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Details:
- Medicaid
- Managed Care
The following information is listed for historical purposes only and is not updated. On March 24, 2011 the Louisiana Department of Health issued a Request for Proposals for qualified external quality review organizations (EQRO) to enter into a contract to perform readiness reviews and undertake external quality review (EQR) activities consistent with federal regulations for Louisiana’s Coordinated Care Networks. The Coordinated Care Networks will consist of two models: Coordinated Care Network-Shared Savings (CCN-S) model and Coordinated Care Network-Prepaid (CCN-P) model. The EQRO will provide analysis and evaluation of aggregated information on the CCNs’ quality, timeliness, and access to certain Medicaid covered health care services. LDH anticipates having two (2) to three (3) CCN-P entities and two (2) to three (3) CCN-S entities in each of three (3) Geographic Service Area (GSA)s. The Contractor will provide services in all GSAs to all CCN-P and CCN-S entities. On April 11, 2011, the Louisiana Department of Health (DHH) issued a Request for Proposals for qualified proposers to enter into a contract to provide healthcare services to Medicaid enrollees participating in the Medicaid Coordinated Care Network (CCN) program. Three companies were subsequently selected for the Prepaid model: Amerigroup Louisiana, Inc., Amerihealth Mercy of Louisiana, Inc. and Louisiana Healthcare Connections, Inc. Two companies were subsequently selected for the Shared Savings model: Community Health Solutions, Inc. and United Healthcare of Louisiana. April 29, 2011 The Louisiana Department of Health (DHH), Bureau of Health Services Financing (BHSF), issued a Request for Proposals (RFP) for qualified proposers for Enrollment Broker services that would provide enrollment services to Coordinated Care Network (CCN), Greater New Orleans Community Health Connection (GNOCHC) or alternative Medicaid managed care program enrollees. Managed Care 1.0 Amerigroup, Healthy Blue, AmeriHealth Caritas, LaCare, Louisiana Healthcare Connections, Community Health Solutions, UnitedHealthcare Community Plan
Downloadable Assets:
CCN Prepaid Request for Proposals CCN Prepaid Systems Companion Guide updated 5.2.2011 CCN State Fair Hearing Guide Prepaid Addendum #4 (updated 5.23.2011) CCN Prepaid RFP Questions & Answers (posted 5.23.2011) CCN Prepaid RFP Addendum #6 (posted 6.10.2011) CCN Prepaid RFP Questions and Answers - Round Two Follow Up Questions (posted 6.10.2011) Addendum Notification (CCN-P) Addendum 9 (posted 6.16.2011) Addendum 10 (posted 6.17.2011) CCN Shared Savings Request for Proposals Shared Savings Systems Companion Guide CCN Shared Savings Addendum #3 (updated 5.23.2011) CCN Shared Savings RFP Questions & Answers (posted 5.23.2011) CCN Shared Savings RFP Addendum #5 (posted 6.10.2011) CCN Shared Savings RFP Questions and Answers - Round Two Follow Up Questions (posted 6.10.11) Addendum Notification (CCN-S) Addendum 8 (posted 6.16.2011) Addendum 9 (posted 6.17.2011) Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Original Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 1 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 2 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 3 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 4 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 5 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 6 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 7 Prepaid Health Plan Executed Contract - Amerigroup Louisiana - Amendment 8 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Original Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 1 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 2 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 3 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 4 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 5 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 6 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 7 Prepaid Health Plan Executed Contract - AmeriHealth Caritas - Amendment 8 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 1 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 2 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 3 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 4 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 5 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 6 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 7 Prepaid Health Plan Executed Contract - Louisiana Healthcare Connections - Amendment 8 Shared Savings Health Plan Executed Contract - Community Health Solutions - Original Shared Savings Health Plan Executed Contract - Community Health Solutions - Amendment 1 Shared Savings Health Plan Executed Contract - Community Health Solutions - Amendment 2 Shared Savings Health Plan Executed Contract - Community Health Solutions - Amendment 3 Shared Savings Health Plan Executed Contract - Community Health Solutions - Amendment 4 Shared Savings Health Plan Executed Contract - UnitedHealthcare Community Plan - Original Shared Savings Health Plan Executed Contract - UnitedHealthcare Community Plan - Amendment 1 Shared Savings Health Plan Executed Contract - UnitedHealthcare Community Plan - Amendment 2 Shared Savings Health Plan Executed Contract - UnitedHealthcare Community Plan - Amendment 3 Shared Savings Health Plan Executed Contract - UnitedHealthcare Community Plan - Amendment 4 Bayou Health Plan Readiness Results - Systems Readiness - Amerigroup Bayou Health Plan Readiness Results - Systems Readiness - Community Health Solutions Bayou Health Plan Readiness Results - Systems Readiness - LaCare (Now AmeriHealth Caritas) Bayou Health Plan Readiness Results - Systems Readiness - Louisiana Healthcare Solutions Bayou Health Plan Readiness Results - Systems Readiness - UnitedHealthcare Community Plan Bayou Health Plan Readiness Results - Systems Readiness - Summary of ISCA Review Bayou Health Plan Readiness Results - Operational Readiness - Amerigroup Bayou Health Plan Readiness Results - Operational Readiness - Community Health Solutions Bayou Health Plan Readiness Results - Operational Readiness - LaCare (Now AmeriHealth Caritas) Bayou Health Plan Readiness Results - Operational Readiness - Louisiana Healthcare Connections Bayou Health Plan Readiness Results - Operational Readiness - UnitedHealthcare Community Plan Bayou Health Plan Readiness Results - Network Adequacy - All Health Plans Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Original Contract Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Prepaid Contract, Exhibit E - RFP 305 PUR-DHHRFP-CCN-P-MVA Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 1 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 2 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 3 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 4 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 5 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 6 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 7 Healthy Blue (formerly known as Amerigroup) Contract and Amendments - Amendment 8 AmeriHealth Caritas Contract and Amendments - Original Contract AmeriHealth Caritas Contract and Amendments - Amendment 1 AmeriHealth Caritas Contract and Amendments - Amendment 2 AmeriHealth Caritas Contract and Amendments - Amendment 2 AmeriHealth Caritas Contract and Amendments - Amendment 3 AmeriHealth Caritas Contract and Amendments - Amendment 4 AmeriHealth Caritas Contract and Amendments - Amendment 5 AmeriHealth Caritas Contract and Amendments - Amendment 6 AmeriHealth Caritas Contract and Amendments - Amendment 7 AmeriHealth Caritas Contract and Amendments - Amendment 8 Louisiana Healthcare Connections Contract and Amendments - Original Contract Louisiana Healthcare Connections Contract and Amendments - Amendment 1 Louisiana Healthcare Connections Contract and Amendments - Amendment 2 Louisiana Healthcare Connections Contract and Amendments - Amendment 3 Louisiana Healthcare Connections Contract and Amendments - Amendment 4 Louisiana Healthcare Connections Contract and Amendments - Amendment 5 Louisiana Healthcare Connections Contract and Amendments - Amendment 6 Louisiana Healthcare Connections Contract and Amendments - Amendment 7 Louisiana Healthcare Connections Contract and Amendments - Amendment 8 Community Health Solutions Contract and Amendments - Original Contract Community Health Solutions Contract and Amendments - Amendment 1 Community Health Solutions Contract and Amendments - Amendment 2 Community Health Solutions Contract and Amendments - Amendment 3 Community Health Solutions Contract and Amendments - Amendment 4 United Healthcare Community Plan Contract and Amendments - Original Contract United Healthcare Community Plan Contract and Amendments - Amendment 1 United Healthcare Community Plan Contract and Amendments - Amendment 2 United Healthcare Community Plan Contract and Amendments - Amendment 3 United Healthcare Community Plan Contract and Amendments - Amendment 4 -
Details:
- Medicaid
- Managed Care
Managed Care Enrollment Broker Executed Contract
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Details:
- Medicaid
- Managed Care
Managed Care EQRO Executed Contract
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Details:
- Medicaid
- Managed Care
Managed Care Rate Setting Executed Contract
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Details:
- Medicaid
- Managed Care
Managed Care Request for Proposals (RFP), RFP# 305PUR-DHHRFP
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
Managed Care Request for Proposals (RFP)
Downloadable Assets:
EQRO Addendum #2 - April 21, 2011 Revised Schedule of Events EQRO Addendum #5 - April 28, 2011 Revised Schedule of Events EQRO Addendum 6 Revision to RFP Language EQRO Addendum 7 Questions and Answers EQRO Addendum 8 Cost Template EQRO Addendum 9 RFP Checklist EQRO Addendum 10 Revised Schedule of Events #4 EQRO Addendum 11 Additional Questions and Answers EQRO MLR Refund Calculation Methodology EQRO CCN-S Performance Measures EQRO Performance Improvement Projects EQRO Cost and Pricing Template EQRO Conducting Focused Studies of Health Care Quality EQRO EQR Overview EQRO Informations Systems Capabilities Assessment for Managed Care Organizations and Prepaid Health Plans (Appendix Z) EQRO Focused Study Protocol EQRO Conducting Performance Improvement Projects EQRO Validating Performance Improvement Projects EQRO Summary of Compliance Determination Activities of Public and Private Quality Oversight Organizations (Attachment A) EQRO Sample Documentation and Reporting Tool (Attachment C) EQRO Monitoring Managed Care Organizations (MCO's) and Prepaid Health Plans EQRO Administering or Validating Surveys EQRO Validating Encounter Data