The Louisiana Rural Health Association is designed to enhance the professional skills of rural health professionals and keep them abreast of the latest legislative and health care issues. The Association offers a wide variety of continuing education topics including fundraising, recruitment, health care reform, and reimbursement to name just a few. LRHA provides CEUs and discounted fees for its membership. Membership is open to any individuals and organizations interested in making a difference in the quality of the health care delivery system for Louisiana's rural citizens.
NRHA Policy Institute
As an affiliate of the National Rural Health Association (NRHA), the Louisiana Rural Health Association supports a number of policy positions at the federal level.
- LRHA’s 2016 Policy Institute
- NRHA Government Affairs
- Links to information on current Federal legislation
a) Information on individual bills and pending legislation
b) Information from the U.S. Senate
c) Information from the U.S. House of Representatives
d) Information from the President and his Administration
e) Find out who your elected officials are here
Louisiana State Advocacy
On behalf of the LRHA membership, the LRHA advocated for the following items in regards to Medicaid expansion:
Medicaid expansion will help address the coverage gaps in rural communities; however, at the same time it may be hard to manage with the shortage of health care providers in rural communities. As you're aware, expanding Medicaid will provide an opportunity of over 300K to enroll into Louisiana's Medicaid program. The positive impacts of Medicaid expansion is definitely greater than the cons associated with expansion. Please see below for a recap of our discussion:
1. Streamlining Credentialing
On behalf of the LRHA, I encourage LDH to offer a one step credentialing portal as a single source system to submit credentialing materials. The portal should have the capability to upload pertinent credentialing documents to avoid having to send the same set of documents to each MCO. Once approved, the provider will be credentialed will all MCOs. It would be nice if applied across the board! Additionally, I’ve recently learned that plans are not credentialing NPs if they don’t have a physician on site when the RHC opens. The plan(s) are credentialing the provider after the RHC is licensed and certified. This is a concern because a RHC takes about a year to year and a half to get started; therefore, NPs can’t take that Healthy Louisiana plan during their whole start up time which in turn creates an access to care barrier. I will get detailed info on this and send it to you ASAP. The plan wants the MD on site until the RHC certification is approved. We encourage LDH to remove all together or put a clause in the credentialing application that states the NP can be credentialed while they’re going through the RHC process.
2. Rural Health Provider Shortage
As thousands more patients seek treatment, a shortage of caregivers – from physicians to dentists – will pose a challenge for Medicaid expansion. An LRHA Board members recommends a governors executive order to remove the collaborative practice agreement (CPA). This would allow nurse practitioners to open much-needed offices. Additionally, increasing Medicaid reimbursement from 85% to 100% would entice more nurse practitioners to see Medicaid patients.
The lack of providers may be most acute in the area of behavioral health services. When the new enrollees get coverage, there’s a real opportunity to engage them in treatment, but there needs to be capacity in the system to do so. In response to a survey the LRHA sent to RHCs; the majority responded saying they're interested in providing and/or enhancing behavioral health services in their RHC. The LRHA recommends working with the RHC providers to provide services as well as enhance access (reimbursement process) to telepsychiatry. Additionally, the LRHA recommends allowing RHCs to bill separately for mental health and primary care services provided on the same day. Currently, this is allowed for primary care and dental services provided on the same day. Allowing RHCs to bill separately for mental health and primary care services on the same day would encourage all RHCs to expand their behavioral health services (which are greatly underserved). This is a state by state Medicaid issue. Louisiana Medicaid does not reimbursement for BH and Primary care services on the same day.
New rules were finalized in the June edition of the Louisiana Register (Vol 42, No. 06, June 20, 2016) regarding delegation of medication administration to unlicensed assistive personnel (UAPs) by RNs and APRN. While we're grateful for the new rule, we understand that LDH interprets the rules to exclude clinics that are categorized under the umbrella of hospitals (provider-based RHCs). We encourage LDH to review the rule and consider changing the language to allow delegation of medication administration in the provider-based clinics. Attached, please find the June edition for your review. The delegation of medication administration to UAPs in outpatient clinic settings can be found on pages 873 -875.
There are proposed rules (see pages 946-948 in the attached June State Register) for RHCs and FQHCs to be able to use MAs to apply fluoride varnish to kids teeth. This is a good thing; however, it must be paired with an existing visit and there is no additional funding for the supplies or procedure. If this is the intention for this to occur broadly in RHCs and FQHCs, the LRHA encourages LDH to provide reimbursement for the varnish/minimal reimbursement to offset the expense of the training, documentation, and time required. It could make a big difference in prevention of cavities with very little expense.
3. Rural Hospitals
For rural hospitals, Medicaid expansion has the potential to half the percentage of revenue tied to treating the uninsured and will decrease the "no pay" patients in the ED. If I'm not mistaken, it will also increase the rate for outpatient services.