Making Medicaid Better Newsletter 7.8.2011
Twelve Entities Submit Proposals to Form Coordinated Care Networks
Last week, the Louisiana Department of Health and Hospitals received proposals from 12 entities to establish Coordinated Care Networks (CCN), which will transform the state's Medicaid program. Last Thursday, June 30, was the proposal submission deadline for qualified entities wanting to participate in the competitive procurement process (Request for Proposals) the State is using to select the networks to provide health services.
Louisiana will offer two CCN models to coordinate health care services for Medicaid recipients, which will be implemented simultaneously:
1. The CCN-Shared Savings (CCN-S) model is an Enhanced Primary Care Case Management (ePCCM) model that includes a network of primary care providers responsible for providing primary care services and coordinating other services in exchange for an enhanced per-member per-month care management fee paid to that CCN. Participating network providers will continue being reimbursed on a fee-for-service basis by the Medicaid fiscal intermediary.
2. The CCN-Prepaid (CCN-P) model is a full-risk, capitated model that receives a risk-adjusted, per-member per-month fee in exchange for providing a full range of Medicaid covered services, including physician, hospital, laboratory and X-ray, durable medical equipment, orthotics and certain supplies and emergency and non-emergency transportation.
Of the 12 entities that submitted CCN proposals, three proposed a shared savings network and nine proposed a prepaid network.
The following entities submitted proposals to be a CCN-Prepaid:
• Aetna Better Health Inc.
• Amerigroup Louisiana Inc.
• AmeriHealth Mercy of Louisiana Inc.
• Children's Hospital Health Plan Inc.
• Coventry Cares of Louisiana Inc.
• Louisiana Cares Health Plan LLC
• Louisiana Healthcare Connections Inc.
• United Healthcare of Louisiana Inc.
• Wellcare Health Plans Inc.
The following entities submitted proposals to be a CCN-Shared Savings:
• Community Health Solutions of America LLC
• LA Physicians Connections LLC
• United Healthcare of Louisiana Inc.
"It is exciting to see so many entities interested in helping us improve health outcomes in Louisiana," said DHH Secretary Bruce D. Greenstein. "This competitive process will ensure that our evaluation teams can select those networks that have the best competencies to meaningfully impact our residents and transform our health system."
The Department released the Request for Proposals for both networks April 11 and received 1,003 written comments, which are available online with the Department's responses at www.MakingMedicaidBetter.com.
To select the CCN that will administer care for Medicaid recipients, DHH staff will carefully evaluate each proposal using a detailed process that begins with a basic review to ensure each meets the minimum requirements specified in the RFP. Once a proposal is cleared for further evaluation, five teams will each review very specific aspects of each proposal, and each team will meet independently to score their specific areas through a process of consensus scoring. The five teams that will evaluate CCN proposals are divided as follows:
• Team 1: Qualifications and Experience; Added Value to Louisiana
• Team 2: Planned Approach to Project; Provider Network; Fraud and Abuse
• Team 3: Member Enrollment and Disenrollment; Member Materials; Customer Service; Emergency Management Plan; Grievances and Appeals
• Team 4: Chronic Care/Disease Management; Service Coordination; Utilization Management; EPSDT; Quality Management
• Team 5: Third Party Liability (CCN-P only); Claims Management; Information Systems
State laws mandate that the composition of teams and contents of proposals submitted remain confidential during the evaluation and scoring process. DHH will announce which entities are recommended for CCN contracts on July 25. The Department is working closely with the Division of Administration, which must approve the evaluation process and the final contracts. Once the awards are announced and scoring is complete, all proposals will become public record.
The CCNs chosen will be the new means of delivering health care for the majority of the state's Medicaid recipients, including children, pregnant women and 80,000 adults with disabilities who do not receive Medicare. The State will transition care for eligible recipients from the current system to CCNs beginning next year.
DHH has divided the state into three Geographic Service Areas (GSA) to implement CCN in phases. Each GSA will be limited to three CCNs of each model for recipients to choose from. Entities submitting proposals to operate a CCN could submit for one, two or all three GSA.
The first GSA, which encompasses the Greater New Orleans and Northshore regions, will begin CCN services Jan. 1, 2012, with the next two GSAs beginning services in 60-day increments after that. All areas are scheduled to have the CCN model in place for eligible Medicaid recipients by May 1, 2012.
Please visit www.MakingMedicaidBetter.com frequently to see the latest updates and information as the State progresses toward CCN implementation.
Featured Question
How is the state going to ensure the money used to fund the Coordinated Care Network (CCN) delivery system for Medicaid goes to patient care, instead of just to insurance companies' profits?
The CCN-Shared Savings model will still operate on fee-for-service, with payments administered through the State's fiscal intermediary. The CCN-Prepaid is the model that will be administered through an insurance company or similar entity. The Request for Proposals the state is using to select the companies to administer these networks for Louisiana Medicaid recipients and the contract that will be executed between DHH and the CCN mandates minimum Medical Loss Ratio (MLR) requirements. The networks must spend 85 percent of the monthly capitation payment on direct patient care and other expenditures that will improve the quality of care. The CCNs must spend money on indirect patient care activities, such as buildup of network adequacy, ongoing provider recruitment and other administrative functions that are classified as administrative in nature but necessary to coordinate care effectively and improve health outcomes.
In the current Medicaid program, Louisiana spends nearly $7 billion in taxpayer funds on direct fee-for-service medical care, but is not seeing improved health outcomes commensurate with the amount of money invested. DHH is unable to hold any one entity accountable for improved health outcomes because of the fragmented system in which the state currently operates. Louisiana Medicaid recipients' health outcomes compare poorly to recipients in other states with similar demographics. The CCN contract will hold entities accountable for improving patients' health with the money available. Because these entities have greater flexibility in administering Medicaid care, this delivery approach is expected to yield better results, improve health and quality of life for patients, and offer taxpayers more value for the funds that support this program.
Updates for Providers
DHH Launches New System to Root Out Fraud and Abuse
Beginning this week, DHH has phased in increased time to review claims for Medicaid services, which will help the department more effectively identify fraud and abuse in the system.
Because of the additional review time, health care providers are being paid one day later than usual. Automated payments now will be deposited in bank accounts on Thursday instead of Wednesday. The same schedule will apply throughout July. In coming months, DHH will incrementally push the payments out further, until there is a full, additional 14-day window for claims reviews.
If you suspect fraud or abuse in the Medicaid program, please report it to DHH's Fraud Hotline at 1-800-488-2917.
A Message from Dr. Rodney Wise, Medicaid Medical Director:
On behalf of DHH, I want to encourage you to review the Coordinated Care Network Resource Guide for Providers, available online at www.MakingMedicaidBetter.com. This downloadable and printable guide, which can be accessed directly here, was created to address the most common questions providers have expressed about the State's proposal to transform Medicaid by implementing CCNs, and I hope it will be a valuable information source for you. The guide covers topics including which Medicaid patients will enroll with a CCN, what providers should expect when interacting with potential CCNs or insurance companies, and what the timeline is for all aspects of CCN implementation.
Please review the guide for details, and please visit www.MakingMedicaidBetter.com frequently to see the latest information and updates on this initiative. Thank you for your continued participation and input into this process.
Rodney Wise, M.D.
Medicaid Medical Director
New 24/7 Hotline Allows Mandated Reporters to Alert Authorities to Possible Abuse, Neglect
On Monday, July 11, the Louisiana Department of Children and Family Services will launch a toll-free number - 855-4LA-KIDS (855-452-5437) - for anyone in the state to call and report child abuse or neglect. Mandated reporters and the public will be able to call this number, 24 hours a day, 7 days a week and speak to a trained child welfare worker to report possible abuse and neglect.
Louisiana Children's Code Title VI, Article 603 states that any health practitioner "who provides health care services, including a physician, surgeon, physical therapist, dentist, resident, intern, hospital staff member, podiatrist, chiropractor, licensed nurse, nursing aide, dental hygienist, any emergency medical technician, a paramedic, optometrist, medical examiner, or coroner, who diagnoses, examines, or treats a child or his family" are mandated reporters for child abuse and neglect in the state of Louisiana.
This new number will replace all previous local DCFS numbers used in the past to report child abuse. To ensure that no reports are missed, these numbers will be automatically forwarded to the new toll-free number during the transition.
Contact Us
Your feedback is important to us as we move forward in transforming Louisiana's Medicaid program. For the latest information or to share your comments, please visit www.MakingMedicaidBetter.com, e-mail coordinatedcarenetworks@la.gov, or call toll-free 1-888-342-6207.
