Bayou Health Newsletter 7.2.2012

DHH Expresses Appreciation for Feedback Received Through Pharmacy Forums

The Louisiana Department of Health and Hospitals held a series of seven statewide forums in the past two weeks to provide an opportunity for dialogue on proposed modernization of the Medicaid pharmacy program, including adding pharmacy as a benefit to the three prepaid Bayou Health Plans.

Nearly 300 people attended one of the public forums to hear DHH's proposal and offer their feedback. The pharmacy forums were similar to the series of statewide forums DHH held in the early stages of Bayou Health to gather input toward developing and implementing the initiative. At each forum, the audience represented a mix of pharmacists, physicians, health care providers, health plan representatives, recipients and advocates.

Bayou Health, which was fully implemented statewide June 1, is the State's new approach to coordinating care for most Medicaid and LaCHIP recipients. DHH has contracted with five Health Plans that are responsible for coordinating health care for recipients and working with them to address issues and empower them to take a more active role in owning their own health.

Initially, pharmacy was one of several services that were "carved out" of Bayou Health, meaning Medicaid recipients in a BAYOU HEALTH Plan got prescriptions filled and received other pharmacy services through the legacy Medicaid fee-for-service program. Now, DHH is moving forward with adding pharmacy as a benefit for recipients in the three prepaid Bayou Health plans, which operate as traditional, MCO-style health care networks with a capitated rate. The three BAYOU HEALTH prepaid plans are Amerigroup, LaCare and Louisiana Healthcare Connections.

The other two plans, Community Health Solutions and United Healthcare Community Plan, are enhanced primary care case management networks. These Plans process and pay claims using the Medicaid fiscal intermediary, and pharmacy benefits for recipients in these networks would continue through the legacy Medicaid fee-for-service program. Membership in these two Plans, combined with those individuals who are not part of Bayou Health and remain in legacy Medicaid, account for more than half of Medicaid recipients. Concurrent with adding responsibility for pharmacy services to the prepaid plans, DHH is seeking feedback on how best to strengthen the legacy Medicaid pharmacy program, which will continue to manage pharmacy benefits for these individuals.

Attendees at the regional forums heard from Secretary Bruce D. Greenstein, Medicaid Medical Director Rodney Wise and Pharmacy Reform Project Lead Calder Lynch, who presented DHH's vision for modernizing the pharmacy program. The presentations were followed by question-and-answer sessions with them and other members of the Louisiana Medicaid staff, including Bayou Health Project Director Madeline McAndrew, who addressed how pharmacy would intersect with the Bayou Health structure

Many attendees offered valuable ideas and insightful feedback, which DHH is reviewing to incorporate as the pharmacy modernization moves forward. Topics addressed at the forums included how the Health Plans would form pharmacy provider networks, prohibitions against patient steering, billing and payment concerns, continuity of care issues for patients who have HIV/AIDS, specialized behavioral health needs or other conditions that require intensive pharmaceutical treatment, ability for providers and consumers to appeal directly to DHH if needed, and continued transparency of the process.

Secretary Greenstein and DHH Medicaid leadership have issued a concept paper outlining their plans to include pharmacy as a benefit of the BAYOU HEALTH prepaid plans, and addressing aspects of the current Medicaid Pharmacy Benefits Program they wish to transform for recipients in the shared savings plans and those recipients remaining in legacy Medicaid. This paper, which is available online at www.MakingMedicaidBetter.com , has been posted for public comment and feedback. DHH will use this feedback to guide the formation of final rules, contract amendments and internal policies.

DHH anticipates implementing changes to the pharmacy program this fall, and there is still time for stakeholders to offer their feedback. The department has added a "Pharmacy" section to www.MakingMedicaidBetter.com , which will be updated frequently throughout this process. The public is advised to check here often to see the latest details. Visitors to the site can see the PowerPoint Presentation given at these forums and watch recorded video of the forum, review information about BAYOU HEALTH, subscribe to DHH's newsletter for frequent email updates and submit questions or comments electronically, using the online form or by emailing bayouhealth@la.gov.

Bayou Health Quality Committee to Hold First Meeting July 13

The Bayou Health Quality Committee will meet from 2 - 3:30 p.m. on Friday, July 13, in Room #118 in the DHH Bienville Building.

This 19-member committee, chaired by Medicaid Medical Director Rodney Wise, includes health care quality experts, advocates, representatives of provider organizations and representatives of the five Bayou Health Plans to advise DHH on best practices, provider relations, ongoing quality improvement measures and recommendations for changes to the initiative's structure as appropriate. The committee also includes representatives of both the Senate and House Health and Welfare committees.

In Bayou Health, the Plans are measured on 37 clinical quality measures. The Health Plans face potential financial sanctions from the State if they do not meet minimum health quality improvement benchmarks for their members. DHH will publish regular reports on Health Plan quality and financial performance online.

The committee will meet at least quarterly, and more often as necessary. Meetings are open to the public, and the meeting dates and minutes will be published online at www.MakingMedicaidBetter.com.  

FOR PROVIDERS:

Changes to Bayou Health Daily Provider Calls Effective July 9

DHH is revising its daily Bayou Health provider conference calls to better address questions specific to various provider types. Beginning Monday, July 9, calls will be held Monday through Thursday (no calls on Friday) with each day aimed a specific provider/service type.

Since January, Medicaid staff directly involved in the development and implementation of Bayou Health, have held these calls each weekday at noon to answer provider and stakeholder questions about the implementation of Bayou Health. Now that Bayou Health has been implemented statewide and the program is entering the ongoing operations phase, DHH is changing the call structure to make this a more focused platform to address providers' issues and concerns.

The new conference call schedule by provider type is:

• Monday - Physicians/FQHCs/RHCs
• Tuesday - Other provider types (e.g. home health, DME, therapies, transportation, dental, pharmacy)
• Wednesday - Hospitals
• Thursday - Magellan/Louisiana Behavioral Health Partnership, and specialized behavioral health services

Providers and stakeholders are welcome to call in for any of these calls, but Medicaid staff will focus the questions and comments for that call on the day's provider type.

The calls will continue to take place at noon each day. The call-in information remains the same and prior registration is not necessary:

• Call-in number: 1-888-278-0296
• Access Code - 7299088#

The noon calls are intended for providers to engage with DHH staff rather than directly with the Bayou Health Plans.

DHH is offering several additional resources to assist providers in answering common questions and provide information.

Informational Bulletin # 12-27 Addresses Protocols for Bayou Health Provider Questions & Issues

Providers' questions and concerns related to a Health Plan should be addressed directly to that Health Plan. Failure to do so can result in delays in the issue resolved. Bayou Health has compiled a work aid that contains on one page the Health Plan numbers for providers to call and/or e-mail addresses for issue escalation.  The chart includes the main provider relations number, the name and contact information for complaints and the e-mail address of the responsible Plan executive.

Informational Bulletins

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, and 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" tab 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.

Bayou Health and Molina to Host Provider Webinar on July 3

Bayou Health and Molina, the Medicaid fiscal intermediary, have been holding a series of bi-weekly webinars to help providers better understand and address issues regarding billing and claims submission for the shared savings Bayou Health plans. The next webinar, which will be the eighth in this series, will take place Tuesday, July 3. Copies of the presentations from previous webinars are available on the provider relations site and are also available at www.MakingMedicaidBetter.com on the Providers portal, under the headline Webinar Presentations.

New Fiscal Year Begins July 1

State Fiscal Year 2013 begins on Sunday, July 1. Providers are reminded to check the Louisiana Medicaid Provider Relations website, www.lamedicaid.com, to see information about fee schedules in effect for the new fiscal year. Updates to reimbursement rates will be posted here.

Emergency rules for reductions in different Medicaid reimbursement rates by provider type will be published in the July 2012 edition of the Louisiana Register.

FOR RECIPIENTS:

Medicaid Waiver Recipients Not Transitioning to Bayou Health At This Time

Medicaid recipients in home and community-based waivers received letters from DHH last month about the Bayou Health program, asking them to choose a BAYOU HEALTH Plan by June 26 to start getting some health care services (doctor visits, hospital care, etc.) through BAYOU HEALTH effective July 1.

After receiving feedback from advocates and recipients, DHH will postpone the start of Bayou Health for people in Medicaid waivers until further notice to give recipients and their families more time to choose the Health Plan that best meets their needs. These recipients will continue receiving their services through the legacy Medicaid (fee-for-service) program, just as they do today. This does not affect waiver services.

Waiver recipients who received the letter and enrolled in a Bayou Health Plan will continue getting their services as they always have, in the legacy Medicaid program. These recipients will not be in their Bayou Health Plans until DHH notifies them otherwise. Waiver recipients who did not choose a Health Plan do not need to do so.

There is no set go-live date for waiver recipients, but DHH will let them know when Bayou Health services will begin for them, and will allow sufficient time for them to choose a Health Plan. Recipients do not need to take any action or pick a Health Plan until they hear from Bayou Health. DHH will also work with providers, advocates and other stakeholders at that time to provide recipients with information.

Waiver recipients who want to learn more about Bayou Health can visit the enrollment website, www.bayouhealth.com, to see the Health Plan options available.

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.