Title V in Louisiana serves as a provider and facilitator of high-quality services and innovative practices that protect and promote the health of women, children, and children and youth with special health care needs (CYSHCN). Led by the Louisiana Department of Health (LDH), Office of Public Health (OPH), Bureau of Family Health (BFH), Title V provides support for maternal and child health (MCH) and CYSHCN populations in Louisiana. BFH works to improve the health of the state’s residents and the health-promoting capacity of its systems by:

 

• Monitoring data to identify, understand, and respond to complex challenges and opportunities
• Aligning efforts and resources to improve community health
• Testing, scaling, and spreading solutions and services that are grounded in best practices and evidence 
• Building coordinated partnerships to advance common goals

 

Like other states, the health and well-being of women, children, and families in Louisiana is influenced by the strengths, challenges, and changes in the state and in local community systems. Louisiana’s Title V program has continued to evolve, with a particular focus over the past five years on increasing the state’s capacity to monitor population health and inform healthcare policy and practice. The following sections describe the most significant changes that have occurred in recent years in the state and the healthcare system.

 

Understanding the Health Status and Needs of the MCH Population in Louisiana

 

The Place: Louisiana is the 31st largest state in the country, covering an area of 43,204 square miles along the Gulf of Mexico (Map 1). Louisiana consists of flat lowlands located on the coastal plain of the Gulf of Mexico and the Mississippi River’s alluvial plain. The economy is heavily dependent on its fertile soils and water to support farming and fishing industries. Louisiana also is one of the leading producers of natural gas and petroleum.

 

Of Louisiana’s 64 parishes (counties), 30 are considered rural per HRSA’s Office of Rural Health Policy.1 The largest urban centers include New Orleans and Baton Rouge. Hurricanes, industrial contamination, and loss of wetlands all represent natural and unnatural disasters that pose threats to the economy, safety, and well-being of Louisiana’s communities and residents. Significant historical events in the past 15 years include hurricanes Katrina and Rita in August 2005, the British Petroleum oil spill in April 2010, severe flooding in August of 2016, tornados and flooding due to Hurricane Harvey in 2017, and persistent coastal land loss of the protective wetlands.

 

The People: Louisiana’s population of about 4.6 million people encompasses a distinct multicultural and linguistic landscape that has been influenced by centuries of colonialism and servitude. Today, the majority of the population in Louisiana identifies as White (62.2%), Black (32.2%), 5.0% identify as Hispanic/Latino, 1.7% Asian (majority Vietnamese), 2.0% two or more races, and 0.6% American Indian/Alaskan Native, with four federally recognized American Indian tribes and several state/local tribes.2,3 Louisiana is unique in that nearly four out of every five residents were born in-state.2 This state’s inherent stability is evidenced through strong social supports and financial stability sustained by family-owned businesses like fisheries, rice-farms, and other crops which have been in operation for hundreds of years. Louisiana is also known for its community-oriented culture. With a 300-year history, Louisiana has some of the longest-lasting cultural traditions in the United States.

 

Challenges and Strengths: There are many challenges and strengths present in Louisiana’s systems, politics, and communities that affect the health and wellbeing of the state’s maternal and child population. The Louisiana Title V Program identifies these challenges and strengths through the lens of the social determinants of health (SDOH): the conditions in which people are born, live, learn, work, and play. Specifically, social and community context, economic stability, education, neighborhood environments, and health and healthcare all pose various challenges and opportunities for health.

 

 

Louisiana’s history of colonization, slavery, and legalized racism disempowered and oppressed portions of Louisiana’s population over multiple centuries. While laws and policies have changed over time, these historical inequities continue to take a significant toll on communities in the state and are perpetuated, often unknowingly, through bias in institutions and systems. The resulting and persistent racial disparities can be best interpreted in light of the conditions in which people are born and live--conditions largely affected by historical and institutional structures and policies that create and sustain differential access to resources and systems of influence and authority.

Economic instability poses a major challenge to the attainment of health for Louisianans. In 2018, about one in five residents lived at or below the FPL, with 27.4% of all children (under age 18) living in poverty. The average household in Louisiana earned approximately $16,000 less than the national household income, and Black households made significantly less annually ($29,508) than White households in Louisiana ($58,632), according to American Community Survey 2018 5-year estimates.2 Conditions of poverty pose unique challenges for CYSHCN families. For parents and caregivers with CYSHCN, full-time employment means less time spent coordinating care for their children. Parents of CYSHCN are more likely than parents of non-CYSHCN to report cutting hours or quitting jobs as a result of their child’s health issues.4 Additionally, out-of-pocket medical expenses for this population are more extensive than those of non-CYSHCN, regardless of insurance coverage.  

 

In addition to economic instability, low educational attainment is a challenge. Adults in Louisiana are less likely to finish high school than their peers across the US, and 24% of students with disabilities drop out of high school, which is higher than the national average of 17% (Table 3). More than 130,000 students in Louisiana were suspended in the 2018-2019 school year (74,043 in-school suspensions, 58,500 out-of-school suspensions). Students of color and students with disabilities were more commonly suspended.5 Due to the challenges, Louisianans consistently have poorer health outcomes compared to the rest of the nation. According to America’s Health Rankings 2019, Louisiana ranked 49th in the nation in overall health.6 Low birth weight (LBW), preterm birth (PTB), infant mortality, maternal mortality, and CYSHCN status remain significant challenges for the MCH population.

 

In 2019, Louisiana had the fifth highest infant mortality rate in the US. Approximately 487 babies born to Louisiana resident mothers die before their first birthday, an average of more than 9 babies per week. Similar to nationwide trends, Black infants in Louisiana die at twice the rate of White infants. Sudden Unexpected Infant Death (SUID) cases represent 21% of all infant deaths in the state, though many SUIDs are determined to be accidental suffocation and strangulation in bed (ASSB) upon further investigation.7

 

According to Louisiana’s latest Maternal Mortality Report, maternal mortality in Louisiana is increasing at a rate exceeding that of the United States. Within Louisiana, disparities by race are significant: black mothers are 4.1 times as likely to die as white mothers.8 Compared to the national average, Louisiana has a higher proportion of CYSHCN. Approximately 23% of children in Louisiana have special health care needs, and among CYSHCN, 67.1% have two or more health conditions.4

 

In recent years, opioid use and abuse has become a pressing issue. The rate of drug related deaths has increased in Louisiana from 13 per 100,000 deaths in 2014 to 21.3 per 100,000 deaths in 2019, according to America’s Health Rankings.6 Neonatal abstinence syndrome is also a growing concern, which will be further discussed in the State Action Plan section on Women’s/Maternal Health.

 

Impact of SARS-CoV-2: In late 2019, cases of severe and acute respiratory illness were attributed to an unknown virus originating in Wuhan, China. By the end of January 2020, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was documented in the United States, and in early March, cases of the novel coronavirus began to appear in Louisiana9,10,11. Within a matter of weeks, Louisiana became a “hot spot” of the outbreak. Cases of coronavirus grew more rapidly in Louisiana compared to other states, and by the end of March, Orleans Parish had the highest number of deaths per capita of any county in the country.12. The initial outbreak in Louisiana was concentrated in Jefferson and Orleans parishes, due in part to rapid transmissions at New Orleans area Mardi Gras celebrations that concluded on February 25th: just two weeks before the state’s first presumptive positive test of SARS-CoV-2. Governor Edwards responded swiftly, declaring a Public Health Emergency on March 11th, the same day that the World Health Organization (WHO) declared SARS-CoV-2 a global pandemic. Shortly thereafter, Governor Edwards issued a statewide “stay at home” order that lasted for nearly two months. This “stay at home” order mandated the closure of several public spaces across the state, including schools, gyms, restaurants, beauty salons, and other commercial venues. The rapid response on the part of Louisiana leadership resulted in a plateau and eventual decrease in cases, hospitalizations, and deaths due to SARS-CoV-2.

 

At time of writing (September 2020), more than 150,000 cases of SARS-CoV-2 have been reported in Louisiana. More than 5,000 Louisianians have died, and thousands more have been hospitalized. Although black people make up roughly 32% of the state population, they account for more than 50% of SARS-CoV-2 deaths in Louisiana11. Conditions like diabetes, hypertension, heart disease, and obesity have been identified as risk factors for SARS-CoV-2 complications13. Louisiana's high rates of the aforementioned conditions, the timing of Mardi Gras celebrations relative to the spread of the pandemic, and the community-oriented culture of Louisiana created a “perfect storm” for SARS-CoV-2 to spread across the state.

 

The economic impacts of the statewide quarantine have been significant and immediate: between March 2020 and April 2020, unemployment increased from 6.7% to 15.1%. Current estimates show that these figures have declined slightly, but according to the most recent data from the U.S. Bureau of Labor Statistics, 13.3% of the state population remains unemployed14. On March 18, 2020, President Trump signed into law the Families First Coronavirus Response Act (FFCRA), which provided additional flexibility for state unemployment insurance agencies and additional administrative funding to respond to the pandemic. This Act enabled Louisiana to offer an additional $600 a week to residents receiving unemployment benefits. This additional funding expired on July 31st, 2020. As of July 14th, 2020, Congress has not passed any additional laws to provide extended aid to unemployed Americans.

 

While state-level data are not available, national data suggest that both the pandemic and the isolation of quarantine have increased mental health issues like depression and anxiety. A Kaiser Family Foundation poll found that nearly half (45%) of adults in the U.S. reported that their mental health had been negatively impacted due to stress over the virus. People who were sheltering in place (47%) were more likely to report negative mental health effects resulting from stress related to coronavirus than among those not sheltering in place (37%). Though necessary to prevent the spread of the virus, social isolation has long been linked to feelings of loneliness and depression in the scientific literature. Research has also demonstrated that job loss is associated with increased depression, anxiety, and low self-esteem, and may lead to higher rates of substance abuse and suicide. Polling data show that more than half of the people who lost income or employment experienced negative mental health impacts from stress due to coronavirus, and lower income people reported higher rates of major negative mental health impacts compared to higher income people15. The emotional impact of coronavirus on children and adolescents has yet to be determined, but given the high prevalence of mental health issues amongst adolescents, increases in incidence and severity of mental illness due to coronavirus are likely.

 

At time of writing, Louisiana is in Phase 2 of Governor Edward’s reopening plan, though an increase in cases has resulted in a second round of closures of some public and commercial venues in August. The public health crisis precipitated by SARS-CoV-2 is ongoing, and its economic, social, and emotional impacts continue to unfold.

 

While Louisiana continues to experience ongoing challenges related to this pandemic, recent changes in healthcare coverage could not have been timelier. Historically, Louisiana had one of the highest uninsured rates in the nation. In July of 2016, Medicaid was expanded to all adults under 138% of the federal poverty line (FPL) (children were not part of this expansion population because children in that income range are already eligible for public insurance coverage). With that change in health policy, Louisiana experienced one of the largest reductions in the uninsured rate for any state.16 With the expansion of Medicaid, more than 516,000 adult men and women have gained health care coverage under public insurance. With the inclusion of the expansion population, Medicaid is now responsible for approximately 1.5 million child and adult participants in Louisiana.17 Furthermore, Medicaid expansion has had a significant positive impact on Louisiana’s economy: within the first year of Medicaid expansion, more than 19,000 new jobs were created and $178 million in new state and local revenues were generated.19 Economic gains are expected to continue, with the state projected to save $1 billion by 2028 due to Medicaid expansion.20

 

Another strength in Louisiana is the long-standing commitment to facilitating healthcare coverage for children. Louisiana has achieved and sustained high rates of coverage for children. Between 2009 and 2016, the percentage of uninsured children decreased from 7% to 3%, and this decrease has been sustained for several years.18 More than half of CYSHCN in Louisiana have public insurance which is higher than the national average, and a lower percentage of CYSHCN in Louisiana have no insurance as compared to the national average.4

 

Louisiana's early care and education system has also undergone significant change in an effort to better serve the state's families. Child care licensing was unified with other early education programs under the Louisiana Department of Education in 2015 in order to create a cohesive early childhood system and improve school readiness. This system has continued to stabilize and mature, though access to childcare subsidies remains more limited than a decade ago.21 According to the State of Babies Yearbook 2020, Louisiana lags behind the national averages for every measure associated with positive early learning experiences22. Given the state of early childhood education in Louisiana, Governor Edwards has declared this issue a top priority for his second term.

 

Until recently, Louisiana was recognized as the “incarceration capital of the world” with more individuals in custody in jails and prisons than any place than any other state or country (more than 1,000 people per 100,000 are incarcerated in Louisiana, compared to 700 per 100,000 nationally). The laws and policies that resulted in Louisiana being an international outlier are multifaceted and have been attributed to sentencing laws for non-violent offenses, the state’s approach to funding jails and prisons, the privatization of facilities, and a lack of investment in services and supports. Under Governor Edwards, the state has begun efforts to reform the criminal justice system and as a result the prison population is beginning to decline. While these changes are promising, they are additional reform is necessary as Louisiana incarceration rate remains the second-highest in the country.23

 

Systems of Care for Vulnerable and Underserved Populations

Financing and Integration of Services: In 2012, Louisiana Medicaid began transitioning from a fee-for-service system to Healthy Louisiana, a network of five managed care organizations (MCOs) to cover Medicaid services for children and adults. As of 2015, the state's MCOs have been responsible for both physical health and behavioral health benefits.

Mandatory MCO populations include the majority of Medicaid eligible population groups including children under 19 years of age, individuals and families receiving Temporary Assistance for Needy Families (TANF), Child Health and Maternity Program (CHAMP)-Child Program, Deemed Eligible Child Program, foster care children, youth aging out of foster care, former foster care children through the age of 26, Regular Medically Needy Program, Louisiana Children’s Health Insurance Program (LaCHIP), Blind/Disabled Children, eligible parents and caregiver relatives, pregnant women, LaMOMs, breast and cervical cancer program, aged, blind and disabled adults, Supplemental Security Income (SSI) Program, individuals diagnosed with tuberculosis and the new adults expansion population. Although there are populations excluded from managed care such as dual-eligible (those who receive both Medicare and Medicaid), waiver recipients, and individuals in long-term care, individuals receiving services through the 1915(c) Home and Community Based Waivers, such as Children’s Choice, are considered voluntary opt-in populations for MCO services and benefits. Furthermore, some dual-eligible are mandatorily enrolled in the MCOs for Specialized Behavioral Health Services, and non-emergency medical transportation.

The MCOs are required to cover all state plan services including the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) at or above the Medicaid published rate, unless the provider/MCO contract allows a different reimbursement rate. These plans also have flexibility to provide other services that will help meet their members' needs through value-added benefits or additional network coverage. Plans are required to report on certain quality measures, with plans offering incentives to both providers and members. Examples of various incentives for members include gift cards for preventative care such as wellness checks, sexually transmitted infection (STI) screenings and prenatal and postnatal care. Extra benefits offered include dental care and hearing aids for adults, tobacco cessation and weight management.

 

In February 2019, the state Medicaid program released a competitive solicitation to re-bid MCO contracts. Grounded in the “Triple Aim”, the vision was to build a Medicaid managed care delivery system that improves the health of populations (better health), enhances the experience of care for individuals (better care), and effectively manages Medicaid per capita care costs (lower costs). The solicitation included a new focus on value-based purchasing contracts, with the aim of improving population health, patient centered medical homes and the quality of provider performance. In September 2020, however, LDH announced that a new solicitation would be issued. Initially, four companies were selected for the new MCO contracts - three companies that currently hold contracts and one new insurer. The two insurance companies that were not selected filed a legal protest that prevented the new contracts from being awarded. In January 2020, the governor signed emergency contracts with the existing five MCOs to prevent disruption of health care coverage for enrollees. No specific timeline has been released for the redevelopment of the solicitation.

Health Services Infrastructure: Overall, Louisiana is recognized as having a substantial and growing unmet need for primary care services. As of July 2020, the US Health Resources and Services Administration (HRSA) recognized 148 primary care shortage areas in the state, compared to 141 in 2018. The number of mental health shortage areas also increased; there are now 144 recognized mental health shortage areas, compared to 129 in 2018—100% of the state24. Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) are essential to addressing these needs. Louisiana currently has 260 FQHCs operated by 36 community health center organizations, and 160 RHC providing primary care and mental health services in the state. Furthermore, a statewide network of 60 school-based health centers affiliated with OPH BFH provide additional access, in particular for adolescents.

 

Services related to mental health are a critical need, as reflected in the federal shortage area designations, the previous OPH State Health Assessment, and the current Title V Needs Assessment. Addressing these gaps is essential and will be a focus of the upcoming Title V State Plan. The Healthy Louisiana MCOs are required to ensure network adequacy based on CMS guidelines and assist their members with making arrangements for access to services, including transportation upon request. The EPSDT mandate makes fulfilling this need a state obligation, in addition to a contractual obligation. However, the specific gaps and problems are not well documented. Assessing the health system performance related to mental health needs will be a priority for Title V. In addition, Title V has begun to prepare for scaling provider capacity-building interventions. Provider-to-provider consultation to support first-line identification and management of social-emotional and psychiatric concerns is one such system-strengthening intervention that has been gaining interest in Louisiana. BFH is exploring ways to address these issues, as discussed throughout the State Action Plan narratives.

 

Like other states, telemedicine has assumed an unexpected and critical role in the delivery of healthcare in Louisiana in the six months since the start of the SARS-CoV-2 pandemic. At the time of writing, the governor’s office and Louisiana Medicaid continue to encourage the use of telemedicine/telehealth to decrease the potential for patient-to-patient transmission in shared spaces (e.g., waiting rooms) and patient-to-provider transmission. While statewide data on the volume of telehealth visits is not available at this time, some health systems have reported that their telemedicine visits have increased from an average of 14 per day to well over 1,000 per day.25 The ability to quickly assemble an infrastructure for telemedicine under such critical circumstances has proven to be an unanticipated strength of Louisiana’s healthcare system and by leveraging this unprecedented momentum, Louisiana can continue to strengthen and refine this capability over time.

 

Changes in OPH Services: Louisiana's statewide network of OPH Parish Health Units (PHUs) once served as the state’s main provider of primary care for low-income women, children and families. Over the past 15 years, however, care has been transitioned to private providers (such as FQHCs) as Medicaid has become more widely accepted. PHUs now primarily provide essential public health services, with a focus on high-quality family planning and sexually transmitted disease (STD) services, WIC (Women, Infants, and Children), CYSHCN safety-net specialty services, immunizations, and tuberculosis testing and treatment. Funded through Title V federal and state allocations, PHUs in LDH Regions 2-9 (see Figure 2 below) provide a total of 29 sub-specialty and genetics clinics for CYSHCN. Additionally, 57 of the 70 PHUs provide Title X-sponsored reproductive health services, with programmatic oversight provided by the BFH Reproductive Health Program (RHP).

 

Figure 2. Louisiana Department of Health Administrative Regions

 

 

While the reproductive health and CYSHCN clinics were beginning to explore telehealth options, the SARS-CoV-2 pandemic expedited the timeline and prompted major changes in service delivery through the PHUs. Within two weeks of the stay-at-home orders and clinic closures, Title V-supported staff worked across programs and clinical service lines together with OPH nursing and revenue teams to develop a HIPAA-compliant virtual visit platform, train clinic staff, and implement telehealth visits at all PHUs.

 

A phased reopening of PHUs and prioritization of clinical services that require traditional office visits is anticipated. Until all PHUs are cleared to be open and fully-operational, telehealth will continue to be recommended for most services. In the long term, telehealth services will likely continue in some capacity after PHUs resume in-person clinic operations. However, certain types of telehealth services have only been available throughout the SARS-CoV-2 pandemic due to temporary changes in regulatory and reimbursement policies. Despite the many unknown factors impacting future health care delivery, BFH is actively planning for post-pandemic direct service operations and exploring options for telehealth sustainability and expansion, especially for underserved communities.

 

With most women, children, and CYSHCN generally accessing care in community settings, Louisiana’s Title V Program has been working to redefine Title V’s role in fulfilling the mandates to ensure access to and the quality of services. For CYSHCN, the charge is even broader, encompassing assurance of a coordinated, community-based, family-centered system of care for all CYSHCN in the state. In 2019, BFH began a series of internal evaluations of programs that provide clinical services. A key part of the assessment was a statewide scan of certain key provider types for CYSHCN historically eligible served in the OPH PHU through the Children’s Special Health Services (CSHS) and Genetics clinics. The initial evaluation showed that several geographic areas continue to lack local providers. To get an accurate understanding of the service gaps experienced by families around the state, BFH is currently conducting landscape assessments of all of the specialty services available to CYSHCN in each region. BFH is contacting all specialty providers in each region to gather information such as insurance plans accepted, waitlist length, openings for new patients, and ability to treat patients with certain medical conditions. The results of the landscape assessments will inform future Title V strategies to strengthen the system of care for all CYSHCN in Louisiana and ensure that the Title V safety net clinical services are accessible to all eligible CYSHCN who need them. 

 

State Health Agency Priorities and Influence on Title V Service Delivery

There are several significant priorities within LDH, OPH, and OPH BFH that affect Title V programming:

• State Health Assessment: In 2019, LDH OPH earned accreditation through the Public Health Accreditation Board (PHAB). As part of OPH’s ongoing efforts to maintain accreditation, OPH is conducting a new State Health Assessment (SHA), which will then inform the development of the next State Health Improvement Plan (SHIP). The Title V Strategy Manager and the BFH Injury Epidemiologist are members of the core SHA/SHIP steering committee, which will ensure that the 2020 Title V Needs Assessment findings and resulting MCH and CYSHCN priorities are considered throughout the SHA/SHIP process.  
• Medicaid MCH State Planning: The state Medicaid program is currently working to develop priorities related to maternal and child health. They recently hired an associate medical director with a background in pediatrics, and are assessing their need for other roles that can bolster their internal maternal child knowledge base and capacity. The policy recommendations developed as a part of the 2016-2020 Title V State Action Plan and through various collaboratives and consultations, such as with Johnson Consulting Group and Zero to Three, are under consideration in Medicaid’s planning. Specifically, policy recommendations related to developmental screening and breastfeeding supports have been prioritized. BFH is currently compiling a synopsis of the Title V policy initiatives to facilitate joint planning for refining policy options and their implementation.
• Medicaid MCO Contracts: Title V staff and Title V-supported commissions and councils provided extensive substantive feedback on the development of the model MCO contracts that were originally anticipated to be awarded in 2019. While the new contracts were not awarded, the input has been used to inform current priorities and approaches. Assisting Medicaid with the design and substance of a new competitive solicitation will likely occur through the standing Title V/Medicaid coordination meetings and the applicable boards and commissions supported by BFH.
• OPH Strategic Effectiveness: In the Fall of 2019, OPH leadership convened section leaders to establish a common agency-wide goal: to become a cohesive, high-performing public health agency that equitably increases life expectancy. As part of this process, all OPH centers and bureaus have identified 1-3 specific areas of work to advance in 2020 to advance this shared goal. BFH’s focus aligns with three key priorities reflected in the Title V workplan: 1) to redevelop the newborn screening programs; 2) to redevelop the CYSHCN services; and 3) to strengthen the BFH workforce, in particular using the Title V MCH Competencies as a benchmark.
• Maternal Morbidity and Mortality: Over the past two years, maternal morbidity and mortality have been the focus of both legislative and departmental action. In 2019, the Healthy Moms, Healthy Babies Advisory Council (Act 497 of the 2018 Regular Legislative Session), a time-limited advisory group charged with reviewing how state programs working to address maternal morbidity and mortality were incorporating community voice and an equity focus, published their first findings and recommendations. In addition, in response to House Resolution 294 and Senate Resolution 240 of the 2019 Regular Legislative Session, the Louisiana Title V Program was tasked with convening a summit and reporting on actions being taken to address mortality outcomes for African-American infants and mothers in Louisiana and a roadmap for the future. The Title V program has been tasked with operationalizing these recommendations.
• Contraceptive Access: Over the past five years, BFH’s Title V and Title X work plans have included targeted efforts to improve access to high quality patient-centered reproductive health services. This work has entailed Medicaid policy changes and on-the ground structured technical assistance to integrate recommended education and clinical practices into routine clinical care, in particular in FQHCs and RHCs. However, the reach has been incremental. Other Medicaid policy changes, such as reimbursement for post-partum Long Acting Reversible Contraception (LARC) methods, have also not been widely implemented and require additional practice-level support around the clinical and administrative processes. Furthermore, quality implementation of these policy and practice changes requires careful monitoring to help ensure they are patient-directed and non-coercive. BFH has proposed plans to scale up a quality-improvement initiative that may be supported as an LDH priority.
• Opioid Strategies: Act 174 of 2018 Louisiana Regular Legislative Session charged LDH with creating a pilot demonstration project to optimize outcomes associated with Neonatal Opioid Withdrawal Syndrome (NOWS). The Title V program was charged with implementing the mandate, which has become a formative pilot for a statewide LaPQC initiative that will be open to all birthing facilities in 2021 focusing on the best care and treatment to support mothers with substance use disorders and their substance exposed newborns.  

 

Louisiana State Statutes and Regulations

Louisiana Revised Statutes

LA Rev Stat 40:1081.2- Providers attending newborn children must test for LDH approved/required genetic diseases

 

LA Rev Stat 40:1081.5 - LDH establishes and operates clinics in cooperation with medical schools at LSU and Tulane to treat those with sickle cell anemia

 

LA Rev Stat 40:1081.1 -LDH to establish programs for combating phenylketonuria, congenital hypothyroidism, galactosemia, sickle cell disease, biotinidase deficiency, and other genetic conditions

 

LA Rev Stat 40:2018.3 - LDH establishes the Louisiana Sickle Cell Commission

 

LA Rev Stat 40:1081.7 - LDH to establish local programs to treat victims of sickle cell anemia and components of treatment

 

LA Rev Stat 40:1081.8 - Outlines functions of the sickle cell navigator program, to be administered by LDH under direction of Sickle Cell Commission; implemented upon appropriated funding

 

LA Rev Stat 40:1071-5 - (CSHS Enabling legislation): Designates OPH to cooperate with Title V of the Social Security Act; receive and expend federal funds for services to extend and improve services for children with special health care needs.

LA Rev Stat §40:31.3 - (ASHP Enabling legislation): The Office of Public Health, Department of Health and Hospitals [currently Louisiana Department of Health], shall establish an adolescent school health initiative.

 

LA Rev Stat 40:2018 (Perinatal Commission Enabling Legislation) - Establishes the Commission on Perinatal Care and Prevention of Infant Mortality. 

 

LA Rev Stat 40:2019 - (Child Death Review Enabling Legislation) - Establishes a child death review panel, protocols, criteria for reporting and investigations for the unexpected deaths of children below the age of fifteen and the ability to suggest recommendations within the agencies presented on the state panel.

 

LA Rev Stat 40:1081.1-7 (Newborn Screening and Sickle Cell Programs Enabling Legislation) - Authorizes LDH to screen for and establish programs designed to reduce mortality and morbidity from sickle cell disease and other genetic conditions.

 

LA Rev Stat 40:1285.1-.5 (Lead Screening Program Enabling Legislation) - Establishes a program for the prevention, screening, diagnosis, and treatment of lead poisoning in the Office of Public Health; Mandatory reporting of lead poisoning cases required; comprehensive records

 

LA Rev Stat 46:2263-4 (Newborn Hearing Screening Enabling Legislation) - Establishes within OPH a program to provide for the early identification and follow-up of infants susceptible to a hearing disability, of deaf or hard of hearing infants, and of infants who have a risk factor for developing progressive hearing loss; establishes an advisory council.

 

LA Rev. Stat. 46.2351-2356 (Louisiana Commission for the Deaf Enabling Legislation) - Establishes the Louisiana Commission for the Deaf within the Louisiana Department of Health; defined duties; permits LDH hiring of executive officer of the commission; permits receipt of money from any source.

 

LA Rev. Stat. 40; 31.41-48 - (LBDMN Enabling Legislation): Establishes a system to collect, analyze, and disseminate data regarding birth defects and to provide information to families regarding services available and prevention programs.

 

LA Rev Stat 46:447.1 (Reproductive Health Program Enabling Legislation)- Establishment of a family planning program to provide family planning education and contraceptives for public assistance recipients.

 

LA Rev Stat 46:973 - Allows the Office of Public Health to provide a special program of preventive, health, and medical care and health education services for adolescents that concentrates on adolescent pregnancy and pregnancy prevention.

 

LA Rev Stat 46:974 - Asks that OPH maintain a statewide toll free number to advise pregnant women on available resources.

 

LA Rev Stat 40:1061.17 - Pertains to Abortion Alternatives/Woman’s Right To Know.

 

LA Rev Stat 13:5713 - Instructs the coroner to report SIDS to the Director of the Parish Health Unit within 48 hours.

 

LA Rev Stat 40:1086.1-4 - Defines Shaken Baby Syndrome and Sudden Unexpected Infant Death Prevention major public health priorities for the state and authorizes LDH to conduct public awareness activities.

 

LA Rev Stat 17:407.40 - Assigns OPH to provide information and resources to the state Department of Education for such training and for other areas of training required for employees of early learning centers in promoting the health, safety, and welfare of children.

 

LA Rev Stat 17:407.23 - Louisiana Early Childhood Education Act (Act 3, 2012) - Establishes the Early Childhood Care and Education Network; Board of Ed must coordinate with the DCFS and LDH to align the standards for the licensing of child care facilities, including the requirements for participation in the Louisiana Quality Start Child Care Rating System, with the standards established for early childhood education programs.

 

LA Rev Stat 40:1075.4 - Emergency Medical Services for Children Program (1995) -

Establishes an Emergency Medical Services for Children Program and shall include a full-time coordinator, education programs for EMS personnel, guidelines for referring, guidelines, inter-hospital transfer system for critically ill or injured children and pediatric rehabilitation units. 

 

LA Rev Stat 40:1086.12 - Neonatal opiate withdrawal syndrome pilot project

Charges LDH with creating a pilot demonstration project to optimize outcomes associated with Neonatal Opioid Withdrawal Syndrome (NOWS).

 

The Healthy Moms, Healthy Babies Act (Act 497, 2018) -

Creates within the Louisiana Department of Health the Healthy Moms, Healthy Babies Advisory Council for the purpose of working with existing state entities to address racial and ethnic disparities in maternal health outcomes and incorporate a community-engaged, equity-focused lens on maternal death and morbidity.

 

Language Equality and Acquisition for Deaf Kids (LEAD K) Task Force (Act 455, 2018) -

Establishes the Language Equality and Acquisition for Deaf Kids (LEAD-K) Task
to develop a resource for parents to monitor and track deaf or hard of hearing children's language acquisition and developmental stages and to develop a framework for assessing children who are deaf or hard of hearing for the purpose of ensuring they have the opportunity to achieve kindergarten readiness in an equitable manner.

 

Early Childhood Care and Education Commission (Act 693) -

Establishes the Early Childhood Care and Education Commission charged with establishing pilot programs in high-performing community early childhood care and education networks that will further efforts to improve kindergarten readiness.

 

Louisiana Administrative Code (Regulations):
LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 17. Children’s Special Health Services Chapters 49 - 59

 

LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 55. Birth Defects Surveillance System Chapter 161-163

 

LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 19. Genetic Diseases Services Chapter 63 Neonatal Screening; 6303.

 

LAC Title 48, Public Health-General, Book 2 of 2; Part V; Subpart 18. Disability Prevention Program Chapter 70. Lead Poisoning Prevention Program; 7001-7009

 

LAC Title 48, Public Health-General, Book 2 of 2; Part I; Subpart 13. Family Planning Chapter 35-37
 

LAC Title 51, Sanitary Code, Part XXI Day Care Centers and Residential Facilities, Chapter 3, Child Day Care Centers, #9
 

DOE Child Care Development Fund Bulletin 137 – Early Learning Site Licensing Regulations requires three hours of training by a child health care consultant on infectious diseases, health, safety, and/or food service preparation.

 

LAC Title 5, Chapter 65,6501, 6503 (April, 1987)- Authorizes LDH to operate Regional Genetic Clinics

 

LAC Title 5, Chapter 69, 6901, 6903 (Aug, 2014)- LDH establishes Genetic Diseases Program Advisory Committee

 

Louisiana Children’s Code:
LA Child Code 609. Mandatory and permitted reporting