Making Medicaid Better Newsletter 3.4.2011

IN CASE YOU MISSED IT:

Louisiana Hospital Association, Louisiana State Medical Society, Metropolitan Hospital Council of New Orleans announce support of Coordinated Care Networks proposal

This week, Louisiana Hospital Association, Metropolitan Hospital Council of New Orleans and Louisiana State Medical Society announced their support for the state's proposal to implement Coordinated Care Networks in Medicaid, following recent, successful collaborations between the state and these groups to improve the proposal. The groups also announced they have formally withdrawn from the Coalition to Protect Louisiana Healthcare, which was formed to oppose the state's Making Medicaid Better initiative.

Joint Statement from Louisiana Hospital Association (LHA) President & CEO John Matessino and Metropolitan Hospital Council of New Orleans (MHCNO) CEO Paul Salles

"The LHA and MHCNO have, for the last few months, been working with a coalition of other healthcare providers to help affect some of the needed revisions to the program. Effective today, the LHA and MHCNO have resigned from the coalition, but remain fully committed to working with the Administration, DHH, other healthcare providers and the legislature to make the CCN program successful, not only for its member hospitals but also for physicians and other healthcare professionals.

Reform is necessary. The LHA and MHCNO will continue to work on behalf of its members and with all stakeholders, as healthcare in Louisiana is evolving on both the state and national scenes, to ensure access to care, to improve quality and to better manage Medicaid dollars through the implementation of CCNs."

Statement: Louisiana State Medical Society (LSMS) Supports Physician, Patient Choice in Revamp of Louisiana Medicaid Program

"After months of careful consideration and one-on-one deliberations with the Louisiana Department of Health and Hospitals (DHH), Louisiana State Medical Society (LSMS) announces its support of the enhanced Coordinated Care Networks (CCNs) plan to reform the state's Medicaid program, a program that serves our most vulnerable patients."

DHH Secretary Bruce D. Greenstein thanked all groups for their support, saying "This announcement marks significant progress in our efforts to transform the state's broken Medicaid program."

Please click here to see the statements of support from these and other groups, available at www.MakingMedicaidBetter.com.  

Louisiana Registered Nurses Support Coordinated Care Networks

Last week, the Louisiana State Nurses Association released a letter supporting the state's proposal to transform Medicaid through Coordinated Care Networks, as a framework to initiate reform of Louisiana's health care service delivery system.

In the letter, Louisiana State Nurses Association President Denise Danna thanked Department of Health and Hospitals Secretary Bruce D. Greenstein and his staff for meeting with the organization to outline the Coordinated Care Networks proposal, which would more effectively coordinate treatment and services for the majority of the state's Medicaid recipients, who today receive care through a strictly fee-for-service system.

Excerpt from Louisiana State Nurses Association (LSNA) Letter

"We understand resources are limited and health care needs are great. We join you in supporting the objectives of an effective reform program, anchored upon evidence-based disease management standards with measurable goals and outcomes. We support provider-demonstrated accountability for services. We acknowledge and support the need for expanded utilization of Information Technology in care delivery, data collection and outcome reporting. Creating an environment of coordinated care, including patient education, is consistent with nursing's goal of providing our patients with a spectrum of services, which can be tailored to meet the individual's health care needs. As we understand, the program will focus on enhancing preventive services and effective chronic care management.

We support Coordinated Care Networks as a framework to initiate a reformed system of care. We commit to you that we will continue to work with you and your staff to address any concerns as this framework develops.

LSNA looks forward to continued active participation in the future of Louisiana's health care to ensure access to affordable and high-quality health care for our citizens. We believe that this is an opportunity for nurses to participate in collaborative efforts with other members of the health care team to redesign and improve health systems."

A copy of the support letter is available online at www.MakingMedicaidBetter.com.

CCN Provider Recruitment Process

DHH advised potential CCNs they could begin contacting providers effective March 1, and the department has provided guidelines to both providers and potential CCNs for this process. Potential CCNs must get Letters of Intent from providers to demonstrate network adequacy in the competitive procurement process to administer care for Medicaid recipients. DHH provided all CCNs that expressed interest in submitting a proposal 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. The department will make this information available to providers and will post it online so providers can contact a potential CCN directly about participating in that network, 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 by June 24 for consideration. DHH expects the final rule for CCNs will be published in the Louisiana Register in early summer, and anticipates awarding CCN contracts in August. At this time, the state will give specific instructions on the contractual process and how to sign up to provide medical services within the networks. 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.   

DHH has also begun posting CCN development resources and materials related to the RFP process for reference at www.MakingMedicaidBetter.com. The site is updated frequently, and the public is advised to check here often for current details.

Featured Question

Why won't the elderly and people with developmental disabilities who receive Medicaid coverage be part of CCN implementation since these recipients usually have more medical needs and represent a large portion of costs in the Medicaid program?

When the state implements CCNs for Medicaid care, the first group of recipients enrolled, representing nearly 80 percent of all Louisiana Medicaid recipients, will be children under 21, their parents and pregnant women. Because CCNs place a stronger emphasis on preventive care and managing diseases than the current Medicaid fee-for-service program, coordinating care for this population will lead quickly to improved health outcomes, and can help these recipients avoid becoming sicker and needing advanced medical services later in their lives.

Louisiana is one of the few states not coordinating care for enrollees, and the CCN implementation next year represents the first step in the process. Because the elderly, people with developmental disabilities and other recipients who reside in long-term care facilities tend to have complex health care needs, the state will first implement CCNs for patients who can benefit most from preventive care and whose services are easier to coordinate. Through this initial implementation, the state will gain necessary experience administering a coordinated care program, then will refine it and make improvements if needed. Once the CCN infrastructure is in place, the state does plan to progress toward covering additional Medicaid recipients through CCN care, such as the elderly and people with developmental disabilities.

Even when the first groups of recipients enroll in CCNs, some medical services will be "carved out," meaning they will continue being paid through Medicaid fee-for-service. Carved-out services include specialized behavioral health treatment, pharmacy, dentistry, long-term care services and personal-care services. It is possible that some of these services will be phased in to the CCN model later, as the program progresses.

Updates for Providers

Provider Questions and Answers

Last week, DHH Medicaid Medical Director Dr. Rodney Wise and staff working on the state's CCN proposal held a series of conference calls with Medicaid doctors, nurse practitioners and other health care providers to discuss the plans for CCN implementation, outline the provider recruitment process that began March 1 and answer questions. Click here to see the questions asked during these calls, with answers. These are also posted on the "For Providers" page at www.MakingMedicaidBetter.com Providers who were unable to participate in last week's calls, or anyone who has additional questions, can submit these to coordinatedcarenetworks@la.gov, or can submit questions using the electronic form at www.MakingMedicaidBetter.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.