Making Medicaid Better Newsletter 7.22.2011

DHH Set to Announce Entities Recommended to Administer Coordinated Care Networks

On Monday, July 25, DHH will announce which entities have been recommended to form Coordinated Care Networks (CCN) to provide care for more than two-thirds of the State's Medicaid recipients. The formal announcement is expected by noon Monday.

DHH is using a competitive procurement process to select the CCNs, with a Request for Proposals issued April 11. Entities had to submit proposals by June 30 for consideration.

Medicaid will offer two types of CCNs, prepaid and shared savings, and will implement the networks within three Geographic Service Areas (GSA), enrolling recipients in phases throughout the state. Entities could propose networks for a specific GSA, or multiple areas.

Under the prepaid model, CCNs will receive a monthly fee for each enrollee covered to provide core benefits and services, with prior authorizations and claims payment handled directly through the entity. These networks also are responsible for establishing a robust provider network of primary care physicians, specialists, hospitals and other providers.

The CCN-Shared Savings is an enhanced Primary Care Case Management program that is responsible for coordinating the care of its members. The entity shares in the savings generated by improving health outcomes and reducing costs. In this model, providers will continue being paid on a fee-for-service basis by the state.

Eleven entities submitted proposals by the June 30 deadline to administer CCNs, with nine proposals for a prepaid network model and three proposals for a shared savings network (one entity submitted proposals for both models).

The following entities submitted proposals to be a CCN-Prepaid:

• Aetna Better Health Inc.
• Amerigroup Louisiana Inc.
• AmeriHealth Mercy of Louisiana Inc.
• Children's Hospital Health Plan Inc.
• Coventry Cares of Louisiana Inc.
• Louisiana Cares Health Plan LLC
• Louisiana Healthcare Connections Inc.
• United Healthcare of Louisiana Inc.
• Wellcare Health Plans Inc.

The following entities submitted proposals to be a CCN-Shared Savings:

• Community Health Solutions of America LLC
• LA Physicians Connections LLC
• United Healthcare of Louisiana Inc.

DHH used a consensus scoring process to thoroughly evaluate all proposals, beginning with a basic review, and used a team approach to examine five specific aspects of each proposal. The teams independently scored their specific areas, and then the five teams' scores were combined to form each proposal's total score.

DHH is working with the Division of Administration, which must approve the evaluation process used and the final contracts before the CCNs take effect.

Recipients in the first GSA, which covers the Greater New Orleans and Northshore areas, are scheduled to transition to the CCN model for care on Jan. 1, 2012. Recipients in the remaining two GSAs will begin CCN care after this in 60-day increments, with all eligible Medicaid recipients enrolled in CCNs by May 1, 2012.

Doctors and other medical providers will be able to sign contracts with as many CCNs as they wish, participate in both prepaid and shared-savings networks in their GSAs and remain Medicaid fee-for-service providers to treat their patients who are not part of the initial CCN implementation. Following Monday's CCN awards announcement, the networks will begin reaching out to providers to execute contracts for medical services.

Recipients will choose their CCNs from among those operating in the area where they live. Last week, DHH announced contract awards for an enrollment broker and an education and outreach campaign to assist eligible Medicaid recipients in selecting their CCNs.

For more information on Coordinated Care Networks, including updates on the process and a detailed overview of CCN implementation, please visit www.MakingMedicaidBetter.com.

Featured Question

How will providers be reimbursed if they provide services to a patient from a CCN-Prepaid  in which that provider doesn't participate?

It depends on the type of service(s) provided and why. Emergency services will be reimbursed  by the CCN-Prepaid  at the  published  Medicaid fee-for-service rate in effect the day the service is performed. Providers who treat patients outside of their networks for non-emergency needs could be reimbursed at up to 90 percent of the published Medicaid rate, but the amount of reimbursement will be determined by circumstances and type of treatment administered.

Providers should keep in mind that they can sign up with as many CCNs as they wish, and can participate in both shared savings and prepaid networks. Providers also will be enrolled with Medicaid to treat patients who will not transition to the CCN model. This is important because while two-thirds of Louisiana Medicaid recipients will enroll with CCNs for their care, other recipients are not part of the initial CCN implementation and will remain on the current, strictly fee-for-service system.

Providers should refer to the "For Health Care Providers" section of the website www.MakingMedicaidBetter.com to see the requirements both CCN models must include in their contracts.

Updates for Providers

Coordinated Care Network Resource Guide for Providers

DHH has issued a Coordinated Care Network Resource Guide for Providers, available online at www.MakingMedicaidBetter.com. This downloadable and printable guide, which can be accessed directly here, was created to address the most common questions providers have expressed about CCN implementation. Please review the guide, and visit www.MakingMedicaidBetter.com frequently to see the latest information and updates on this transformation of the Medicaid program.  

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.