Louisiana continues to rely more heavily on institutions for the developmentally disabled than most states across the nation, according to a legislative auditor’s report issued Monday.

The informational report said the overreliance is happening even though the state Department of Health and Hospitals has either closed or downsized public facilities.

“The number of Louisiana Medicaid beds … that were filled decreased from 5,082 in 2011 to 4,789 as of June 2014,” the auditor said. “Despite this decrease, DHH acknowledges Louisiana’s dependence on institutional care, stating in November 2012 that Louisiana has a disproportionately high number of ICFs-DD (intermediate care facilities for the developmentally disabled).”

Advocates for the developmentally disabled have long fought for more community-based services, arguing people should be able to stay in their homes with family support. They also argue it is more cost-effective.

According to the report, Louisiana’s use of facilities exceeds national benchmarks. The report cites an October 2013 American Health Care Association report in which Louisiana had the fifth-highest number of facilities in the nation. The state also had the sixth-highest number of beds and residents in the facilities.

Legislative Auditor Daryl Purpera issued the report to provide current utilization, cost and quality of care data as the state is moving to Medicaid-managed care for those in need of long-term care services. Purpera said the report is designed to help “evaluate the future impact of managed care in these areas.”

The Jindal administration is working on a plan to privatize management of care for the elderly and developmentally disabled. The general objectives stated by health officials are to improve care through better coordination while serving more people at home with the dollars available. Another goal goes to the heart of an issue the state has wrestled with for decades: overreliance on institutions for care of the elderly and developmentally disabled as the demand for community services skyrocketed.

DHH communications director Olivia Watkins said the agency is continuing to work “on final design elements” and anticipates releasing a request for proposals by the end of the calendar year.

Information can be found at MakingMedicaidBetter.com/longtermcare.

From fiscal year 2011 through 2013, the facilities for the developmentally disabled received about $1.3 billion in Medicaid payments. As of May 2014, there were 524 facilities participating in the Medicaid program.

During the same time period, Louisiana facilities for the developmentally disabled were cited for 2,996 deficiencies. “The most frequently cited deficiency was providers not paying for required services, such as medical supplies, resulting in quality of care issues,” the auditor said.

DHH assessed 39 sanctions, resulting in $64,000 in fines. Thirty-seven of the sanctions “addressed issues that threatened the health, safety or welfare of a resident,” the report said. Two others addressed issues “where a substantial probability that death or serious harm to a resident would result if the condition remained uncorrected.”

The report also lists the facilities with the highest number of deficiencies over the three-year period as well as specific information about each facility operating in the state.

Follow Marsha Shuler on Twitter, @MarshaShulerCNB.

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