BAYOU HEALTH Newsletter 3.6.2012

DHH Continues Daily BAYOU HEALTH Provider/Stakeholder Calls Monday through Friday from Noon to 1 p.m.

Providers can participate in daily BAYOU HEALTH calls to get more information about the program as it is implemented across the state. The toll-free number to call is 1-888-278-0296, and the Access Code is 729 9088#. It is not necessary to pre-register, and any interested provider can participate from noon to 1 p.m. on weekdays.

DHH staff begin each call with announcements related to BAYOU HEALTH implementation and then open the line for questions and comments. Questions and comments addressed on the call differ,  depending on whether providers have already implemented BAYOU HEALTH and are submitting claims to the Health Plans, or if providers are still in the contracting stages. Multiple provider types are represented on these calls, including employees from hospitals, physician's offices, Rural Health Clinics and DME providers. Any Medicaid provider is welcome to participate and have questions answered. If Medicaid staff are unable to answer your question on the call, they will follow up via email. Questions are usually answered within one business day.

Informational Bulletins (IBs) Available for BAYOU HEALTH Issues

The Medicaid staff members who are implementing BAYOU HEALTH have developed a series of numbered Informational Bulletins for providers and stakeholders, which answer frequently asked questions about the initiative and/or consolidate information from each of the five BAYOU HEALTH Plans into a single document.

These bulletins cover a range of topics, including member assignment to Health Plans and PCPs, newborn enrollment, arranging non-emergency medical transportation, Electronic Data Interchange (EDI) and continuity of care for pregnant women. The bulletins are available at www.MakingMedicaidBetter.com, through the tab "Informational Bulletins."

Medicaid staff will update the bulletins as needed, and any revisions will include the date of the revision. The staff are also adding new bulletins on a regular basis, based on requests for information and questions received. Providers are advised to check the site frequently to see the latest information.

If you have questions about BAYOU HEALTH, please email bayouhealth@la.gov, and the appropriate Medicaid staff member will respond. Typically, questions are answered within one business day.

DHH's BAYOU HEALTH website, www.MakingMedicaidBetter.com, contains abundant information about the program, including specific information for providers and recipients. This site is updated daily to provide the latest details on BAYOU HEALTH implementation.

BAYOU HEALTH Education and Outreach Events Taking Place in Second Area of the State to Transition

The next area of the state to implement BAYOU HEALTH, known as Geographic Service Area B, is beginning aggressive education and outreach efforts to Medicaid and LaCHIP recipients to help them prepare to choose a Health Plan.

GSA B includes the Capital Area, Acadiana and South Central Louisiana regions. The go-live date for GSA B is April 1. Eligible enrollees in these regions received their BAYOU HEALTH Enrollment Packets, which outline their Health Plan choices, in mid-February.

BAYOU HEALTH outreach staff are holding multiple Choose Health events to give enrollees an opportunity to meet with representatives of the Health Plans, speak in person with an enrollment specialist and select a Health Plan for their families. A schedule of GSA B enrollment events is available on www.MakingMedicaidBetter.com.  The deadline for choosing or changing Health Plans for an April 1, 2012 effective date is Wednesday, March 28 at 5 p.m. Central Daylight Time. Choices made after March 28 will have an effective date of May 1.

BAYOU HEALTH will be implemented statewide by June 1. Recipients who wish to select a Health Plan should call 1-855-BAYOU-4U (1-855-229-6848) to speak with an enrollment agent or use the automated voice cues to enroll in a plan, attend a Choose Health Meeting, enroll online at www.bayouhealth.com, or fill out the paper forms that come in the BAYOU HEALTH Enrollment Packet and mail or fax these back to the Enrollment Center.

For the past week, the average hold time for callers to 1-855-BAYOU-4U (1-855-229-6848) was 30 seconds to reach an English-speaking enrollment agent, and 50 seconds to reach a Spanish-speaking enrollment agent. The BAYOU HEALTH Enrollment Center issued a report on average call times for the past two weeks.

To date, more than 25,000 of the enrollees who live in GSA B have selected a Health Plan for themselves and their families. The breakdown among the five BAYOU HEALTH Plans thus far is:

• Amerigroup Louisiana, Inc. - 2,812
• Community Health Solutions - 4,207
• LaCare - 4,378
• Louisiana Healthcare Connections - 4,133
• UnitedHealthcare Community Plan - 9,421
• Optional BAYOU HEALTH enrollees who elected to remain on fee-for-service Medicaid -- 159

The BAYOU HEALTH staff have posted February enrollment reports online at www.MakingMedicaidBetter.com. Enrollment reports for March will be available by March 15.

UPDATE FOR RECIPIENTS:

FREQUENTLY ASKED QUESTION: What Happens if Recipients Move from GSA A to a GSA That Has Not Implemented BAYOU HEALTH Yet?

If a Medicaid recipient who lived in GSA A (New Orleans and Northshore areas) and was enrolled in a BAYOU HEALTH Plan moves to GSA B or C, which have not implemented BAYOU HEALTH yet, that recipient does not revert back to fee-for-service/legacy Medicaid. The recipient will remain in his/her BAYOU HEALTH Plan, and will receive services through BAYOU HEALTH in the new GSA. All five BAYOU HEALTH Plans have agreed to pay out-of-network costs at the Medicaid fee-for-service rate in effect on the day the service is performed to reimburse providers who treat recipients in this scenario. Also, if the recipient's BAYOU HEALTH Plan has already contracted with providers in the GSA where the recipient moved, the recipient is able to see those providers through the Health Plan. 

UPDATE FOR PROVIDERS:

Verify Provider Registry Information Listed with BAYOU HEALTH Plans

As BAYOU HEALTH is implemented statewide, each of the five Health Plans is submitting an electronic Provider Registry to DHH with key information regarding their network providers such as specialty, whether the provider is a PCP, parish, physical  address(es) of all practice locations for that provider and phone numbers. The accuracy and completeness of the information is critical, as it is used to populate the web-based interactive Provider Search on the enrollment website, www.bayouhealth.com, and is also used by BAYOU HEALTH Enrollment Agents to assist recipients in determining the Health Plans with which a provider is "in network." This is important because when choosing a Health Plan, many recipients want to enroll in one in which they can continue seeing their  current doctor.

The BAYOU HEALTH staff urges providers to check the accuracy and completeness of information by going to www.BayouHealth.com, clicking on  "Search for Provider" and reviewing their information listed. Please verify that this information is correct, as this will help your patients find you easily as they choose their BAYOU HEALTH Plans. If your information is not correct for any of the Plans, you are advised to contact that Health Plan and request an immediate correction.

Updates to the electronic Provider Registry are made weekly on Mondays, no later than early afternoon.

Providers who have trouble getting their information correctly listed with the BAYOU HEALTH Plans should report this to bayouhealth@la.gov so a Medicaid staff member can follow up appropriately.

Providers in GSA B and GSA C Can Begin Making Preparations Now Before BAYOU HEALTH Goes Live in Their Areas

Providers who practice in Geographic Service Areas B and C can begin  preparing for their go-live date by getting enrolled with any necessary login IDs  and  passwords for Health Plans' provider websites and  registering for EFT with those Plans with whom they have contracted under BAYOU HEALTH.

There are five BAYOU HEALTH Plans that will coordinate care for Medicaid recipients: Amerigroup Real Solutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and United Healthcare Community Plan. Three of the Health Plans - Amerigroup Real Solutions, LaCare and Louisiana Healthcare Connections - are prepaid Plans that operate as traditional MCO, capitated models. The other two Health Plans, Community Health Solutions and United Healthcare Community Plan, are shared savings Plans that operate as enhanced primary care case management models. Providers have the option to sign up with as many Health Plans as they wish, and they can remain Medicaid fee-for-service providers to treat their patients who are not included in BAYOU HEALTH.

As providers consider their Health Plan options, they should familiarize themselves with the contact information, payment processes and provider relations functions for each. BAYOU HEALTH will go live in GSA B (Capital area, Acadiana and South Central Louisiana) on April 1, and in GSA C (Southwest, Central and North Louisiana) on June 1. Providers will want to have the information for each Plan ready on that day so they can more easily contact the Health Plans in which their patients are enrolled and can promptly bill for services provided. A list of all Health Plans' contact information is available at www.MakingMedicaidBetter.com.

Once BAYOU HEALTH is implemented in a GSA, the check write dates for each of the five Health Plans will occur as follows:

• Monday and Wednesday: LaCare
• Tuesday and Friday: Amerigroup
• Tuesday night: Louisiana Healthcare Connections
• Tuesday night: Molina for legacy/fee-for-service Medicaid program, Community Health Solutions, United Healthcare Community Plan

Contact Us

BAYOU HEALTH is the State's new approach to delivering and financing health care for nearly 900,000 Medicaid and LaCHIP recipients. Under BAYOU HEALTH, DHH has contracted with five private Health Plans responsible for coordinating and managing the care of their members to improve health outcomes while controlling costs in the program.

For the latest information about BAYOU HEALTH, please visit www.MakingMedicaidBetter.com or the enrollment website, www.bayouhealth.com. To share your comments or ask questions, email bayouhealth@la.gov. Call toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance in picking a Health Plan.