LBHP Integration - Provider FAQs

We’ve long known that our ultimate goal was the integration of behavioral and acute care services once the systems in place had matured. We began working on the next phase of both Bayou Health and the LBHP well over a year ago. Since then, we’ve continued to look at the best practices across the country and the capabilities of our contracted partners. As a result, the Louisiana Department of Health and Hospitals will be integrating all specialized behavioral health care services into its Medicaid Managed Care program known as Bayou Health. Beginning Dec. 1, 2015 most patients who previously accessed care through Magellan (also known as the Louisiana Behavioral Health Partnership) will now get their specialized behavioral health care directly from their Bayou Health Plan. If they do not currently have a Bayou Health Plan, they will be given the opportunity to choose one prior to integration. Magellan will continue to manage a small group of children identified with a high level of risk of out of home placement that are referred to the Coordinated System of Care program (CSoC) for their specialized behavioral health and other wrap around support services.

Providers will continue to bill Magellan for specialized behavioral services for dates of service through 11/30/2015 and should maintain their contractual agreements through this period. Beginning 12/1/15, the SMO contract with Magellan will terminate for all but the CSoC population, and claims will then be submitted to the respective member’s Bayou Health Plan for all Medicaid services. With the exception of CSoC services, authorizations, reimbursement, and all other managed care functionality for Medicaid services will flow through Bayou Health effective 12/1/15. Between now and Dec. 1, there are no changes to patient’s benefits or how they get care.

All five of our health plans that have been awarded contracts have extensive experience managing specialized behavioral health services in their other plans across the country. Each of these plans has an affiliated company as part of their corporate parent, meaning services will be truly integrated and coordinated and not subcontracted out to a third party plan. We are very confident in their ability to administer these services and continue to build out the provider network, and will be working over the next year to ensure that they are prepared on day one.

There are no savings budgeted or anticipated from this transition. However, we know that nationally, four of the top 10 reasons for hospital readmissions are behavioral health/substance use related according to the Centers for Medicare & Medicaid Services (CMS). By integrating behavioral health services, one entity will be contractually and financially responsible for the provision of both behavioral health and acute care services. This creates a strong incentive for plans to invest in expanding less costly community based treatment services to promote adherence to treatment protocols and help avoid costly emergency room (ER) visits and inpatient admissions. Therefore, in the long-term, we actually would expect to see spending on behavioral services increase, even if overall spending declines due to avoided ER or hospital costs.

Yes, new contracts must be developed and all reimbursement rates renegotiated. Current contracts with Magellan do not transition to Bayou Health. All Magellan contracted providers in good standing with Medicaid will be considered by the Bayou Health Plans for inclusion in their networks with an effective date of 12/1/15. Until then, providers will continue to remain contracted with Magellan. The Department intends to include in its contracts with the Bayou Health plans specific continuity of care requirements, developed with input from stakeholders, to ensure no interruption in care for Medicaid enrollees. As a provider, it is important to let your patients know what Bayou Health Plans you are accepting.

Yes, however, the Office of Behavioral Health has expedited the recertification process, holding it from May 1, 2015, through June 30, 2015.  More information on this process can be found in the Bayou Health Informational Bulletin 15-8 here: http://new.dhh.louisiana.gov/assets/docs/BayouHealth/Informational_Bulletins/IB15-08.pdfhttp://new.dhh.louisiana.gov/assets/docs/BayouHealth/Informational_Bulletins/IB15-08.pdf">http://new.dhh.louisiana.gov/assets/docs/BayouHealth/Informational_Bulletins/IB15-08.pdf>.http://new.dhh.louisiana.gov/assets/docs/BehavioralHealth/LBHP/Carve-In/LBHPTransition-ProviderContractingInfo_MCOs.pdf

As per the Bayou Health RFP, Section 14.5.5, the Bayou Health Plans shall completely process credentialing applications from all provider types within sixty (60) calendar days of receipt of a completed credentialing application, including all necessary documentation and attachments, and a signed provider agreement.  In order to streamline this process, OBH and Medicaid are exploring options with CAQH as a repository of primary source documents for the Bayou Health plans to access for credentialing individual providers (this is not applicable to organizations/agencies).

To learn more about credentialing requirements for each Bayou Health plan, please contract their network liaison at the following contact information:

The Office of Behavioral Health (OBH) issued a Request for Information (RFI) in February to solicit interest in the administrative management of this population.  Based on these responses, recenetly received in March of 2015, OBH issued a Request for Proposals (RFP) to solicit bids from potential contractors on Aug. 28, 2015. Please visit the following link to check for the RFP posting: http://new.dhh.louisiana.gov/index.cfm/newsroom/category/47

No. Upon carve-in to Bayou Health on 12/1/15, Clinical Advisor will terminate as the electronic health record for specialized behavioral health services since this is a proprietary system owned by Magellan. However, the Department is reviewing its contractual requirements for health plan capacity for receipt of electronic claims and prior authorization requests. At this time, the Department recommends that all providers begin investigating the purchase of an individual electronic health record system, or in lieu of purchasing a new system, begin researching and practicing using paper billing prior to 12/1/2015 in order to adjust to any difficulties that may arise with billing and claims submission via a new system through transition.

A patient’s eligibility can be verified in the same manner it is today, using the Web, phone and swipe card options in the eligibility verification system operated by Molina. This is considered the “source of truth” for eligibility. A member may have a Bayou Health Plan ID card, but it is possible for a member to be enrolled in a Plan different from the card they have on hand, so the Molina system is always recommended.  If a provider is not currently enrolled with Molina, as this was not an LBHP requirement, the provider will be assigned a unique provider ID to access the Molina system (MEVS).  MEVS can be accessed by any of these methods:

• Emdeon Business Services
• HealthNet Data Link
• Healthcare Data Exchange, Passport Health
• Communications and Dorado Systems LLC

The Bayou Health Plans will be trained on the level of prior authorization required as per the Louisiana Behavioral Health Partnership (LBHP) Services Definition Manual and will give further guidance and education to providers as this continues to develop.

The Department will consider the current LBHP Medicaid State Plan amendments and waivers and the LBHP service definitions manual to build a comprehensive and robust behavioral health care benefit package within Bayou Health. The Department will be working with key stakeholders and through this advisory group, will assess any changes that may need to be made. Notification of any changes in benefits upon transition will be communicated to the providers and members through Magellan, the Bayou Health Plans, the Department and informational bulletins.

It is the intent of the Department to address mixed service protocol concerns by eliminating payment based on diagnosis and switching to a provider based protocol. Moving forward, services will be reimbursed based on provider type. Magellan will be responsible for reimbursement of services provided or ordered by psychiatrists and LMHPs only (including in an FQHC setting). Magellan will also remain responsible for services by providers in a distinct part psych unit or psychiatric hospital emergency department. The effective date of this change is expected in February/March of 2015. Upon carve-in, Bayou Health will be the responsible payor for all physical and behavioral health Medicaid services.

Yes, new providers continue to contract within the LBHP through Magellan; however, Magellan will no longer accept new provider contracting and credentialing applications after May 31, 2015.  After May 31^st, new providers will be directed to the Bayou Health plans in preparation of the behavioral health integration beginning December 1, 2015.  If you are a provider interested in joining the LBHP network, Magellan needs to hear from you very soon! 

• A potential provider will need to ensure they are certified through OBH before credentialing with Magellan for LBHP provider network consideration.
• Only a complete Credentialing Application can be considered (must be complete in its entirety and include all necessary documentation).
• Visit Become a Provider for step-by-step instructions and contacts for contracting and credentialing.

Today, Magellan manages the LBHP, and will continue in this role until the state's scheduled integration on December 1, 2015.

Clinical Advisor, powered by ClaimTrak, is a proprietary electronic health record system that Magellan offered LBHP providers to help ease the transition to Managed Care in Louisiana and meet some unique needs for the state.  With Magellan transitioning out of the role of Statewide Management Organization (SMO), Clinical Advisor (CA) will be decommissioned December 1, 2015.  Several key considerations providers should be aware of include: 

• Magellan and OBH are working very closely together to work out transition steps and benchmarks for the decommissioning process over the coming months, including data transfer protocols for existing data in CA and claims run-out procedures among several other pieces.
• While CA will be decommissioned December 1, 2015, claims billing/processing functions will remain active through February 29, 2016, for dates of service prior to December 1, 2015. The state and Bayou Health plans will not offer a replacement EHR, so providers will need to decide what kind of system is needed to meet their individual practice management, clinical, reporting and billing needs.
• Providers should begin now evaluating their individual practice needs, understanding that, under the Bayou Health plans, providers will need to bill each plan they are contracted with separately.
• DHH will be hosting an EHR vendor fair for providers to speak with vendors regarding their EHR needs on May 21, 2015 in the Bienville Building located downtown Baton Rouge at 628 North 4^th Street. Providers can RSVP for this event to Jackson Carney at 225-342-9814 or Jackson.Carney@LA.gov.

Please note that nothing is changing for providers using CA today.  Magellan and OBH are meeting to work through a seamless and appropriate transition off of CA.  Additional information will be shared as the transition steps are finalized.

Verity HealthNet is a provider network utilized by some of the Bayou Health plans to assist providers with enrollment.  Providers also have the option to go to each Bayou Health plan separately and obtain a direct contract without utilizing Verity's services.

Louisiana Healthcare Connections (LHCC) does have a network rental arrangement with Verity HealthNet for all provider types; however, contracting through them is not required. LHCC does contract directly with providers when possible.

Aetna Better Health of Louisiana is contracted with Verity HealthNet.  Verity HealthNet contracts with interested providers for the provision of Covered Services for Aetna Better Health of Louisiana members.  It is Aetna Better Health of Louisiana’s intent that behavioral health providers currently contracted with Verity HealthNet will provide behavioral health services to members.  The agreement between Aetna Better Health of Louisiana and Verity HealthNet is not exclusive and providers are free to contract directly with Aetna Better Health of Louisiana.

AmeriHealth Caritas Louisiana (ACLA) is developing contractual relationships directly with specialized Behavioral Health providers and not using a subcontractor (such as Verity) for provider relationship development and contracting.  However, ACLA does have a contractual relationship with Verity HealthNet as it relates to Baton Rouge General and its affiliate provider groups only, for both the Bayou Health physical and behavioral health benefits. 

UnitedHealthcare and Amerigroup are not using Verity HealthNet to contract with behavioral health providers.

If your patients ask, you can let them know that, as of now, there is no change to their care. Medicaid patients will receive a letter from Bayou Health as part of the annual “Open Enrollment” process. During Open Enrollment individuals have sixty days to choose the Bayou Health Plan that is right for them. The mailings are staggered and begin on Aug. 24. Open Enrollment ends Nov. 6.

• For enrollees who do not currently have a Bayou Health Plan, the letter will ask them to select one. If they do not proactively choose a plan, one will be chosen for them.
• For enrollees that do currently have a Bayou Health Plan, the letter will explain how to change to another Health Plan if they wish to do so. If they do not proactively change plans, they will remain with their current plan.

As a provider, it is important to let your patients know what Bayou Health Plans you are accepting. There are limitations on what you can tell a member – when you enroll with a Bayou Health Plan, your provider services representative should explain these to you. In general, you can inform members of the Plans you accept and the benefits, services and specialty care offered, but you cannot recommend one MCO over the other or incentivize a patient to select one Health Plan over the other. You can also reference Informational Bulletin 12-31, found at www.MakingMedicaidBetter.com, for additional details on communications with your members.

DHH launched the Integrated Health Care webpage dedicated to the transition of the Louisiana Behavioral Health Partnership into Bayou Health. This webpage is continuously updated with transition related information, including Frequently Asked Questions.

You can access the integrated health care page through www.MakingMedicaidBetter.com. Click on the "Behavioral Health" tab.

You can direct questions to DHH as well through this e-mail account: integratedhealthcare@la.gov or bayouhealth@la.gov.

You can review the Informational Bulletins at www.MakingMedicaidBetter.com for the latest integration details, or you can sign up to have these delivered direct to your inbox through the "Subscribe" tab on the right hand side of the home page at www.MakingMedicaidBetter.com. Select "Bayou Health" to get only Bayou Health information, that includes Informational Bulletin updates. Select "All Department News" to get information on all DHH programs.

You may also speak directly with your provider relations contact with your Bayou Health plan. All claims or provider enrollment questions should be directed to the Health Plan.

DHH is submitting requests to CMS to retire the 1915(i) and move those services into the regular and rehabilitation sections of our state plan amendment. Current state plan amendment and contract language includes requirements that the LOCUS tool continue to be used for members seeking rehabilitation services (i.e., CPST, PSR, Crisis Intervention and ACT). However, future/proposed language will no longer require that assessments for such services be independent. Bayou Health Plans will have some flexibility and discretion in this matter. With proposed changes and the retirement of the 1915i, CMS would no longer require independent assessments, plans of care or treatment plans for covered services performed by licensed practitioners.

DHH requires that the following behavioral health provider types be accredited:

• Providers of mental health rehabilitation services, i.e. Community Psychiatric Support and Treatment (CPST), Psychosocial Rehabilitation (PSR) and Crisis Intervention (CI);
• Providers of Assertive Community Treatment (ACT);
• Psychiatric Residential Treatment Facilities (PRTFs);
• Therapeutic Group Homes (TGHs);
• Residential addiction treatment facilities.

DHH approved national accreditation organizations include:

• The Council on Accreditation (COA);
• The Commission on Accreditation of Rehabilitation Facilities (CARF);
• The Joint Commission (TJC).

Site visits by the Bayou Health Plans are not an alternative to accreditation.