SR 154

2026 Regular Session  ENROLLED
SENATE RESOLUTION NO. 154
BY SENATOR MCMATH
  A RESOLUTION
To urge and request the Louisiana Department of Health to study the adequacy of the
       in-home skilled nursing services market in Louisiana and to report its findings and
       recommendations to the Senate Committee on Health and Welfare.
       WHEREAS, medically fragile children and adults, including those with
tracheostomies, ventilator dependence, cerebral palsy, and other conditions requiring
multiple hours of skilled nursing each day, depend on a stable network of in-home nursing
providers to remain safely at home and out of institutional settings; and
       WHEREAS, Louisiana home and community based services waiver waitlists for
children and adults with complex medical needs have historically extended for many years,
magnifying the dependence of medically fragile beneficiaries on in-home skilled nursing;
and
       WHEREAS, in-home skilled nursing services delivered on a continuous or
extended-hour basis are clinically and operationally distinct from traditional intermittent
home health services, with different workforce, staffing, and provider economics; and
       WHEREAS, Title XIX of the Social Security Act and federal Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) requirements obligate Louisiana Medicaid
to arrange for medically necessary continuous skilled nursing services for eligible children
under twenty-one years of age; and
       WHEREAS, federal workforce projections anticipate a substantial registered nurse
shortage in Louisiana over the coming decade, and sixty of the state's sixty-four parishes are
designated Health Professional Shortage Areas, conditions that bear directly on the ability
of in-home nursing providers to staff authorized hours of care; and
       WHEREAS, when authorized hours of in-home nursing care cannot be staffed,
beneficiaries are often served in higher-cost institutional or hospital settings, resulting in
increased Medicaid expenditures and avoidable hardship for Louisiana families; and
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SR NO. 154  ENROLLED
       WHEREAS, on May 13, 2026, the Centers for Medicare and Medicaid Services
imposed a nationwide moratorium on new Medicare enrollments for home health agencies
and hospices, including in Louisiana, narrowing the avenues by which new in-home provider
capacity may enter the market; and
       WHEREAS, the Centers for Medicare and Medicaid Services finalized the Ensuring
Access to Medicaid Services rule in 2024, establishing new federal expectations for state
Medicaid agencies regarding service delivery timeliness, unfilled authorized hours, and the
adequacy of provider networks, and beginning in 2026, requiring states to report and publish
state hourly Medicaid payment rates for specified in-home services on a basis comparable
with other states; and
       WHEREAS, any future adjustments to Louisiana's longstanding licensure framework
for home health agencies should be informed by data, stakeholder input, and careful study.
       THEREFORE, BE IT RESOLVED that the Senate of the Legislature of Louisiana
does hereby urge and request the Louisiana Department of Health to study the adequacy of
the market in Louisiana for in-home skilled nursing services provided to Medicaid
beneficiaries, with particular attention to services provided on a continuous or extended-hour
basis to medically fragile children and adults, and to identify any barriers to ensuring that
authorized hours of medically necessary services are timely delivered.
       BE IT FURTHER RESOLVED that the study shall examine:
       (1) Current provider network capacity for continuous and extended-hour skilled
nursing services, including geographic distribution and identification of parishes in which
the number of enrolled and actively serving providers is insufficient to meet authorized
service hours.
       (2) The extent to which authorized hours of care are being filled and the workforce,
operational, and regulatory factors contributing to any unfilled hours, including wage
competition with hospitals and other settings, training pipeline capacity, and scope of
practice considerations.
       (3) Whether current state policies governing the licensure and enrollment of
providers of continuous and extended-hour skilled nursing services are calibrated
appropriately to the unique characteristics of those services, including a comparison of
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SR NO. 154  ENROLLED
Louisiana's framework with the frameworks used in other states and identification of any
state-level exceptions or accommodations that have been adopted to maintain access to these
services, and whether targeted adjustments, including consideration of whether continuous
skilled nursing warrants treatment distinct from traditional home health for purposes of
provider participation, would improve access without compromising patient safety or
program integrity.
  (4) The prior authorization criteria and utilization management practices used by
Medicaid managed care organizations for continuous and extended-hour skilled nursing,
including any reliance on commercial clinical guidelines, and the effect of those practices
on the number of hours authorized relative to ordered hours of care.
  (5) The methodology by which payment rates for continuous and extended-hour
skilled nursing services are established under fee-for-service and incorporated into managed
care capitation, the relationship between current rates and prevailing registered nurse and
licensed practical nurse wage rates in Louisiana, and a comparison to rates in neighboring
states.
  (6) The number of Medicaid beneficiaries, including medically fragile children, who
are receiving services in hospitals, long-term acute care, pediatric subacute, or nursing
facility settings primarily because authorized in-home skilled nursing hours could not be
staffed and an estimate of the associated Medicaid expenditures.
  (7) The availability and capacity of Pediatric Day Health Care and other
community-based service models that complement in-home skilled nursing for medically
fragile children, including geographic distribution and unmet demand.
  (8) The extent to which gaps in authorized hours are absorbed by family caregivers,
including evidence of caregivers reducing or leaving paid employment to provide care, and
the implications for family economic stability.
  BE IT FURTHER RESOLVED that the Louisiana Department of Health shall
consult with affected stakeholders, including beneficiaries and their families, in-home skilled
nursing providers, home health agencies, managed care organizations, clinical professionals
familiar with the care needs of the medically fragile population, the Louisiana State Board
of Nursing, the bureau of family health, children's hospitals operating in Louisiana, pediatric
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SR NO. 154  ENROLLED
subspecialty societies including the Louisiana Chapter of the American Academy of
Pediatrics, disability rights and family-support organizations including Families Helping
Families regional centers, the Arc of Louisiana, and the Advocacy Center of Louisiana,
long-term acute care hospital representatives, and the legislative auditor as appropriate.
        BE IT FURTHER RESOLVED that the department shall use existing Medicaid
claims, encounter data, electronic visit verification records, prior authorization data, and
managed care organization network adequacy filings to the maximum extent practicable to
minimize the administrative burden of the study.
        BE IT FURTHER RESOLVED that the department shall provide a preliminary status
update to the Senate Committee on Health and Welfare no later than October 1, 2026,
describing the scope of work undertaken, the data sources accessed, and any interim
observations.
        BE IT FURTHER RESOLVED that the department's report shall include any
recommendations for legislative or regulatory action the department considers appropriate,
including whether targeted adjustments to provider participation requirements for continuous
and extended-hour skilled nursing services would improve access while preserving patient
safety and program integrity.
        BE IT FURTHER RESOLVED that the department shall report its findings and
recommendations to the Senate Committee on Health and Welfare no later than February 1,
2027.
        BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
secretary of the Louisiana Department of Health and the legislative auditor.
  PRESIDENT OF THE SENATE
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