|
Baton Rouge, La. - The Louisiana Department of Health and Hospitals (DHH) released a new request for proposals (RFP) today that will make substantial improvements to operations of the Louisiana Behavioral Health Partnership (Partnership). The Partnership has provided coordinated care for more than 85,000 children and 106,000 adults through mental health care and/or addiction services. Individuals utilize the contractor's resources to receive all related services from private, public and non-profit providers. The changes will improve care management for children, streamline claims payment and allow the Department to more actively monitor and manage the State's Partnership contractor, the Statewide Management Organization (SMO).
Launched in 2012, the Partnership has provided a substantial expansion of services, increased use of those services, particularly community-based, by more Louisiana residents in need and more than doubled the number of available enrolled providers. The Partnership has also increased the number of adult inpatient beds at facilities throughout the state by 87 percent. From Feb. 2012 to Jan. 2014, there was an 18 percent decrease in hospital readmission rates for children, and a 13 percent decrease in the amount of time adults spend in the hospital. That means more Louisiana residents are getting the care they need when they need it and are being provided the needed follow-up services in their communities to help break the cycle of inpatient hospitalization. Community services are vital to keeping children in their homes with their families.
"We listened carefully to providers, recipients, stakeholders and members of the Legislature throughout the first two years of the Partnership," DHH Secretary Kathy H. Kliebert said. "The new RFP reflects those concerns and suggestions. We are so proud of all that the Partnership has accomplished already, but we still want to do a better job serving the needs of children and adults in our state."
"The Partnership has been so successful at providing coordinated care for thousands of Louisiana residents with behavioral health care needs," said DHH Office of Behavioral Health Assistant Secretary Dr. Rochelle Head-Dunham. "Our next contract has to build on those successes as well as learn from our challenges. I am excited at the opportunity we have now to enhance the Partnership so that we can continue to meet the needs of our communities."
Some of the most crucial changes will directly impact providers. For over two years of the Partnership, the Department has worked closely with the current contractor to simplify authorization for services and billing concerns. The new RFP specifically addresses many of those provider concerns, including streamlining payment of claims for recipients that are eligible for both Medicaid and Medicare. It also aligns with national trends for billing of prescription medications by shifting pharmacy benefits prescribed by behavioral health specialists under the Partnership, where the SMO can manage appropriate authorization and perform medication management. The new RFP also clearly outlines what services and medications are eligible for billing under the Partnership or through Medicaid's managed care program, Bayou Health. Providers will now bill based on their type, rather than on the recipient's diagnosis. This will help to dramatically improve the claims process for providers.
Beginning in March, the Partnership will also have more flexibility in the kinds of services that can be provided to children. The legacy Medicaid system specifically defined the kinds of services that could be provided to children that would be eligible for reimbursement. By moving children into the capitated program, meaning the SMO is paid a single flat rate for all care provided to enrolled child, the SMO can work with providers to provide any service that best fits the need of the recipients. Currently, only adults are paid through a captitated system; adding children will simplify the mechanism for payment to the contractor. This change may also help the SMO to attract new providers to expand the network.
DHH is also implementing numerous changes to enhance its relationship and monitoring capability in the new RFP. Starting with the March contract, DHH will monitor the Partnership for a set of incentive-based national quality measures (HEDIS and Joint Commission measures). The Partnership SMO will be penalized $250,000 for falling below each benchmark. There will also be clearer guidelines and amounts for penalties to be assessed to allow the Department to more effectively impose contractual obligations.
|
