Enrollment Under Way for Recipients in Southwest, Central and North Louisiana
The final phase of BAYOU HEALTH implementation is taking place, and eligible Medicaid recipients who live in the Southwest, Central, Northwest and Northeast Louisiana regions are choosing Health Plans to prepare for their June 1 go-live date. These areas comprise Geographic Service Area (GSA) C, which is the third and last portion of the State to implement BAYOU HEALTH. Once this GSA goes live, BAYOU HEALTH will be operational statewide.
The BAYOU HEALTH Enrollment Center began mailing Enrollment Packets, which contain information about the five Health Plans and the different services and benefits available with each, to eligible recipients in these regions in mid-April. The BAYOU HEALTH education and outreach team began holding Choose Health meetings this week, in which recipients can meet with representatives of the five Health Plans and enrollment specialists who can help them pick a Plan in person,. These meetings will take place throughout GSA C. A full schedule of the Choose Health meetings is available online at www.MakingMedicaidBetter.com.
In addition to the Choose Health meetings, outreach staff will hold numerous immersion events, in which information about BAYOU HEALTH is available at convenient locations where Medicaid and LaCHIP recipients receive other services, such as a parish health units, WIC distribution sites, nonprofit and community-based organizations, food banks and Medicaid application centers.
Already, more than 21,000 recipients in GSA C have selected Health Plans. There are several ways that recipients who have not yet chosen a Health Plan for their families can enroll. Recipients can call 1-855-BAYOU-4U and have an enrollment specialist assist them in choosing a Plan, or they can follow the automated phone cues to select a Plan; enroll online at www.bayouhealth.com; complete the forms provided in their Enrollment Kits and mail these back to the Enrollment Center in the envelope provided or fax them back at the number indicated in their packets; or enroll in person at a Choose Health or immersion event.
Eligible recipients in this area have until Friday, May 29, at 5 p.m. Central Daylight Time to pick a Plan and be enrolled in that Plan effective June 1.
BAYOU HEALTH Replacing CommunityCARE, KIDMED Programs
The CommunityCARE and KIDMED programs are ceasing operations, as these programs are being replaced by BAYOU HEALTH. Recipients' Medicaid services are not changing. KIDMED was established in Louisiana in the 1990s for administration of EPSDT screenings. The member's BAYOU HEALTH Plan will now be responsible for coordinating EPSDT services for members.
CommunityCARE was a limited primary care case management program in which Medicaid recipients were linked to a primary care provider. The Medicaid recipients who were in CommunityCARE are mandatory enrollees for BAYOU HEALTH. Under BAYOU HEALTH, recipients will be enrolled in a network administered by a Health Plan, in which their care is coordinated. A recipient's Health Plan is responsible for linking each recipient to a primary care provider within the network. Medicaid recipients who wish to continue seeing their CommunityCARE doctor in BAYOU HEALTH are advised to contact the BAYOU HEALTH Enrollment Center at 1-855-BAYOU-4U or visit the online provider search at www.bayouhealth.com to see which Health Plans their doctor will participate in for BAYOU HEALTH.
BAYOU HEALTH is currently active in five regions of the state ( Greater New Orleans Area, Capital Area, South Central Louisiana, Acadiana and Northshore), and will be implemented statewide on June 1, 2012. BAYOU HEALTH replaces KIDMED and CommunityCARE throughout Louisiana.
Effective May 1, 2012, the CommunityCARE Enrollee Hotline and Nurse Helpline telephone numbers will no longer be in operation. Callers to those lines will receive an automated message directing them to the BAYOU HEALTH or general Medicaid hotline if they have questions.
Please note that as CommunityCARE and KIDMED are ending, DHH and the Medicaid program will no longer issue rosters showing member linkages and status in these programs to providers. Medicaid providers should review the GSA C provider notice posted on the Louisiana Medicaid provider website or contact Molina Provider Relations at 1-800-473-2783 for assistance with billing questions.
Claims for services provided to enrollees with dates of service in May 2012 will bypass the CommunityCARE 106 and KIDMED 424 error edits when billed to Louisiana Medicaid.
Recipients in Previous GSA Can Still Change Plans
Eligible Medicaid and LaCHIP recipients in the Acadiana, Capital Area and South Central Louisiana regions, GSA B, began receiving services through BAYOU HEALTH on April 1. Prior to the go-live date, more than 100,000 eligible Medicaid and LaCHIP recipients, nearly 34 percent of all those in BAYOU HEALTH, selected their own Health Plans.
After recipients are enrolled in a Health Plan, either by choice or through auto-assignment, they receive a letter from BAYOU HEALTH, including information about the services and benefits available through that Plan. Recipients have 90 days from the date on their letter from BAYOU HEALTH with the name of their Plan to contact the Enrollment Center and select another Health Plan. Recipients will be enrolled in the new Plan effective the first day of the following month.
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. Some recipients in this region have already passed the 90-day window for changing Health Plans, but others may still be within 90 days of the letter from BAYOU HEALTH.
After the 90-day period ends, recipients can change Plans at any time if they have a good reason for doing so, such as moving to a different area of the state or their doctor leaving their Health Plan's network.
Enrollees who wish to change Plans can do so online via the enrollment website, www.bayouhealth.com, or calling toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance.
Providers Should Verify Data in Health Plans' Registry Prior to Auto Assignment for GSA C Beginning on May 13
As BAYOU HEALTH is implemented statewide, each of the five Health Plans is submitting an electronic Provider Registry to DHH with key information regarding their network providers such as specialty, whether the provider is a PCP, parish, physical address(es) of all practice locations for that provider and phone numbers.
The accuracy and completeness of the information is critical, as it is used to populate the web-based interactive Provider Search on the enrollment website, www.bayouhealth.com, and is also used by BAYOU HEALTH Enrollment Agents to assist recipients in determining the Health Plans with which a provider is "in network." This is important because when choosing a Health Plan, many recipients want to enroll in one in which they can continue seeing their current doctor.
The BAYOU HEALTH staff urges providers to check the accuracy and completeness of information by going to www.BayouHealth.com, clicking on " Search for Provider" and reviewing their information listed. Please verify that this information is correct, as this will help your patients find you easily as they choose their BAYOU HEALTH Plans. If your information is not correct for any of the Plans, you are advised to contact that Health Plan and request an immediate correction. Updates to the electronic Provider Registry are made weekly on Mondays, no later than early afternoon.
While printed copies of each Plan's Provider Registry are available through the Enrollment Broker, the most up-to-date information for a Plan's network providers is available in the electronic listing.
Providers who know there is incorrect information listed for them or their practice in a Health Plan's registry should bring this to that Health Plan's attention immediately. Please review the recent Informational Bulletin that BAYOU HEALTH issued on the Provider Registry for information about how to report data errors. The Enrollment Broker will begin auto-assigning recipients from GSA C who have not yet selected a Health Plan on May 13, and it is imperative to have updated provider information on this process.
Providers who have trouble getting their information correctly listed with the BAYOU HEALTH Plans should report this to firstname.lastname@example.org so a DHH staff member can follow up with that Plan appropriately. If Health Plans do not make necessary corrections before May 13, DHH has the right to bar them from the auto-assignment process.
Providers are reminded that they can tell their Medicaid patients which BAYOU HEALTH Plans they will accept so Medicaid recipients can use this information in picking their Plans. The BAYOU HEALTH team has created a one-sheet flier that providers can use to identify the names of all the BAYOU HEALTH plans in which they will participate. Providers can distribute this flier to all their Medicaid patients. Providers can download the flier in color or black and white.
DHH Announces Appointments to BAYOU HEALTH Quality Committee
DHH Secretary Bruce D. Greenstein has announced the members of the BAYOU HEALTH Quality Committee.
DHH chose to form the Quality Committee to provide oversight and monitoring of the program. Under the rules and contracts that govern BAYOU HEALTH, there are extensive requirements regarding health outcomes, quality measures and consumer engagement. Health Plans are required to participate on the Quality Committee and will be measured on 37 clinical quality measures. The Health Plans face potential financial sanctions from the State if they do not meet minimum health quality improvement benchmarks for their members. DHH will publish regular reports on Health Plan quality and financial performance online.
"Our primary objective from day one in BAYOU HEALTH has been improving the health of Louisiana residents," Greenstein said. "This committee represents some of the sharpest medical minds in our State, and they will provide the oversight and expert guidance needed to raise the bar."
This 19-member committee includes health care quality experts, advocates, representatives of provider organizations and representatives of the the five BAYOU HEALTH Plans to advise DHH on best practices, provider relations, ongoing quality improvement measures and recommendations for changes to BAYOU HEALTH's structure as appropriate. The committee also includes representatives of both the Senate and House Health and Welfare committees.
The Committee Chairman is Medicaid Medical Director Dr. Rodney Wise. The Committee will meet at least quarterly, and more often as necessary. Meetings will be open to the public, with meeting dates and minutes published online at www.MakingMedicaidBetter.com.
Committee members include:
1. Rodney Wise, M.D., Medical Director, Louisiana Medicaid (Chairman)
2. Sonya Nelson, Executive Director, Amerigroup (BAYOU HEALTH Plan)
3. Yolonda Hill-Spooner, M.D., Medical Director, LaCare (BAYOU HEALTH Plan)
4. Karenlyn Dawson, M.D., Plan Medical Director, Louisiana Healthcare Connections (BAYOU HEALTH Plan)
5. Michael H. Dickey, Ph.D., Director of Clinical Quality, United Healthcare (BAYOU HEALTH PLAN)
6. Stewart Gordon, M.D., Chief Medical Director, Community Health Solutions (BAYOU HEALTH Plan)
7. Representative Scott Simon, Chair, House Health & Welfare Committee
8. Chris Wroten, M.D., Doctor of Optometry, Designee, Senate Health & Welfare Committee
9. John A. Vanchiere, M.D., Pediatric Infectious Disease Specialist
10. Rebekah Gee, M.D., Project Director, DHH Birth Outcomes Initiative
11. Sandra Blake, Ph.D., Director, Office of Outcome Research & Evaluation, University of Louisiana at Monroe - College of Pharmacy
12. Joe Rosier, CEO, Rapides Foundation
13. James Hussey, M.D., Medical Director, Louisiana Behavioral Health Partnership
14. Ron Ritchey, M.D., Chief Medical Officer, EQHealth Solutions (Louisiana's Medicare External Quality Review Organization)
15. Bryan G. Sibley, M.D., Pediatrician, specialized on children with special health needs
16. Justin Bennett, Rural Nurse Practitioner
17. Mary Noll, Director of Case Management, HCA Mid America, Louisiana Hospital Association Representative
18. Lyn Kieltyka, Ph.D., Epidemiologist, CDC Representative working with DHH Maternal and Child Health Program
19. Maitland Deland, M.D., Radiation Oncologist, President and CEO, Oncologics, Inc.
"BAYOU HEALTH will be fully launched across our state on June 1," said Chairman Dr. Rodney Wise. "As we move into the operational phase, this committee will be instrumental in providing real-time evaluation and oversight so we can ensure continuous improvement and better health for our enrollees."
Resources Available to Assist Providers During BAYOU HEALTH Transition
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.
The BAYOU HEALTH education and outreach team is conducting a series of Provider Outreach Sessions in the regions and parishes throughout GSA C (Southwest, Central and North Louisiana) from mid-April to the end of May. These meetings are scheduled at the request of various provider organizations/locations. The hosting location can decide whether they want participation from the five BAYOU HEALTH Plans at a provider meeting or not. This depends on many factors, including the space and accommodations available for the meeting, whether they want to allow Plans to recruit providers or keep the meeting as a strictly Q&A session, etc. Given these variations, if you have questions about a specific session and whether that meeting will include Health Plan representation, or if you are interested in attending or scheduling a Provider Outreach Session, please contact Anita Byrne at email@example.com or 225.769.2676.
In general, because BAYOU HEALTH cannot guarantee Health Plans will be at all provider meetings, providers who have questions about a specific Health Plan or are interested in contracting with a Plan should contact the Provider Relations staff of that Health Plan. The contact information for all Plans, including Provider Relations information, is available at www.MakingMedicaidBetter.com.
Medicaid staff continue to hold a 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.
In addition, the 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. These bulletins cover a range of topics, including a recent addition on the Provider Registry. The bulletins are available at www.MakingMedicaidBetter.com, through the tab "Informational Bulletins." Providers are advised to check the site frequently to see the latest information.
If you have questions about BAYOU HEALTH, please email firstname.lastname@example.org, and the appropriate Medicaid staff member will respond. Typically, questions are answered within one business day. Providers who have complaints about BAYOU HEALTH can send these to DHH via the form on the Medicaid program website.
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.
Providers Should Prepare Their Business Processes Before BAYOU HEALTH Goes Live in Their Areas
Providers in GSA C can begin preparing for BAYOU HEALTH implementation by getting enrolled with any necessary login IDs and passwords for Health Plans' provider websites and registering for EFT with those Plans with whom they have contracted under BAYOU HEALTH.
There are five BAYOU HEALTH Plans that will coordinate care for Medicaid recipients: Amerigroup Real Solutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and United Healthcare Community Plan. As providers consider their Health Plan options, they should familiarize themselves with the contact information, payment processes and provider relations functions for each.
BAYOU HEALTH will go live in in GSA C (Southwest, Central and North Louisiana) on June 1. Providers will want to have the information for each Plan ready on the day BAYOU HEALTH goes live so they can more easily contact the Health Plans in which their patients are enrolled and can promptly bill for services provided. A list of all Health Plans' contact information is available at www.MakingMedicaidBetter.com.
Providers should keep in mind that as patients are transitioning to BAYOU HEALTH, they can access the eligibility website eMEVS to see which Plan that patient is in. The Medicaid eligibility database is the ultimate source of information. A patient may think he is in a different Plan or have a letter from another Plan, but providers should always consider the Medicaid eligibility verification system response to take precedence over information in the possession of the patient or Health Plan and default to the Plan listed in Medicaid's database.
BAYOU HEALTH is the State's new approach to delivering and financing health care for nearly 900,000 Medicaid and LaCHIP recipients. Under BAYOU HEALTH, DHH has contracted with five private Health Plans responsible for coordinating and managing the care of their members to improve health outcomes while controlling costs in the program.
For the latest information about BAYOU HEALTH, please visit www.MakingMedicaidBetter.com or the enrollment website, www.bayouhealth.com. To share your comments or ask questions, email email@example.com. Call toll-free 1-855-BAYOU4U (1-855-229-6848) to speak with an enrollment counselor for assistance in picking a Health Plan.