropriation, would be located in each region of the state and will receive, examine, triage, refer or treat people suffering from a behavioral health crisis. The legislation allows the centers to be placed in hospitals, mental health facilities, other health care facilities, or may be freestanding.

LONG TERM CARE

There were several pieces of legislation dealing with various aspects of the long term care industry. This year, as in years past, most of the attention in the area focused on the facility need review process.

Senate Bill 75 by Representative Gray (Act 393) extends the time period that the exception to the moratorium on nursing homes applies to January 1, 2010. Current law provides that the facility need review approval for licensed nursing homes or intermediate care facilities for people with developmental disabilities (ICF/DD) located in an area or areas which have been affected by an executive order or proclamation of emergency or disaster and which were operating at the time the executive order or proclamation was issued under R.S. 29:724 shall remain in effect and shall not be terminated, considered to have expired, or revoked until January 1, 2008. In addition current law provides that this exception to the moratorium does not apply if the provider fails to recommence providing services prior to January 1, 2008. This legislation extends the time period that the exception shall apply to January 1, 2010. In addition, the legislation provides that the exception to the moratorium does not apply if the provider fails to recommence providing services prior to January 1, 2010.

Senate Bill 249 by Senator Mount (Act 187) repeals the moratorium on nursing homes with respect to replacement facilities. Under current law, the nursing home moratorium on the replacement of existing nursing facilities until expires July 30, 2008. This legislation moves that date forward upon the signature of the governor.

House Bill 155 by Representative Katz (Act 341) makes technical changes to the facility need review process. Current law provides for a facility need review process for adult residential care providers and community and group homes for the mentally retarded. This legislation adds nursing homes and changes the reference to community and group home beds for the mentally retarded to community and group home beds for the developmentally disabled.

House Bill 466 by Representative Richard (Act 490) provides an exception to the Louisiana Smoke-free Air Act for nursing homes. Under present law, smoking is allowed in designated and well-ventilated smoking rooms in nursing homes which permit smoking. This legislation retains the current law and adds that the designated and well-ventilated smoking rooms of nursing homes which permit smoking cannot be the reception area, lobby, waiting room, or any other room or area defined as a public place under the La. Smoke-free Air Act.

RURAL HOSPITALS

Senate Bill 36 by Senator Dupre (Act 389) broadens the definition of "rural hospital" under the Rural Hospital Preservation Act to include as a "rural hospital" one which met the qualifications of a sole community hospital as of June 30, 2005, and subsequently converted to critical access hospital status.

DEPARTMENT OF HEALTH AND HOSPITALS

Several pieces of legislation this session dealt with penalties and sanctions that can be imposed against certain health care providers which are regulated by the Department of Health and Hospitals.

Senate Bill 43 by Senator Mount (Act 518) allows the Department of Health and Hospitals to adopt by rules and regulations remedies for health care facilities which have violations of the licensure standards, certification requirements, or the Medicaid standards of participation. These alternative remedies may include denial of Medicaid payment, denial of new admissions into the facility, removal from the freedom of choice list, the transfer of residents or patients from the facility, suspension of the license, or other alternate remedies with the goal of deter noncompliance.

Senate Bill 229 by Senator Mount (Act 785) amends the penalties for nursing homes and other health care facilities to make such penalties consistent among all types of facilities.

House Bill 194 by Representative Katz (Act 255) allows the Department of Health and Hospitals to revoke, deny, or not renew a license of a home health provider if the provider fails to allow department surveyors from entering the facility for the purposes of conducting a survey.

Several pieces of legislation made changes to licensure and operational requirements of certain health care providers.

House Bill 1333 by Representative Mills (Act 332) provides for a licensing framework for supervised transitional residential and aftercare facilities. The legislature found there was a need for a secured residential facility for persons found not guilty of a crime by reason of insanity or found incompetent to stand trial after such person has been released from a state forensic facility. Historically, all secured residential facilities have been overseen by the Department of Social Services under its authority to regulate traditional adult residential care homes. This legislation moves these types of facilities to the Department of Health and Hospitals to license and regulate these types of facilities serving forensic clients due to the mental health issues of the residents, the fact that the individuals are discharged from forensic hospitals operated by the Department of Health and Hospitals, and the security issues involved at such facilities.

Senate Bill 234 by Senator Mount (subject to call - House Referral) would have moved the regulation of substitute family care services for developmentally disabled children from the Department of Social Services to the Department of Health and Hospitals. The legislation defines a substitute family as an unrelated person or persons, or a family member except for a parent, spouse, or legal guardian who provides for the needs of an individual with developmental disabilities. The legislation further defines a substitute family agency as an agency, institution, society, corporation, person, or any other group responsible for recruiting, selecting, training, and monitoring a substitute family. The legislation requires that a substitute family agency may not be established, operated, or reimbursed for Medicaid services unless the Department of Health and Hospitals has licensed the agency to perform such services.

House Bill 1361 by Representative Patricia Smith (Act 174) changes the requirement that adult day health care programs render services from five or more hours a day to a portion of the day. Under current law an adult day health care program is a program which offers services to adults who are physically or mentally impaired. This legislation provides that the program offer services to adults who are functionally impaired and eliminates the five-hour requirement in favor of rendering services for a portion of the day.

House Bill 1098 by Representative Katz (Act 839) provides for a home and community-based service provider license. Current law provides for licensing of community-based services providers, including personal care attendant services agencies, respite care services agencies, supervised independent living programs, adult day care agencies, and family support agencies. This legislation changes current law by consolidating licensing for these community-based services providers and providing for one home and community-based service provider license and uniform fees for personal care attendant services agencies, respite care services agencies, supervised independent living programs, adult day care agencies, and family support agencies. This legislation further changes present law by authorizing the secretary of the Department of Health and Hospitals to set and collect fees for the licensure of home and community-based service providers. Sets fees at $600 per year for the base license fee for home and community-based services provided in the home and an additional $200 per year for providers who offer adult day care services and out-of-home respite care.

House Bill 1224 by Representative Nowlin (Act 328) places a moratorium on the licensure of new home- and community-based service providers that provide personal care attendant services, respite care services, and supervised independent living program services, with certain exceptions, effective July 1, 2008, until July 1, 2010. This legislation provides an exception to the moratorium by allowing the Department of Health and Hospitals to license new or additional home- and community-based service providers that provide personal care attendant services, respite care services, and supervised independent living program services if it determines, in its sole discretion, that there is a need for such providers in a certain geographic location.

House Bill 1062 by Representative Mills (Act 166) extends the moratorium on the licensure of methadone maintenance programs and clinics. Current law authorizes a moratorium upon the certification of additional methadone maintenance programs until July 1, 2008. This legislation extends the moratorium until July 1, 2010. In addition, the legislation allows the Department of Health and Hospitals the discretion to determine if there is a need for new or additional methadone maintenance programs in a certain geographic location and in the event an additional methadone maintenance program is needed the Department of Health and Hospitals can issue a license. The legislation requires the department to promulgate and adopt rules and regulations in accordance with the Administrative Procedure Act to provide criteria and processes for determining whether a need for a new program exists, as well as procedures for selecting a methadone maintenance program to be licensed once a need has been determined.

Senate Bill 540 by Senator Mount (failed House Final Passage) would have made changes to the moratorium placed upon the licensure of hospice facilities. Present law provides that the Department of Health and Hospitals shall implement a moratorium on the issuance of licenses for hospices until December 31, 2008. This legislation retains the moratorium and provides that the Department of Health and Hospitals shall not process any new applications for hospice or its satellites for licensure unless the department can substantiate that for the preceding year, beginning October 1, 2008 through September 30, 2009, that all of the existing licenses applicable that year along with their satellites or branches have been surveyed.

House Bill 1051 by Representative Katz (Act 165) removes the prohibition against patients who are related from obtaining treatment from the same adult brain injury facility. Present law prohibits related brain injury patients within the same facility. This legislation removes the prohibition in present law against related brain injury patients within the same facility.

House Bill 1341 by Representative Tucker (Act 333) provides for situations in which a parent, stepparent, grandparent, brother, sister, aunt, or uncle of a recipient may serve as a paid direct service worker. Present law requires rules and regulations to be promulgated by Department of Health and Hospitals for the maintenance of the direct service worker registry which must include minimum mandatory criteria regarding any parent, stepparent, grandparent, brother, sister, aunt, or uncle of a recipient serving as a paid direct service worker. This legislation retains present law and further clarifies that in order for a relative to serve as a direct service worker, he must obtain a waiver issued by the secretary of the Department of Health and Hospitals stating that he is the best available appropriate direct service worker for the recipient. The legislation also contains a grandfathering provision for any relative serving as a direct support worker as of July 1, 2008.

Senate Bill 269 by Senator McPherson (Act 534) moves the Louisiana Health Works Commission from the Louisiana Workforce Commission to the Board of Regents. The legislation further changes the composition of the members of the commission and the composition of the executive committee of the commission.

HUMAN SERVICE DISTRICTS

House Bill 930 by Representative Mills (Act 373) makes changes to the way human service districts are operated. The Department of Health and Hospitals has found it necessary to make these changes in order to ensure the greatest success for future human service districts. The legislation conditions operation and management of existing and newly created districts upon execution of a contract with the department as well as compliance with other applicable criteria. Conditions operation and management of newly created districts on the successful completion of a readiness assessment. This legislation provides uniform standards for the governing boards of districts and requires the board to consist of one resident of each parish in the region appointed by the local governmental body and three residents appointed by the governor. The legislation also requires the adoption of governance bylaws within 90 days of being established, including the following: (1) Procedures for the election of officers including terms of office and methods and grounds for removal; (2) Procedures and grounds for removal of any board member which must include removal for the conviction of a felony or for failure to meet board attendance requirements.

CLONING & UMBILICAL CORD BLOOD

Senate Bill 738 by Senator Morrish (pending Senate Health & Welfare) would have prohibited human cloning and human-animal hybrid cloning. This legislation mandated criminal penalties of imprisonment at hard labor for not more than 10 years, or a fine of not more than $100,000.00, or both. The legislation further provides that whoever violates the provisions of the legislation that involves the derivation of a pecuniary gain shall be fined not less than $1,000,000.00 and not more than an amount equal to the amount of the gross gain multiplied by two, if that amount is greater than$1,000,000.00. The legislation would not have prohibited areas of scientific research not specifically prohibited by the legislation, including research in the use of nuclear transfer or other cloning techniques to produce molecules, DNA, cells other than human embryos, tissues, organs, plants or animals other than humans or human animal hybrids.

House Bill 370 by Representative Henry (Act 486) prohibits the use of public funds, including tax proceeds, funds received from the federal government, or other revenues of the state or political subdivisions thereof, from being used by any person or entity, including any state-funded institution or facility, for human somatic cell nuclear transfer, commonly known as human cloning. The legislation provides for exceptions from the prohibition for areas of scientific research which are not specifically prohibited by proposed law including research in the use of nuclear transfer or other cloning techniques to produce molecules, deoxyribonucleic acid, cells other than human embryos, tissues, organs, plants, or animals other than humans. In addition, the legislation stipulates that the use of federal funds for research using embryonic stem cell lines approved for federal funding prior to August 9, 2001, shall not be prohibited.

House Bill 861 by Representative Hines (Act 163) establishes the Umbilical Cord Blood Banking Program within the Department of Health and Hospitals for the purpose of promoting public awareness of the benefits of cord blood banking, encouraging research into the uses of cord blood, and facilitating pre-delivery arrangements for banking of cord blood donations. This legislation requires the Department of Health and Hospitals to develop a public education and outreach program, coordinate and promote professional education programs, and establish a toll free hotline to receive requests for information and direct potential cord blood donors to available cord blood banks.

SEXUALLY TRANSMITTED DISEASES

Senate Bill 238 by Senator Cassidy (Act 449) provides an innovative tool for treating sexually transmitted diseases. This legislation provides that when any physician, registered advanced practice nurse, or physician assistant diagnoses or does a clinical assessment of a case of chlamydia or gonorrhea in an individual patient the physician or advanced registered practice nurse may prescribe or otherwise provide prescription antibiotic drugs to that patient's sexual partner or partners absent a doctor-patient relationship and without examination of that patient's sexual partner or partners. The legislation requires that the health care provider provide to the patient written documentation to give to their sexual contact which contains important medical information that the sexual contact should follow.

OPTOMETRY

Senate Bill 112 by Senator Heitmeier (Act 439) expands the definition of "optometry" to include dispensing of frames and lenses, therapeutic purposes for contact lenses and the dispensing of pharmaceutical agents provided that such dispensing activities shall conform to the rules and regulations relative to packaging, labeling, and record keeping.

SENIOR CITIZENS

Many people are aware of the Amber Alert system for missing children. Senate Bill 423 by Senator Cravins (Act 453) expands on this concept and creates the Silver Alert system for senior citizens and those citizens suffering from a developmental disability. The Department of Public Safety and Corrections is mandated to provide for a procedure to determine that the senior citizen or person with a developmental disability is truly missing. In addition, the department must provide for a procedure for notifying the general public that a senior citizen or person with a developmental disability is missing and the type of notification to be utilized to inform the general public. The legislation also requires that the department coordinate with and encourage the private sector to participate in secondary distribution, including the creation and distribution of flyers, electronic mail, and text messaging of the missing senior citizen or person with a developmental disability.

NO WRONG DOOR

Senate Bill 701 by Senator Mount (Act 775) expands the "No Wrong Door" initiative in a further effort to make it easier for the citizens of this state to become aware of the services offered by the state and to make it easier to receive access to these programs and services. The legislation provides for a state leadership composed of various cabinet level positions. In addition, it requires the leadership group to identify opportunities & implement recommendations regrading human service integration. The legislation provides that in cooperation with local government & community organizations, the state leadership group shall establish a Neighborhood Place service integration delivery model initially in one of the nine regional service areas defined. Local governmental and community organizations shall be engaged with the state to expand the Neighborhood Place model to additional sites in multiple regional service areas. The legislation further defines the goals for the human services integration model to be the following: (1) To provide economic self sufficiency among families who receive services; (2) To provide citizens with timely access to an array of health care, education, employment and human services; (3) To improve the level of student participation and achievement in the school among children who receive services; and (4) To prevent fraud and abuse to ensure funds are appropriately utilized.

MEDICAID

Several pieces of legislation this session dealt with Louisiana's Medicaid Program.

The first piece of legislation, House Bill 366 by Representative Katz (Act 352), expands Medicaid eligibility to former foster children who have reached adulthood. Under current law, there is no provision which allows for an election of the Chafee Option under the state Medicaid program. This legislation law allows the Department of Health and Hospitals to exercise its option under applicable federal statutes to extend an alternative Medicaid benefits package or regular Medicaid to independent foster care adolescents who are not otherwise eligible for Medicaid (the Chafee Option). As defined by federal statute, independent foster care adolescents are persons who: (1) have left the custody of the state, (2) have attained the age of 18 and are under the age of 21, and (3) have assets, resources, and income that do not exceed a level established by the state Medicaid plan. The legislation provides that an alternative benefits package may consist of the following: (1) A high deductible private insurance policy; (2) A health savings account; (3) A program to educate recipients about health insurance.

The second piece of legislation, House Bill 154 by Representative Mills (Act 139), gives the Department of Health and Hospitals the statutory authority to determine is a Medicaid provider is out of business. This is not an ability the department had under current law and was necessary to prevent overpayments to defunct Medicaid providers.

Another change in the Medicaid program requires prostheses, orthoses, and the related services which are purchased by a state agency or reimbursed by Medicaid to be provided by an accredited facility. House Bill 799 by Representative Baldone (Act 732) defines an "accredited facility" as any facility that is accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics, or by the Board for Orthotist/Prosthetist Certification which provides prostheses, orthoses, prosthetic services, or orthotic services. The legislation further provides applicable penalties if these types of services and products are not purchased from ana accredited facility.

EMERGENCY PREPAREDNESS

House Bill 53 by Representative Mills (Act 480) provides that during a declared state of emergency, the limitation of liability for health care providers who gratuitously render emergency health care to persons injured as a result of the emergency extends to any area in which the emergency health care is rendered. Under current law, a person shall not be held liable for death, injury, or destruction to property if they, in good faith and without charge, render health care services, first aid, or emergency services to a person injured in a disaster area as a result of the emergency. This limitation of liability does not apply if the person rendering the care acts in gross negligence or willful misconduct. This legislation extends the limitation of liability to emergency health care services rendered anywhere in the state, provided that the health care providers render the care without compensation of any kind.

ELECTRONIC CONSENT & TELEMEDICINE

Three pieces of legislation dealt with the practice of telemedicine. As the technology advances and physicians are able to use video and web conferencing effectively to diagnose patients, the need for this type of practice will likely increase. The two pieces of legislation allow telemedicine to practiced in the state of Louisiana.

House Bill 1384 by Representative Marchand (Act 850) provides for the licensure of physicians practicing telemedicine. This legislation defines telemedicine as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive video communications via video communications only. Telemedicine under this legislation does not include telephone conversations or electronic mail messages. This legislation requires out-of-state physicians to acquire either an unrestricted license to practice medicine in this state or license to practice telemedicine in order to perform medical services deemed the practice of medicine upon persons located in this state. Additionally, the presence of a licensed health care professional in the examination room at the time telemedicine services are being provided is required.

House Bill 653 by Representative LaBruzzo (Act 153) allows for an actual examination of a patient conducted by a psychiatrist to be conducted by telemedicine utilizing video conferencing technology. Under current law, psychiatrists may only conduct an actual examination of a person alleged to be mentally ill or suffering from substance abuse. This legislation allows the examination to be conducted through the use of telemedicine so long as a health care professional who can adequately and accurately assist with obtaining information is in the room at the time. The legislation requires the licensed health care professional to be responsible for obtaining, recording, and then attaching to the emergency certificate the following information: the date, the starting and ending times, the names of all persons who were in the room, and the type of license issued to the health care professional.

House Bill 193 by Representative Katz (Act 717) provides for medical malpractice coverage for physicians who provide voluntary telemedicine services for the state. Current law provides for medical malpractice liability coverage for a state health care provider who is performing voluntary professional services in a health care facility or institution for or on behalf of the state. This legislation extends this coverage to telemedicine services.

Senate Bill 323 by Senator Thompson (assigned to House Civil Law & Procedure) would have expanded the definition of medical consent to include an electronic signature or affirmative electronic mark. Under present law, only handwritten consent to medical treatment is effective to constitute medical consent. With the emergence of health care technology, such as electronic medical records, and the use of the internet it is becoming increasingly difficult on health care providers to have to obtain a handwritten consent. This legislation expands the definition of medical consent to include the voluntary and continuing permission of a patient, through signature, marking, or other affirmative action including electronically.

Senate Bill 340 by Senator Thompson (assigned to House Civil Law & Procedure) would have provided that electronic signature authentication and identification may be used for an individual who participates in agreements, authorizations, contracts, records, or transactions that involve individually identifiable health information, including medical records and record keeping, transfer of medical records, medical billing, health care mandates or powers of attorney, health care directives, consent to medical or dental treatment, medical research, and organ and tissue donation or procurement. The legislation provides that the electronic authentication and identification may be accomplished by an interactive system of security procedures that include any of the following: (1) A tamper proof electric appliance that receives input of unique identification numbers, unique biometric identifiers, or location devices; (2) A computerized authentication process for biometric identifiers that is linked to the appropriate identification numbers upon receipt of identifiers; (3) Transmission of verification of the identifiers to a securely maintained electronic repository.

AUTISM

Under current law the office of human services of the Department of Health and Hospitals is responsible for providing services to autistic persons and must report to the House and Senate committees on health and welfare at the end of the fiscal year. House Bill 670 by Representative Williams (Act 154) retains present law but removes specific reference to the office of human services. In addition, this legislation renames the center of excellence for autistic services to the center of excellence for autism spectrum disorder, transfers the center from the office of human services to the office of citizens with developmental disabilities (OCDD) and clarifies that the center may partner with the LSU Health Sciences Centers in New Orleans and Shreveport as well as St. Mary's Training School in Alexandria, La. The legislation further empowers the center to receive any gifts, grants, donations, or any sum of money, property, aid, or assistance from any person, firm, or corporation upon the creation of a special fund by the legislature.

WATER FLUORIDATION

Senate Bill 312 by Senator Mount (Act 761) makes changes to the statutes which regulate water fluoridation. Under current law the intent of the water fluoridation program is to encourage each public water system with at least 5,000 service connections to provide fluoridation of its water supply by January 1, 2000. This legislation provides that each public water system that has at least 5,000 service connections and natural levels of fluoride that are less than the minimum established in the rules and regulations adopted pursuant to present law shall acquire, install, operate and maintain appropriate equipment and material in order to maintain the level of fluoride in its water system in the optimum range for the purpose of protecting the dental health of citizens of this state.

The legislation further provides that such public water system shall provide to the Department of Health and Hospitals no later than March 1, 2009, an estimate of the total capital costs to acquire and install fluoridation treatment equipment capable of maintaining fluoride levels within the optimum range for the purpose of protecting the dental health of citizens of this state. The legislation only requires compliance by a public water system when sufficient funds have been identified by the state, whether by appropriation, capital outlay, grants or similar appropriation, as available to that system for the cost of acquiring and installing fluoridation equipment and the cost of material required to fluoridate the system for at least six months from the date of initial installation.

The legislation further provides that a public water system that has never used fluoridation to adjust fluoride levels in its water and whose water contains fluoride in amounts less than the minimum established in the rules and regulations adopted pursuant to present law as optimal for the purpose of protecting the dental health of the citizenry shall be exempt from compliance with proposed law provided all of the following apply: (1) A petition requesting the exemption has been signed by at least thirty percent of the registered voters in all municipalities served by said water system, as certified by the parish registrar of voters, and has been presented to the governing body of each municipality in whose jurisdiction the system provides service; (2) Each municipal government in whose jurisdiction the water system provides service, after receiving the petition and certification from the parish registrar of voters, has called for a local election on the exemption; (3) Each local election pertaining to the exemption of said water system has been held in accordance with state and local law, and the certified results of each election show that a majority of the registered voters who cast a vote in said election approve the exemption; and (4) No election on the same question in the same municipality took place in the four years immediately prior to the election in which the exemption was approved.



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