DHH helps local government, health care providers to improve access to care through UPL programs

Tuesday, July 12, 2011  |  Contact: Lisa R. Faust; (225) 342-7913 or (225) 252-3579 (cell)

BATON ROUGE - The Department of Health and Hospital is helping local governments, hospitals and other health care providers maximize health care dollars and preserve access to care for Medicaid patients through a series of new programs being implemented or expanded this fiscal year. Gov. Bobby Jindal signed HB1, which provides more than $102 million in expenditure authority for DHH to pay local public hospitals and ambulance services through the Upper Payment Limit (UPL) programs.

"For the past several years, our providers have worked closely with us as we have weathered difficult budget times together," said DHH Secretary Bruce D. Greenstein. "These three programs will pump more than $100 million into our local health care communities to enhance access to care for our most vulnerable patients."

In addition to the budget authority provided for the UPL programs in House Bill 1, Gov. Jindal has signed Senate Bill 176 by Sen. David Heitmeier to authorize UPL programs and the payment methodology for the Public Hospital UPL.

"Ultimately, these UPL programs are really about helping our most vulnerable populations by ensuring they have the kind of access to health care needed to treat chronic ailments such as diabetes, heart disease and stroke," Sen. Heitmeier said. "These dollars help enhance the quality of life for all Louisiana residents, while also helping our economy by preserving and creating jobs in the health care sector. I'm glad I am able to be a part of this historic transformation with Secretary Greenstein and his team at DHH."

The Public Hospital UPL is expected to generate about $72.8 million for non-rural, non-state public hospitals throughout the state. In this program, local dollars from hospital districts are sent to the state and used as match to draw down federal UPL payments.

Non-state, non-rural public hospitals that should benefit from the UPL payment include:

• East Jefferson General Hospital
• Iberia Parish Hospital
• Lane Memorial Hospital
• North Oaks Medical Center
• North Oaks Rehab Center
• Opelousas General Hospital
• Slidell Memorial Hospital
• St. Tammany Parish Hospital
• Terrebonne General Hospital
• Thibodaux General
• West Calcasieu-Cameron  Hospital
• West Jefferson Medical Center

DHH submitted a State Plan Amendment on June 29 to the federal government outlining the Public Hospital UPL plan and expects approval by November with the first payments going out as early as December.

The second program provided for in House Bill 1 is the Hospital Based Physician UPL. Already in place, DHH is planning to make $15 million this fiscal year in payments to participating non-rural, not state public hospitals for hospital-based physician services.  There are 43 hospitals in the state eligible for the program.

DHH paid out $6.3 million to two hospitals - East Jefferson and West Jefferson - last fiscal year. In this program, non-state, non-rural public hospitals send local or state general fund dollars to DHH to use as matching funds to access UPL payments. Those UPL payments are made back to the hospitals to ensure continued access to physicians, physician assistants, certified registered nurse practitioners and certified registered nurse anesthetists at the hospitals for Medicaid recipients.

"The UPL program brings in additional federal dollars to our state, which helps our hospitals during these difficult economic times," said John Matessino, president and CEO of the Louisiana Hospital Association. "This funding benefits patients by protecting access to care and critical, life-saving services for communities. The hospital industry will continue to work with DHH and Gov. Jindal on solutions to ensure that we have a strong healthcare delivery system in our state."

The final program is known as the Ambulance UPL, and DHH anticipates making about $14.5 million in payments to companies or government entities that provide ambulance services once the program is up and running later this fiscal year. The Department is submitting a rule to the state Registrar on July 20 outlining the Ambulance UPL followed in September by a State Plan Amendment to the federal government.

Once approved, ambulance providers could see the additional dollars by March 2012. While the exact payment methodology is still being developed, it is expected that this UPL program will allow local governments (whether they run their own ambulance service or contract that service out) to send local dollars dedicated to emergency medical services to the state. The state can then use those dollars, which are currently unmatched, as match to access federal UPL dollars to pay to ambulance services to ensure continued access for Medicaid recipients.

As appropriate reimbursement will support access to critical Emergency Medical Services (EMS), the citizens of Louisiana will be the ultimate beneficiaries of any UPL program payments directed to EMS providers," said Donna Newchurch, CEO of the Louisiana Ambulance Alliance. "The EMS  provider community is committed to working with Governor Jindal and DHH to continue to strive to assure these essential services remain available.

The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and Facebook.