Bayou Health Newsletter 11.26.2012

Pharmacy Transition of Care Policies for Bayou Health Plans Available Online

Effective Nov. 1, pharmacy became a benefit of three Medicaid Bayou Health Plans --  Amerigroup, LaCare and Louisiana Healthcare Connections, with those plans assuming responsibility for helping members access pharmacy services, encouraging compliance with medication and driving use of the most clinically effective, least expensive drug available.

Each of the three plans has outlined its policies for transition of care, which are available on the plans' websites. Bayou Health has also provided links to each plan's policy on the website www.MakingMedicaidBetter.com, under the "Pharmacy" tab, within the section "Transition of Care Procedures." Providers can click the link for Amerigroup, LaCare or Louisiana Healthcare Connections to see that plan's care transition policy.

The other two Bayou Health plans, Community Health Solutions and United Healthcare Community Plan, continue to provide pharmacy benefits through the legacy Medicaid fee-for-service program.

To ensure questions are answered quickly and accurately, pharmacists are encouraged to first direct pharmacy integration specific questions to the appropriate plan. Plan contact information is available online. Providers who do not receive resolution through a plan can call 1-800-437-9101 to contact the Medicaid Pharmacy Program.

Providers can also submit questions by email to bayouhealth@la.gov, and the appropriate staff will address any issues or concerns. Staff are typically able to respond within one business day.

Clarification Regarding 30-day Pharmacy Contracting Grace Period

While each health plan's PBM has an existing commercial network in Louisiana, DHH has required that the health plans secure proactive agreement from these pharmacies to participate in their Medicaid network. In order to ensure a smooth transition, DHH allowed a 30-day grace period for pharmacies to review contracts and sign amendments while still being able to fill prescriptions under the Medicaid terms of that health plan.

Providers have until Friday, Nov. 30, to return their signed amendments or contracts to the health plan in order to be considered an in-network provider going forward. Any providers who do not have a signed contract or amendment by Nov. 30 will be considered out of network for the respective health plans as of Dec. 15. This will allow an adequate amount of time for health plans to notify their members of any network changes that may affect them.

Rules that require health plans to accept any willing provider will continue, and pharmacies may continue to join a health plan's network after Nov. 30. 

Bayou Health Provider Call to Take Place Each Wednesday

Since January, Medicaid program leadership have held a daily call for providers to discuss aspects of the Bayou Health program. Now that Bayou Health is fully implemented statewide, Medicaid staff will transition to one weekly phone call for all provider types to discuss issues and answer questions.

Effective Nov. 21, the Bayou Health weekly provider call will take place on Wednesdays at 1 p.m. The call in number is 1-888-278-0296, and the access code is 6556479#. Any provider is welcome to call in, and pre-registration is not required.

Providers should first bring any issues they encounter with a Bayou Health plan to that plan's attention for resolution. To address issues directly with Medicaid outside the weekly call, providers can email bayouhealth@la.gov. Staff typically are able to respond to any issues received by email within one business day. Providers are also encouraged to frequently visit www.MakingMedicaidBetter.com to see the latest news, information and updates about Bayou Health.

A weekly call will continue to take place on Thursdays that focuses on specialized behavioral health services, conducted through Magellan/Louisiana Behavioral Health Partnership. The call-in information for this call is 1-888-205-5513, Access Code: 827176.

Secretary Announces Next Medicaid Medical Director

Medicaid Medical Director Dr. Rodney Wise retired in November after nearly 30 years of state service. During his time as medical director, Dr. Wise played an instrumental role as a trailblazer for Bayou Health. Dr. Wise performed a tremendous amount of work to fundamentally change how the State provides health care to Medicaid recipients and to establish collaborative relationships with Louisiana providers.

DHH Secretary Bruce D. Greenstein announced Dr. Rebekah Gee will be the agency's next Medicaid Medical Director. Like Dr. Wise, Dr. Gee is an OB/GYN, and she has played a prominent role in DHH's health transformation agenda for the past two years as Director of the Louisiana Birth Outcomes Initiative. In that role, she has led prominent efforts to improve health outcomes, most notably the 39 Week Initiative to end elective, pre-term deliveries at all of Louisiana's birthing hospitals.

Dr. Gee will begin her role as Medicaid Medical Director in January.

Reminder: Bayou Health Members and Plan Choice vs. Provider Steering

All health care providers delivering services to Louisiana Medicaid and LaCHIP recipients enrolled in Bayou Health plans are welcome to inform their patients of the Bayou Health plans they have chosen to participate with, but Bayou Health has strict prohibitions against patient steering, which all providers must observe:

• Providers may inform their patients of all health plans in which they participate, and can inform patients of the benefits, services and specialty care services offered through the health plans in which they participate.
• Providers are not allowed to disclose only some of the health plans in which they participate. Disclosure of health plan participation must be all or nothing.
• Providers can display signage, provided by the health plan, at their location indicating which health plans are accepted there, but must include all health plans in which they participate in this signage.
• If a provider participates in only one Bayou Health plan, the provider can display signage for only one health plan and can tell a patient that is the only health plan accepted by that provider.
• Providers MAY NOT RECOMMEND one health plan over another health plan, MAY NOT OFFER patients incentives for selecting one health plan over another, or MAY NOT ASSIST IN ANY WAY (faxing, using the office phone, computer in the office, etc.) the patient in deciding to select a specific health plan. Some assistance from providers was allowed through CommunityCARE participation, but this program no longer exists and the above requirements must strictly be observed.

Patients who need assistance with their health plan services should call the Member Services Hotline for the plan in which they are enrolled, and those who wish to learn more about the different health plans should contact the Bayou Health Enrollment Broker at 1-855-BAYOU-4U to receive assistance in making a decision.

Under NO CIRCUMSTANCES is a provider allowed to change a member's health plan for him/her, or request a health plan reassignment on a member's behalf. Members who wish to change health plans for cause must make this request to Medicaid themselves through the Bayou Health Enrollment Broker.

These prohibitions against patient steering apply to participation in the prepaid and shared savings health plans as well as the legacy Medicaid program.

For pharmacies enrolled as Louisiana Medicaid providers, you can provide pharmacy benefits to Medicaid and LaCHIP recipients who get their prescription drugs through the Community Health Solutions and United Healthcare Shared Savings Bayou Health Plans as well as the fee for service/legacy Medicaid Program with no additional action needed to contract with any plans. As such, the same steering prohibitions stated above apply to your communications with Bayou Health members as well.

If a provider or health plan is found to have engaged in patient steering, they may be subject to sanctions such as, but not limited to, monetary penalties, loss of linked patients and/or excluded from enrollment in Medicaid/Bayou Health plan network opportunities.