Friday, Nov. 19, 2010

Contact: Lisa R. Faust (225) 342-7913 or (225) 252-3579 (cell)

Louisiana Medicaid Announces New Enhanced Primary Care Case Management Program

Initiative will serve as 'bridge' to Medicaid reform, offer improved incentives to physicians

BATON ROUGE - Louisiana Medicaid will launch a revised Enhanced Primary Care Case Management (PCCM) Program on Jan. 1 to better connect payments to physicians who meet key indicators of effective health care management, Department of Health and Hospitals Secretary Bruce D. Greenstein announced today.

It was previously announced that the department's current PCCM program, CommunityCARE, would end as structured presently on Dec. 1 as part of reductions necessitated by a mid-year spending deficit in Medicaid. Under the new system announced today, CommunityCARE will now end Jan. 1, and the new Enhanced PCCM will begin at the same time.

"We want a case management program that can serve as a bridge from CommunityCARE to our more comprehensive Medicaid reform we're developing now. What is important to me was that we provide real incentives, accountability and rewards for health care providers to ensure that enhanced pay was tied to actual results, ensuring care coordination for children," Secretary Greenstein said. "We worked hard in the past several weeks directly with pediatricians to develop this payment system that meets those goals."

Under the revised PCCM:

• Medicaid children under age 21 will be linked to primary care physicians as they currently are in the CommunityCARE program. Children will remain linked to their current CommunityCARE physicians.    
• Children receiving Social Security Income (SSI) benefits will be included in the PCCM program and will be linked to primary care providers. Those children are not currently included in the CommunityCARE program. These children often are ones who present some of the most complex medical concerns and can benefit significantly from effective care coordination.
• Physicians will receive a flat rate of $1.50 per month for each child enrolled in Medicaid on their patient panels, and $3 per month for each SSI child.
• Physicians will have an opportunity to earn an additional rate of up to $3 per member per month for reaching certain health quality measures that gauge how well they are coordinating the care of their patients.
• The $1.50 per-member per-month rate will be paid out on a monthly basis, while the additional $3 per-member per-month payment for demonstrating care coordination will be paid out quarterly, allowing time for quality goals to be measured appropriately.

A group of pediatricians and other physicians is being brought to together to develop those quality measures, and the Department will begin working with SSI children and families to help them link up with primary care providers. Children currently enrolled in CommunityCARE will not have to make changes to their providers.

The revised PCCM will not apply to adults with Medicaid coverage. Louisiana Medicaid will be communicating directly with adult patients currently enrolled in CommunityCARE to let them know that the program will no longer be required for them. Physicians will no longer receive the $3 per-member per-month fee for seeing adult patients. No current CommunityCARE physicians were included in reductions to provider reimbursement rates announced last month.

"Working collaboratively with our providers, we are making great improvements to the state's care coordination effort and we know this revised PCCM will help us transitions effectively to a fully reformed Medicaid delivery system," Secretary Greenstein said.

The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog at www.myhealthla.org, Twitter at http://twitter.com/La_Health_Dept and search for the Louisiana Department of Health and Hospitals on Facebook.