BATON ROUGE—The Louisiana Department of Health and Hospitals launches the second phase of its historic transformation of the Medicaid program April 1, as the second Geographic Service Area (GSA) of the State goes live with BAYOU HEALTH, an improved Medicaid health care service delivery program.
BAYOU HEALTH is the State's new approach to coordinating care for nearly 900,000 Medicaid and LaCHIP recipients. Its focus is on improved access to quality health care and better health outcomes for recipients. Under BAYOU HEALTH, DHH has contracted with five Health Plans - Amerigroup RealSolutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and UnitedHealthcare Community Plan -- that are responsible for coordinating health care for their members.
Eligible recipients in the Acadiana, Capital Area and South Central Louisiana regions, known as GSA B, are the second group of Medicaid enrollees to begin receiving services through BAYOU HEALTH. Eligible Medicaid recipients in this area will start receiving services through a BAYOU HEALTH Plan on Sunday, April 1. In GSA B, more than 100,000 eligible Medicaid and LaCHIP recipients, nearly 34 percent of all those in BAYOU HEALTH, selected their own Health Plans.
"We are thrilled by the number of enrollees who took proactive steps to make a choice and own their own health," said DHH Secretary Bruce D. Greenstein. "One of the primary focuses of BAYOU HEALTH is giving recipients the tools and responsibility to take a more active role in their health decisions. Our efforts to engage them in the process of choosing how they and their families receive care continue to yield success."
The Greater New Orleans and Northshore regions, GSA A, transitioned to BAYOU HEALTH on Feb. 1 and had a 27 percent enrollee self-selection rate. That number has since increased to nearly 29 percent, as enrollees who were auto assigned chose new Health Plans after their Feb. 1 go-live date.
Each eligible Medicaid and LaCHIP recipient had the opportunity to choose a Health Plan, and BAYOU HEALTH outreach staff scheduled numerous events throughout GSA B to meet with recipients in person and assist them as needed. There were 40 Choose Health meetings, in which recipients could meet with representatives of the five Health Plans and work directly with an enrollment specialist to pick a Plan. The staff also scheduled 117 immersion events in GSA B, providing information about BAYOU HEALTH in locations such as parish health units, food banks, Medicaid application centers and WIC distribution sites. The BAYOU HEALTH outreach team worked with numerous advocates, faith-based groups and churches, nonprofits and community-based organizations throughout GSA B to reach as many Medicaid recipients as possible.
Recipients who did not choose a Plan were assigned to one to begin receiving services through a BAYOU HEALTH Plan on April 1.
Of the 308,902 eligible recipients in GSA B, the breakdown of recipients among Health Plans for the April 1 launch is:
An additional 598 recipients whose enrollment in BAYOU HEALTH was voluntary elected to remain in the current fee-for-service Medicaid program.
Recipients will receive a confirmation letter from the BAYOU HEALTH Enrollment Center listing which Health Plan they are linked to, and will receive membership cards from their Plans in addition to their DHH-issued Medicaid cards. Members have an opportunity to select a primary care provider from their Health Plan's network. If the member does not choose a primary care provider, the Health Plan will automatically assign one.
Recipients who are unsure about which BAYOU HEALTH Plan they are in can contact the BAYOU HEALTH enrollment hotline at 1-855-BAYOU-4U (1-855-229-6848), or they can ask their doctor to verify their eligibility and see their Plan assignments.
Effective April 1, recipients' doctors can see which BAYOU HEALTH Plan that member belongs to through the online Medicaid eligibility verification system, eMEVS. This information will also let providers know which BAYOU HEALTH Plan to bill for services or obtain authorizations as needed. Providers should consider the Medicaid eligibility database the ultimate source of information for BAYOU HEALTH Plan assignment. A patient may think he is in a different Plan or have a letter or membership card from another Plan, but the eMEVS information takes precedence.
Any Medicaid recipient who had surgeries or other medical procedures scheduled before April 1 are pre-authorized for these procedures under BAYOU HEALTH. Because April 1 is a Sunday, most patients will not begin seeking treatment through BAYOU HEALTH until Monday, April 2. Patients who have emergency medical needs can go to the emergency room and receive care, and patients who have non-emergency medical needs can contact their Health Plan effective April 1 if they need assistance locating an in-network provider.
"We've used the lessons learned from implementing BAYOU HEALTH in GSA A for continuous improvement, and for GSA B, this allowed us to more effectively reach out to recipients and providers to prepare them for this transition and let them know people can absolutely still access services, " said BAYOU HEALTH Project Director Ruth Kennedy. "We've begun receiving feedback from recipients in GSA A, who began BAYOU HEALTH on Feb. 1, about how 'hands-on' their Health Plans have been in helping them locate doctors, make appointments and get the treatment they need. We're glad this unprecedented level of care coordination in our Medicaid program is expanding to include more enrollees."
The April 1 go-live date does not end recipients' chances to choose a BAYOU HEALTH Plan if they decide the Plan they are in right now is not a good fit. Medicaid and LaCHIP members have 90 days from the time they receive notification from the BAYOU HEALTH Enrollment Center telling them which Plan they are enrolled in to change Plans. If recipients change Plans after April 1, they will be in the new Health Plan effective May 1, unless they make the change in the last three business days of the month. In those cases, recipients would be enrolled in the new Health Plan effective June 1.
After this 90-day change period, a recipient can change Health Plans any time with a good reason, such as their primary care provider leaving the network or moving to another area of the state. After BAYOU HEALTH is implemented statewide on June 1, recipients will have an annual enrollment period in which they can change Plans.
BAYOU HEALTH recipients who wish to change Health Plans can call 1-855-BAYOU-4U (1-855-229-6848) to speak with an enrollment specialist or change Plans online at www.bayouhealth.com.
Resources for Providers
DHH is committed to working with providers during the Medicaid program's transition to BAYOU HEALTH, and is offering several resources to assist in answering common questions and provide information.
DHH's BAYOU HEALTH staff have established a Rapid Response phone line for Medicaid providers in GSA B to quickly resolve issues as they arise during the first several days of this transition. Providers can call (225) 229-7152 to speak with Medicaid staff who are knowledgeable about BAYOU HEALTH. The Rapid Response hotline will be available from 7 a.m. until 6 p.m. on weekdays from Monday, April 2 through Friday, April 13.
In addition, DHH has designated Medicaid staff members to work directly with some of the major Medicaid providers in GSA B and address any transition issues that arise in real time. Nine large hospitals, provider offices that treat high volumes of Medicaid patients and the major medical associations throughout the GSA will have a Medicaid staff member serving as a direct liaison to their staff during the first two weeks of BAYOU HEALTH implementation. That individual will be the provider's point person for resolving any issues quickly.
During the transition and beyond, providers can e-mail firstname.lastname@example.org for assistance. BAYOU HEALTH staff are typically able to address any emailed questions or concerns within one business day. Medicaid staff continue holding a daily BAYOU HEALTH call for providers each week day from noon until 1 p.m. The toll-free number to call is 1-888-278-0296, and the Access Code is 729-9088#. It is not necessary to pre-register, and any interested provider can participate. These daily calls began prior to BAYOU HEALTH going live in GSA A, and will continue indefinitely. Providers should note that there will be no call on Friday, April 6 because of the holiday.
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. 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.
Providers who have complaints about BAYOU HEALTH can send these to DHH via the form on the Medicaid program website.
Final GSA to Adopt BAYOU HEALTH to Begin Outreach in April
Beginning in late April, the final area of the state to implement BAYOU HEALTH, known as Geographic Service Area C, will have a series of education and outreach events for Medicaid and LaCHIP recipients to help them prepare to choose a Health Plan.
GSA C includes all parishes in Southwest, Central and North Louisiana. The go-live date for GSA C is June 1. Eligible enrollees in GSA C will receive their BAYOU HEALTH Enrollment Packets, which outline their Health Plan choices, beginning in mid-April, and will have the opportunity shortly thereafter to attend enrollment events and learn more about BAYOU HEALTH. A schedule of all GSA C Choose Health events is available on www.MakingMedicaidBetter.com. The BAYOU HEALTH outreach staff are also scheduling numerous immersion events throughout the area. When this GSA goes live on June 1, BAYOU HEALTH will be implemented statewide.
"Foundation reforms like BAYOU HEALTH help move Louisiana off the predictable path for poor health outcomes, and points us toward a system that emphasizes the right care in the right place at the right time," Greenstein said. "We understand that any transition can be a challenge, but we are encouraged by the many recipients, providers, advocates and other stakeholders who join us in remaining focused on our ultimate goal: moving out of 49th place and becoming a better, healthier, stronger state."