BAYOU HEALTH Newsletter 5.25.2012

Medicaid and LaCHIP Recipients in Southwest, Central and North Louisiana Have Until May 29 to Select a Health Plan for June 1 Go-Live Date

Eligible Medicaid and LaCHIP recipients in Geographic Service Area C, the last part of the state to transition to BAYOU HEALTH, who have not yet selected a Health Plan have until Tuesday, May 29 at 5 p.m. Central Daylight Time to choose a Health Plan and be enrolled in that Plan effective for the go-live date of June 1.

Recipients can call 1-855-BAYOU-4U and have an enrollment specialist assist them in finding the plan that is a good fit or follow the automated phone cues to select a Plan, 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.

As of this week, 32 percent of eligible recipients in GSA C have selected their own BAYOU HEALTH Plan. BAYOU HEALTH outreach staff held multiple Choose Health events in GSA C throughout the past month 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.

This week, the BAYOU HEALTH Enrollment Center finished auto-enrolling eligible recipients in GSA C who did not select a Plan so they will be in a BAYOU HEALTH Plan effective June 1. Recipients who were auto-assigned can still choose their own Health Plans as long as they make a choice by May 29. Recipients who select a different Health Plan after May 29 will have an effective start date of July 1, and will be in the original Plan they selected or were auto assigned to for the first month of BAYOU HEALTH in their area.

When recipients are enrolled in a Health Plan, either by choice or through auto-assignment, they receive a welcome letter from the Plan to which they are assigned, including information about the services and benefits available through that Plan. Recipients have 90 days from the date on their welcome letters to contact the BAYOU HEALTH staff and select another Health Plan.

After the 90-day enrollment period, recipients can change Plans at any time if they have a good reason for doing so, such as moving to a different area of the state or their doctor leaving their Health Plan's network.

When GSA C goes live on June 1, BAYOU HEALTH will be fully implemented statewide.

Some Waiver Recipients Will Transition to BAYOU HEALTH July 1

Effective July 1, 2012, some Medicaid home and community-based waiver recipients will transition to BAYOU HEALTH. These recipients were not included in the initial rollout, but many wanted to participate in BAYOU HEALTH to have the benefit of being part of a network that can provide increased access to and coordination of primary and specialty care, and will be added in this second phase. It is important to note that this transition does not change the waiver services these recipients are getting now, and it does not change their waiver eligibility status.

The home and community-based waiver recipients who will be part of BAYOU HEALTH are those who are not also receiving Medicare or enrolled in LaHIPP, in which Medicaid pays a premium for private insurance coverage. Medicaid recipients who live in a nursing home or other long-term care facility, are in the PACE program, are in TAKE CHARGE (Family Planning waiver) or are ages 3 to 21 on the waiting list for waiver services and do not already receive Medicaid fee-for-service coverage are still excluded from BAYOU HEALTH and will remain in legacy Medicaid. The waiver recipients transitioning to BAYOU HEALTH include those who were linked to a primary care provider in the previous CommunityCARE program.

Waiver recipients will have only their primary and acute medical services, e.g. doctor visits, X-rays, home health services, lab work, home health, hospital services coordinated through BAYOU HEALTH (all services that are mandatory services of BAYOU HEALTH and covered for other recipients). Personal care services, caregiver respite services or other waiver-specific services they receive as part of their waiver eligibility that are not offered to other recipients through BAYOU HEALTH will be paid and provided through the fee-for-service program.

Providers should note durable medical equipment, e.g. wheelchairs, is a covered benefit for the three prepaid model BAYOU HEALTH Plans - Amerigroup, LaCare and Louisiana Healthcare Connections. Recipients in the two shared-savings Plans, Community Health Solutions and United Healthcare, will still receive durable medical equipment through fee-for-service Medicaid.

Eligible waiver recipients older than 19 will be mandatory BAYOU HEALTH participants as of July 1. Recipients younger than 19 are voluntary, and their parents can choose whether it is better for the child to remain on fee-for-service (legacy) Medicaid or be in BAYOU HEALTH. Those who wish to be in BAYOU HEALTH will have an opportunity to select a Health Plan. Recipients who do not select a Health Plan will be auto-assigned to one. If a recipient does not notify BAYOU HEALTH that he/she wishes to remain on fee-for-service Medicaid, that recipient will be auto-assigned to a Health Plan. Recipients are encouraged to notify BAYOU HEALTH of their choice regardless of whether it is to enroll in a Plan or remain on fee-for-service.

Eligible waiver recipients will receive their Enrollment Kits and Health Plan choice letters in late May. They will then have until the last week of June to select a Health Plan. As with other groups of enrollees, they will have 90 days from the time they select a Health Plan or are auto-assigned to one to change Plans.

DHH estimates there are approximately 7,200 Medicaid home and community-based waiver recipients statewide who will be eligible to join BAYOU HEALTH in this next phase of implementation (though many of these recipients are voluntary and can elect to remain in legacy Medicaid).

Providers are encouraged to let Medicaid waiver services recipients they treat know which BAYOU HEALTH Plans they participate with using the flier provided. Providers can download the flier in color or black and white. Providers can also emphasize to Medicaid patients that they will remain a Medicaid fee-for-service provider to treat patients who may not be transitioning to BAYOU HEALTH.

Recipients can call 1-855-BAYOU-4U or visit the enrollment website, www.bayouhealth.com, to get more information or pick a Plan.

FOR PROVIDERS

Providers Should Verify Information Listed in BAYOU HEALTH Plan Directories

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 doctors.

Following the initial implementation of BAYOU HEALTH, as new Medicaid and LaCHIP recipients enroll, they will view this information to choose a Health Plan. Waiver recipients who are transitioning to BAYOU HEALTH on July 1 will also view this information, as well as recipients in GSA C who want to change Plans within their 90-day windows.

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.

While printed copies of each Plan's Provider Registry are available through the Enrollment Broker, the most up-to-date information for a Plan's network providers is available in the electronic listing.

Providers who know there is incorrect information listed for them or their practice in a Health Plan's registry should bring this to that Health Plan's attention immediately. Please review the recent Informational Bulletin that BAYOU HEALTH issued on the Provider Registry for information about how to report data errors.

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

Providers are reminded that they can tell their Medicaid patients which BAYOU HEALTH Plans they will accept so Medicaid recipients can use this information in picking their Plans. 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.

Resources Available to Assist Providers During BAYOU HEALTH Transition

DHH is committed to working with providers during the Medicaid program's transition to BAYOU HEALTH, and is offering several resources to assist in answering common questions and provide information.

In general, providers who have questions about a specific Health Plan or are interested in contracting with a Plan should contact the Provider Relations staff of that Health Plan. The contact information for all Plans, including Provider Relations information, is available at www.MakingMedicaidBetter.com.

Medicaid staff continue to hold a call for providers each week day from noon until 1 p.m. 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.

In addition, 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 recent additions on billing for behavioral health services for BAYOU HEALTH members, hospital observation hours and situational fax numbers for hospitals to submit clinical information and/or prior authorization requests. The bulletins are available at www.MakingMedicaidBetter.com, through the tab "Informational Bulletins." Providers are advised to check the site frequently to see the latest information, and BAYOU HEALTH will send an email alert when a new Information Bulletin is posted or an existing bulletin is revised. Providers who wish to sign up to receive these alerts can sign up with an email address at www.MakingMedicaidBetter.com using the "Subscribe to newsletter" list on the right side of the page, or can email bayouhealth@la.gov and request to be added to the email distribution list.  

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. Providers who have complaints about BAYOU HEALTH can send these to DHH via the form on the Medicaid program website.

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

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.