Today, DHH Secretary Bruce D. Greenstein announced that all five Health Plans contracted to manage care under the BAYOU HEALTH program have passed their operational and systems readiness review, and each has been certified as having an adequate provider network in the first region of the state to roll out BAYOU HEALTH.
"This is a hallmark moment in our state's journey toward improved health outcomes," Secretary Greenstein said. "We strongly believed when these five Plans were selected that they had what we needed to help us provide the coordinated approach to health care that Louisiana's Medicaid and LaCHIP recipients need to improve health outcomes. In short order, they have proven that by passing our rigorous readiness and network adequacy requirements."
Operational and systems readiness reviews were conducted by DHH's BAYOU HEALTH staff to ensure that the Plans are fully prepared to manage health care for some 865,000 Medicaid and LaCHIP recipients. The reviews examined each Plan's ability to handle everything from case management and claims payments, where applicable, to member grievances and fraud prevention. In total, Prepaid Plans had to prove readiness on 906 different factors, and Shared Savings Plans had to show readiness on 788 factors.
Each Plan also had to show they have contracted with an adequate network of doctors, including specialists, where applicable and other providers, for the first region of the state to go live, which is the four-parish New Orleans and five-parish Northshore areas - known as Geographic Service Area A (GSA A). GSA A goes live on Feb. 1 with member enrollment beginning Thursday, Dec. 15. The Plans will also have to show network adequacy in each subsequent GSA before they launch, which will occur in 60-day increments following GSA A.
"Now is the time for our Medicaid and LaCHIP enrollees to engage in this process," Secretary Greenstein said. "Those who live in our first region to phase in have already begun seeing a lot of information - in the mail, in the newspaper and on TV. We will be holding 41 different community meetings in those regions over the next six weeks. We will have resources as each of these to help you choose the Health Plan that fits the needs of you and your family. "
BAYOU HEALTH is the state's new approach to health care for about 865,000 Medicaid and LaCHIP enrollees. Under BAYOU HEALTH, the state has contracted with five Health Plans that will be responsible for coordinating care and services for their members. Three of the Plans are called Prepaid Plans, and two are known as Shared-Savings Plans. Under the Prepaid model, Health Plans must contract with a broad network of health care providers that their members can access. In addition to care coordination, these Plans will be responsible for paying claims submitted by physicians. The two Shared-Savings Plans must have a network of primary care providers and while they have the same responsibilities for care coordination, physician bills will continue to be paid by the state. The Shared-Savings plans do not have the same requirements for specialists in their network as Pre-Paid plans, but still must assist members in finding specialists as needed.
All benefits and core services remain the same under BAYOU HEALTH, but Plans may offer additional benefits and services.
The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and Facebook.