LEGISLATIVE FISCAL OFFICE
Fiscal Note
Fiscal Note On: HB 35 HLS 202ES 93
Bill Text Version: ORIGINAL
Opp. Chamb. Action:
Proposed Amd.:
Sub. Bill For.:
Date: October 6, 2020 8:58 AM Author: ECHOLS
Dept./Agy.: LDH/Medicaid
Subject: non emergency medical transportation Analyst: Shawn Hotstream
TRANSPORTATION OR INCREASE GF EX See Note Page 1 of 1
Authorizes transportation network companies to provide nonemergency medical transportation services through the state
Medicaid program and all other publicly and privately issued health insurance plans (Item #32)
Proposed law provides that any transportation network company may connect a driver to a rider for the purpose of providing
nonemergency medical transportation services within the state through the Louisiana Medicaid program, a Medicare plan, a
Medicare supplement plan, a Medicare Advantage plan, or any other type of publicly or privately issued insurance. The
Louisiana Department of Health shall not require any driver affiliated with a transportation network company to enroll as a
nonemergency medical transportation provider in the Louisiana Medicaid program in order for any nonemergency medical
transportation services provided to Medicaid enrollees by the driver to be eligible for Medicaid reimbursement. Proposed law
provides that LDH may require a transportation network company to be under contract with a transportation broker that
contracts with LDH or an MCO. Ambulances, emergency medical response vehicles, and EMS practitioners shall not be used
for the purpose of providing nonemergency medical transportation. Proposed law provides that LDH promulgate rules for
implementation by March 1, 2021.
EXPENDITURES 2020-21 2021-22 2022-23 2023-24 2024-25 5 -YEAR TOTAL
State Gen. Fd. SEE BELOW INCREASE INCREASE INCREASE INCREASE
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other $0 $0 $0 $0 $0 $0
Federal Funds SEE BELOW INCREASE INCREASE INCREASE INCREASE
Local Funds $0 $0 $0 $0 $0 $0
Annual Total
REVENUES 2020-21 2021-22 2022-23 2023-24 2024-25 5 -YEAR TOTAL
State Gen. Fd. $0 $0 $0 $0 $0 $0
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other $0 SEE BELOW SEE BELOW SEE BELOW SEE BELOW $0
Federal Funds $0 $0 $0 $0 $0 $0
Local Funds $0 $0 $0 $0 $0 $0
Annual Total $0 $0
EXPENDITURE EXPLANATION
Proposed law is anticipated to increase Medicaid expenditures in FY 22 and future fiscal years as the result of adding a new provider type
(transportation network companies) that may provide nonemergency medical transportation (NEMT) to Medicaid enrollees. This measure
authorizes additional transport service providers to be reimbursed by Medicaid. The fiscal impact below reflects new Medicaid costs
associated with an increase in NEMT utilization as a result of increased access to these services. LDH indicates transportation network
companies that would be eligible for Medicaid reimbursement include companies such as Uber and Lyft. The assumptions and calculations
are reflected below.
1. Base year number of trips (2019) - 1,783,212
2. Projected increase based on utilization increase in nonemergency medical transportation services
3. 10% increase in year 1, 3% increase in year 2, 1% in FY 23 through FY 2025
4. Average of $15 charged per ride, $30 round trip (based on Arizona Medicaid transportation model)
5. Estimated utilization increase could be overstated due to the prevalence of COVID
6. Fiscal note assumes FY 22 implementation date (rules promulgated by March 2021)
% increase Total projected
Fiscal year in trips cost @ $30 a trip
FY 22 178,321 $5,349,636
FY 23 183,671 $5,510,125
FY 24 185,508 $5,565,226
FY 25 187,363 $5,620,879
Note: Reductions in missed primary care visits and increased access could result in an indeterminable savings in Medicaid under this
measure. To the extent emergency care or inpatient hospitalizations would be reduced as a result of increased NEMT access for chronic
disease patients, Louisiana Medicaid could realize savings, however, savings are unknown and not quantifiable. The LFO has requested
the department inquire with Mercer (LDH rate actuary) if an efficiency measure (savings offset) would be considered when determining the
actuarial impact on the per member per month capitation rate.
REVENUE EXPLANATION
To the extent managed care per member per month capitation rates increase as a result of this measure, premium tax
revenues generated would increase. The MCO premium tax is 5.5% of total premiums.
Senate Dual Referral Rules House
x 13.5.1 >= $100,000 Annual Fiscal Cost {S & H} x 6.8(F)(1) >= $100,000 SGF Fiscal Cost {H & S}
13.5.2 >= $500,000 Annual Tax or Fee Christopher A. Keaton
6.8(G) >= $500,000 Tax or Fee Increase
Change {S & H} or a Net Fee Decrease {S} Legislative Fiscal Officer