After a year-long transition, the Louisiana Department of Health (DHH) will integrate behavioral services for Medicaid members within the Bayou Health program on December 1. Bayou Health managed care organizations (MCOs) already provide for the physical health needs of Medicaid members. The newly integrated Medicaid program provides members with a single source of care for their total health needs. Approximately 980,000 of the 1.4 million total Medicaid enrollees will be affected by the change.
"DHH is breaking down silos and looking at health, prevention and treatment of the whole person. There is an extraordinary degree of coordination between our Medicaid and Behavioral Health offices, and our staff has worked tirelessly over the past year on this," said LDH Secretary Kathy H. Kliebert. "The transition has removed the barriers of having separate entities for different aspects of an individual's care. Bayou Health plans can now treat the whole person with the integration of behavioral health services." The Bayou Health plans are especially well-positioned to provide case management and guide members through a continuum of care that promotes life-long wellness.
Bayou Health Plans
- Louisiana Healthcare Connections
- United Healthcare
- AmeriHealth Caritas Louisiana
To avoid disruption of services, the Bayou Health plans will honor any Magellan authorized service for a designated grace period. Bayou Health plans will not deny payment solely if a provider is not in network on the day of service through February 29. Members can change plans until February 26 for any reason by calling (855) 229-6848. The new changes will take effect on the first day of the following month.
"Members are now better positioned to be successfully treated for the myriad of complex, co-occurring physical and psychological conditions, all of which are primary and contribute to high morbidity rates," said LDH Office of Behavioral Health Assistant Secretary Dr. Rochelle Head-Dunham. "Lives will be saved by this improvement to care coordination at the provider level."
While there is a level of additional complexity for some behavioral health providers, the Department has worked preemptively to alleviate their concerns by providing tools and work aids and simplifying administrative tasks.
A number of factors have played an important role in the Department's decision to integrate behavioral health into Medicaid. These factors have created an environment in which behavioral health can flourish in a managed care setting.
- The private behavioral health provider network has been greatly expanded and has matured.
- Providers now have experience in billing and following the authorization requirements of a managed care entity.
- The Bayou Health MCOs' have improved their abilities to execute care coordination.
- The state's ability to provide necessary monitoring and oversight has improved.
- All parties are positioned to place greater focus on behavioral health.
- Clinical support for members has increased.
- Commitment to transparency and improved outcomes has strengthened.
- Identifying and addressing co-occurring behavioral health needs has led to better management of physical health concerns (e.g. diabetes, hospital readmissions)
- Integrated claims data, access to synthesized information and the assumption of financial responsibility for all care has led to better management of behavioral health, including mental health needs and substance use care.
- The level of involvement between plans and members has been raised.
- Both LDH and MCOs can now exercise greater accountability for both physical and behavioral health outcomes.
In January, LDH hosted a series of workgroup meetings with its Integration Advisory Group composed of behavioral health providers, with participation across all provider types. The group was asked to provide recommendations to LDH on specific topics for integration that were factored into contract implementation with the Bayou Health plans. LDH lead several focus groups this summer that included both Medicaid members and providers to identify any concerns with the transition. The purpose of the sessions was to share information with providers and stakeholders and to receive their feedback. LDH's Medicaid office and Office of Behavioral Health (OBH) also provided informational meetings in nine regions, hosting 1,130 individuals throughout the state.
"While transitions of this scale always include details to be ironed out and issues to be corrected, we feel strongly about the work we have done to support the smooth, positive transition of services," said LDH Medicaid Director Ruth Kennedy. "For many this integration of behavioral health services has been a 30-year goal! After integration, we're going to continue to improve and refine the program."
A series of statewide integration summits, initiated in 2012 by LDH and hosted by local lead agencies, significantly contributed to behavioral health providers' preparedness for integration. Care coordination, communication and funding were identified as areas of concern. In September, LDH convened a culmination summit allowing prior participants the opportunity to interact with state partners and MCOs for up-to-date guidance and discuss any evolving areas of concern.
LDH also established a rapid response phone line for any questions regarding the integration beginning December 1. The line can be reached at (225) 219-4195 and will be open from 8:00 a.m. to 4:30 p.m. Monday through Friday. For more information on the integration and Medicaid please visit www.MakingMedicaidBetter.com.
The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. To learn more about LDH, visit www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's Twitter account and Facebook.