Making Medicaid Better Newsletter 2.23.2011

IN CASE YOU MISSED IT:

DHH Secretary Welcomes Blueprint Louisiana's Support to Reform the State's Medicaid Program

Last week, DHH Secretary Bruce D. Greenstein welcomed an endorsement from Blueprint Louisiana to transform Medicaid by implementing a system of coordinated care. In unveiling its recommendations for next fiscal year at Baton Rouge Press Club Feb. 14, Blueprint Louisiana urged the adoption of a coordinated care system as proposed by the Department for implementation next year.  The Making Medicaid Better initiative transforms Medicaid by moving away from a pure fee-for-service system to a system of networks charged with coordinating the care of enrollees and ensuring access to care. 

Blueprint Louisiana Chairman Bill Fenstermaker noted: "Coordinated care will provide both savings to taxpayers and better outcomes to Louisiana's most vulnerable population.  Secretary Greenstein, his staff, health care providers and consumer advocates across the state have worked hard to share ideas and feedback to create the best proposal for Louisiana. A sense of urgency should guide the state and providers as they work together to implement a managed care system this fiscal year that benefits taxpayers and patients."

In its recommendation, the group noted the state's recent ranking of 49^th in the United Health Foundation America's Health Rankings Report, and advised that CCNs would emphasize preventive care and could help the state improve its standing in critical areas such as obesity, infant mortality and avoidable hospitalizations. In addition to increasing Medicaid recipients' quality of life, the group noted that coordinated care would reduce state costs to support the health care delivery system.

Secretary Greenstein concurred with Blueprint Louisiana's sense of urgency toward implementing coordinated care, and expressed his appreciation for the organization's acknowledgement that the state's health care delivery system must change.

"We have repeatedly said that we must favor quality over quantity, value over volume in our Medicaid system. These are common sense principles, many of which you find in the business world. That's why I am so proud that this group of the state's top business leaders from every sector, including health care, is supporting this effort as a priority for our state moving forward," Greenstein said. "Louisiana has languished in national health indicators for far too long, and we all want to change this dismal outlook. I thank Blueprint Louisiana for joining us, and I look forward to further engaging with them and other groups as we transform Medicaid in Louisiana."

Blueprint Louisiana is a community-focused, nonprofit organization of civic leaders and others who identify and recommend changes that will make Louisiana a better place to live and work. Blueprint Louisiana looks specifically at government-level reforms in several areas, one of which is health care. For more information on Blueprint Louisiana, please visit http://blueprintlouisiana.org. 

IN CASE YOU MISSED IT:

Louisiana Ambulance Alliance Issues Statement on State's Medicaid Reform Efforts

Today, the Louisiana Ambulance Alliance issued a statement from its board president supporting the state's efforts to better coordinate care for Medicaid recipients.

Statement from Louisiana Ambulance Alliance Board President Gary Peters on Transforming Medicaid System in Louisiana

"As major participants in Louisiana's health care system and providers of emergency medical transportation and services, our board and members are optimistic about the progress of health care in our state. Over the past few months, Secretary Greenstein has engaged stakeholders in a transparent and productive dialogue all across Louisiana about our challenges and solutions that require our collaboration and collective agreement.

We all agree that healthcare must be managed for the citizens of Louisiana and we can no longer wait for this to happen. We as providers, our Governor, our DHH Secretary and consumer and civic groups are ready to do something different in health care in Louisiana. We've had a productive discussion, our concerns were shared, and we now feel confident that the proposal effectively protects both consumers and ambulance service providers and creates a better system focused on improving health outcomes. Further, we are positive that the Secretary will continue to work closely with all constituents during his tenure as the health care leader of our state.

Our tremendous progress to date has motivated our board and members to formally withdraw its opposition to the Administration's Medicaid revamp. We support the efforts of Secretary Greenstein and the Department to coordinate care within the state of Louisiana and his commitment to continue to engage in a meaningful dialogue with the health care community. We are ready to move forward and are thankful the Secretary's actions have matched his words in addressing our issues as an EMS community. We are eager to continue working with the Administration, the DHH team and the health care community to find best practices in the Medicaid program to ensure access to care, to improve quality and to better manage Medicaid dollars-all while preserving the critical service we provide to Louisiana's residents."

DHH Secretary Bruce D. Greenstein thanked Louisiana Ambulance Alliance for this support, and emphasized the need for continued collaboration with their membership and other health care stakeholders as the state progresses toward a historic transformation of the Medicaid program.

Statement from DHH Secretary Bruce Greenstein

"As we strive to accomplish in all our efforts, the DHH team and I have made it a priority to constructively engage with Louisiana's ambulances and emergency medical services providers in how we improve health in our state. If we are going to take Louisiana's health care system firmly into the 21st century, we must do it together, and I'm pleased we are making that evolution with the LAA. We are glad health care providers shared their concerns with us, which resulted in many changes to Louisiana's Coordinated Care Networks plan. Continued collaboration with the LAA and our state's providers is a cornerstone of how we fundamentally transform our health care system, improve health outcomes and responsibly invest taxpayer dollars.

I would like to thank LAA board president Gary Peters, CEO Donna Newchurch and the LAA membership for asking the difficult questions on how we transform our health care system, moving forward with us, supporting CCNs and continuing our partnership."

Notice of Intent and Provider Recruitment Process

The state's Notice of Intent, which serves as the proposed rule for implementing the CCN model, was published in the Louisiana Register Sunday, Feb. 20, enacting a public comment period on the rule. DHH plans to hold meetings to discuss the CCN proposal, including a public hearing on March 30 at the Bienville Building in downtown Baton Rouge.

DHH has advised potential CCNs they can begin contacting providers March 1, and the department has provided guidelines to both providers and potential CCNs for this process. Potential CCNs will need to get Letters of Intent from providers to demonstrate network adequacy in the competitive procurement process to administer care for Medicaid recipients. This week, DHH held a series of provider-focused conference calls to give information about what to expect. DHH is also providing all prospective CCNs that expressed interest in participating with a standard Letter of Intent to use in recruiting providers, and gave copies of this letter to providers for reference. DHH will ask prospective CCNs to send letters stating their intent to propose a network, including contact information for each entity, and will make this information available to providers and will post it online so providers can contact a potential CCN directly, if they choose.

The state anticipates issuing the Request for Proposals to solicit CCNs on April 11, and prospective CCNs would have to submit their proposals in June for consideration. DHH expects the final rule for CCNs will be published in Louisiana Register in early summer, and anticipates awarding CCN contracts in August. At this time, recipients are expected to enroll with CCNs in three regional phases, with the first recipients enrolled for service effective Jan. 1, 2012, and all eligible Medicaid recipients enrolled in a CCN by May 1, 2012.   

Visitors to www.MakingMedicaidBetter.com can see the Notice of Intent and related information, including a fact sheet outlining improvements made to the Notice of Intent from the draft version presented at the Health & Welfare Committee hearings in January, the proposed timeline for CCN implementation, regions for different phases of CCN go-live implementation and other materials. DHH has also begun posting CCN development resources and materials related to the RFP process for reference. The site is updated frequently, and the public is advised to check here often for current details.

Featured Question

Can prospective CCNs require providers to pay a fee to sign up with them?

No, they cannot. No provider has to pay to participate in a CCN and treat Medicaid recipients. Starting March 1, prospective CCNs can begin recruiting providers, using a standard Letter of Intent DHH wrote and issued. This Letter of Intent is non-binding and is NOT a contract; providers are not obligated to actually sign up with the network, should that CCN be successful in receiving a contract to administer care for Louisiana Medicaid recipients. Providers also do not have to pay a fee when signing a Letter of Intent, and will not have to pay a fee to join a network when CCNs are selected. When the final CCNs are selected, DHH will issue specific guidelines to providers on the contractual process. During the recruitment phase, providers can sign Letters of Intent with as many CCNs as they wish, and can remain fee-for-service Medicaid providers now and when CCNs are in place for Medicaid recipients. This is important because while most Medicaid recipients will transition to CCNs, some will remain fee-for-service. DHH has issued providers a letter outlining how CCNs must represent themselves during the recruitment process. This letter, along with minimal terms and conditions any CCN would have to include in an agreement with a provider and the Letter of Intent CCNs must use to recruit providers, are available at www.MakingMedicaidBetter.com. Please report any suspected abuse of the recruitment process to DHH immediately.

Clarification

Please see the following clarification to the question from last week's newsletter, regarding ER treatment requirements.

For emergency services providers, there are legal guidelines in place to assist in encouraging proper use of ER services among patients. Medicaid requires that all medically necessary services are provided. But, ER staff are not mandated under federal or state law to provide emergency care to treat individuals who come to the ER with non-emergent medical conditions. Federal law requires an appropriate medical screening for everyone who presents to the ER. But, stabilization is only required when an emergent condition is identified.

Updates for Providers

DHH Secretary Announces Appointments to CommunityCARE 2.0 Quality Committee

DHH Secretary Bruce D. Greenstein announced appointments to the recently created CommunityCARE 2.0 Quality Committee, which was established after DHH worked with a group of providers and stakeholders to revamp CommunityCARE, DHH's program linking Medicaid recipients to a primary care physician who acts as their medical home. The revised program, called "CommunityCARE 2.0," includes mechanisms for physicians to earn bonus payments if they meet certain performance measures, which will be established and have metrics reviewed by the CommunityCARE Quality Committee

This 15-member committee is appointed by the DHH Secretary, and membership includes representatives of providers, stakeholders and departmental staff to advise the Secretary concerning health care quality, ongoing quality improvement opportunities, and recommendations for changes in the distribution of the pay-for-performance pool as appropriate. The committee also includes the chairs of both the Senate and House Health & Welfare committees, or their designees.

The Committee will be chaired by the Medicaid Medical Director, Dr. Rodney Wise, and staffed by the Department.  The Committee will meet at a minimum the first month of each quarter, and will meet more often as deemed necessary by the Secretary. A full list of committee members and details of the CommunityCARE 2.0 program, including additional information on pay-for-performance measures and rates, can be found at www.la-communitycare.com.

CommunityCARE 2.0 Immunization Pay-for-Performance Program

DHH issued information to providers about the Medicaid Immunization Pay-for-Performance (P4P) Program, which rewards primary care providers whose pediatric Medicaid patients adhere to a specific immunization schedule recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics. Physicians can achieve supplemental rates for this in the CommunityCARE 2.0 program. The rate schedule and calculation methods are available online at www.la-communitycare.com.

To address some concerns raised by providers participating in the Medicaid P4P program, effective February 1, 2011 an enhancement was made to match immunization records based on the Medicaid ID number the PCP entered into the Louisiana Immunization Network for Kids Statewide (LINKS) system, which affects how P4P rates are determined.  The LINKS system already has the ability to accept the Medicaid ID number when a provider updates a child's immunization record or demographic information.  By providing an additional opportunity to match a child's LINKS record to Medicaid, DHH believes this will address the concerns of the providers and more accurately reflect the number of children who are actually up to date on the immunizations counted in the P4P calculations.

Providers can contact Molina Provider Relations at (800) 473- 2783 or (225) 924-5040 for any additional questions, and can learn more about CommunityCARE 2.0 and the P4P rates at http://www.la-communitycare.com.

Louisiana Medicaid EHR Incentive Program

The Louisiana Medicaid EHR Incentive Program, which opened registration in January 2011, is offering payments to eligible providers and hospitals who treat Medicaid patients and wish to adopt this technology so they can better coordinate care. Program registration is open, and providers can learn more or sign up for the program at www.MakingMedicaidBetter.com.

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.