Making Medicaid Better Newsletter 1.13.2012

Medicaid and LaCHIP Recipients Should Call 1-855-BAYOU-4U for Assistance with Health Plan Enrollment

Louisiana has begun implementing the new Medicaid service delivery model, known as BAYOU HEALTH, which will be fully implemented in all parishes by June 1. During this transition, many Medicaid and LaCHIP recipients likely will have additional questions about their options and what they need to do in selecting a Health Plan for their families. The state has established a hotline, 1-855-BAYOU-4U (1-855-229-6848), which recipients can call with questions related to BAYOU HEALTH. BAYOU HEALTH enrollment agents are available through the hotline to assist with questions about the five BAYOU HEALTH Plans, benefits and more in English or Spanish. The agents can also assist recipients with enrolling in one of the BAYOU HEALTH plans. Enrollees can also find answers to frequently asked questions online at www.bayouhealth.com.

Please note that 1-855-BAYOU-4U is specifically for BAYOU HEALTH and is separate from the main Medicaid hotline, 1-888-342-6207. Enrollees can call the Medicaid hotline with eligibility questions, to request a new card or for Medicaid services and programs that are not part of BAYOU HEALTH.

CommunityCARE Primary Care Physicians Can Assist with BAYOU HEALTH Outreach

Primary care providers (PCPs) enrolled in DHH's CommunityCARE program now have an opportunity to be part of outreach efforts for BAYOU HEALTH, to help patients who ask for assistance in enrolling with a Health Plan.

BAYOU HEALTH is a transformation of Louisiana's Medicaid program that will further improve and coordinate services for recipients, enabling them to make proactive choices about health care for themselves and their families. BAYOU HEALTH will be fully implemented during the first half of 2012, with the first group of enrollees, in the Greater New Orleans and Northshore areas, transitioning to this model of care effective Feb. 1. All eligible enrollees, close to 900,000 of the State's Medicaid recipients, are expected to be receiving care through BAYOU HEALTH by June 1.

DHH recognizes that patients often seek health care information from their trusted caregivers. For many Medicaid recipients, the PCP plays a critical role in continuity of care, and many recipients have approached (or will approach) their PCPs for assistance in enrolling in BAYOU HEALTH.

DHH has initiated a limited outreach campaign in which PCPs who currently participate in the CommunityCARE program can enter into a voluntary agreement with the department to assist their patients who specifically ask for help in completing and submitting a BAYOU HEALTH enrollment form. These forms will be submitted to the enrollment center, which is staffed by Maximus, the contracted Medicaid enrollment broker.

In order to voluntarily participate in BAYOU HEALTH outreach with DHH, PCPs must:

• Be an active CommunityCARE provider
• Be a participating provider in at least one BAYOU HEALTH plan (there are five Health Plans that are part of BAYOU HEALTH, and providers have the option to participate with as many as they wish)
• Have current Medicaid recipients linked to them (effective Jan. 1, 2012, CommunityCARE stopped making changes to linkages or making new linkages for recipients in GSA A, the first BAYOU HEALTH implementation area, to prepare for this change. Please see the memo for more information on this.)

PCPs who wish to volunteer to assist with outreach must register with DHH by completing the BAYOU HEALTH supplemental agreement to participate as an outreach site. Any outreach PCPs conduct must meet the terms of this agreement. PCPs should also note that there is a difference between outreach and marketing, and the marketing prohibitions listed in the BAYOU HEALTH contracts remain in effect. These prohibitions are also outlined in the supplemental agreement.

A CommunityCARE practice can complete the outreach agreement for the entire practice, designating an individual outreach liaison and having the agreement signed by someone who is authorized to do so for the entire practice.

CommunityCARE PCPs who have questions about participating with BAYOU HEALTH outreach to recipients should contact Damiane Ricks at (225) 342-7877 or damiane.ricks@la.gov.

Availability of BAYOU HEALTH Flier for Providers to Distribute to Their Patients to Indicate Health Plan Participation

The BAYOU HEALTH team has created a one-sheet flier that providers can use to identify the names of all the BAYOU HEALTH plans in which they will participate.  Providers can distribute  this flier to all their Medicaid patients. Providers can download the flier in color or black and white.

DHH Hosting Daily Medicaid Provider Q&A Calls Addressing BAYOU HEALTH Implementation

The Department of Health & Hospitals has scheduled a series of daily provider conference calls that will take place indefinitely Monday through Friday from noon until 1 p.m. with the exception of Wednesday, Jan. 18 through Friday, Jan. 20, when BAYOU HEALTH staff will not be available. The calls are open to all provider types on a first-come, first-served basis until all available lines are filled. Providers do not need to register in advance to participate.

The call-in line for each day is 1-888-278-0296. The access code is #7299088. Providers can use this information to call in at noon on weekdays if they wish to participate.

Medicaid staff directly involved with BAYOU HEALTH will be on the calls to answer your questions. The Medicaid staff will give a brief introduction and implementation update, but the bulk of each conference call will be devoted to provider questions and answers.

PLEASE NOTE: Provider Billing Changes to Take Effect on Feb. 1 for BAYOU HEALTH Members Who Live in GSA A

The first group of Medicaid and LaCHIP recipients will begin receiving services through BAYOU HEALTH Plans on Wednesday, Feb. 1. As part of this transition, prior authorization requests and claims for applicable Medicaid services for dates of service of 2/1 or after must be submitted to the member's BAYOU HEALTH Plan for processing, rather than to Molina (the Medicaid fiscal intermediary). Providers will be responsible for verifying a patient's Medicaid eligibility and enrollment status with that member's BAYOU HEALTH Plan before rendering services. Any services provided for Medicaid patients who are not enrolled in a BAYOU HEALTH Plan should still be submitted to Molina. Additionally, not all covered Medicaid services will be handled through BAYOU HEALTH. Some services, such as dental and pharmaceutical services, will continue being billed to Molina as fee for service. Please see the Medicaid flier on this billing change to find contact information for all five BAYOU HEALTH plans to verify recipient eligibility, as well as a list of services not included in BAYOU HEALTH that will continue being authorized and billed as they currently are.

Updates for Recipients

Enrollment in Health Plans continues for eligible recipients in Geographic Service Area A, which encompasses the Greater New Orleans and Northshore region parishes. These recipients will transition to BAYOU HEALTH effective Feb. 1. Medicaid staff and outreach organizations have scheduled numerous events to give participants a chance to learn about their available health options and what they need to consider when selecting a Health Plan for their families. See the outreach events calendar to find an activity close to you, or call 1-855-BAYOU-4U for enrollment assistance.

Contact Us

Call toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance in picking a health plan.

For the latest information or to share your comments about BAYOU HEALTH, please visit www.MakingMedicaidBetter.com or email bayouhealth@la.gov.