Re-Enrollment for All Medicaid Providers Beginning Thursday, Feb. 28
All Louisiana Medicaid Provider Enrollment activity (new enrollments, changes, re-enrollment of all existing providers) will be performed by contractors CNSI and Noridian Administrative Services beginning Thursday, Feb. 28. The new claims processing system for Louisiana Medicaid, called PRISM (Provider Recipient Integrated System for Medicaid), is scheduled to replace Medicaid's current claims system operated by Molina in the fall of 2014 and provider enrollment, including re-enrollment of all current Medicaid providers, is the first step in PRISM implementation.
Current Medicaid providers may begin re-enrollment on Feb. 28 (or as soon as they have received the necessary credentials to log onto the PRISM Portal), and all current providers must re-enroll in PRISM by Dec. 31, 2013.
2013 Re-enrollment of Current Providers
Re-enrollment of current providers is required to meet provider enrollment requirements in the Affordable Care Act (ACA) and to continue to receive Medicaid reimbursement after the 2014 transition to claims payments through PRISM. Completing re-enrollment prior to January 1, 2014 will allow adequate time for robust testing to minimize interruptions in provider cash flow as a result of this transition. All enrollment activity, including new enrollment and re-enrollment, can be done online at www.medicaid.la.gov/PRISM.
Currently enrolled Medicaid providers will receive three separate letters from PRISM regarding enrollment:
An introductory letter explaining re-enrollment (mailed week of Feb. 18)
A second letter will include the provider's NPI (if applicable) and a user name and the PRISM Domain
The third letter will include the account password and is being sent separately
The second and third letters will be sent in phases, by provider types. Below are targeted dates when you can expect to receive these letters:
Billing Agents/Clearinghouses - March
Facilities, Agencies, Organizations, and Institutions - March
Groups - March
Individual Practitioners - April
All Other Providers - May
Changes to Provider Records
Once enrolled in PRISM, any updates or changes to a provider file may be made online.
Before a change can be made to an existing provider file, the provider must first enroll in PRISM. If a provider needs to make changes to their record and has not yet received the necessary User ID/PRISM Domain and Temporary Password to re-enroll, they can contain the PRISM Provider Enrollment Unit at 888/780-7858 and request the necessary information (beginning Thursday February 28th).
Answers to frequently asked questions (FAQs) and specific training and enrollment information are now available at www.medicaid.la.gov/PRISM.
Bayou Health Marks One-Year Anniversary
This month marks one year since the first Medicaid and LaCHIP recipients began receiving health care services through one of five Bayou Health Plans. February 1, 2012, began a year of transformation, as the State transitioned from its 45-year-old legacy, fee-for-service program to a managed health care delivery system for nearly 900,000 recipients.
The Bayou Health Program got its start in nine southeastern parishes, eventually leading the way to statewide implementation by June 1. Although still in its infancy, Bayou Health is making progress toward its goal of "making Medicaid better."
DHH gathered input from health care professionals within the state and around the country to combine best practices and lessons learned and create a health care delivery model that would improve the quality of life for some of the state's most vulnerable, underserved populations. The resulting Bayou Health model was then implemented in three phases across the state over a five-month period in accordance with three identified geographic service areas (GSA).
DHH responded to provider issues during implementation with daily conference calls, a "rapid response" hotline with extended hours during the first two weeks following "go live" in each GSA, one-on-one meetings and the assignment of Bayou Health staff liaisons who worked directly with high-volume providers. Frequently Asked Questions have been addressed through a series of Informational Bulletins published on the Making Medicaid Better website for easy access and quick dissemination.
Expanded Benefits, Expanded Membership
As members of the Bayou Health plans, eligible recipients have access to benefits and enhancements not offered in the traditional fee-for-service Medicaid program. In addition to coordinated care and chronic care management, adults receive unlimited PCP visits, access to wellness programs and, in some cases, expanded benefits such as dental and vision services.
Beginning in October 2012, DHH began automatically enrolling expectant mothers into a Bayou Health Plan during their first month of eligibility to expedite their access to the benefits of Bayou Health. This move ensures the mother full advantage of the coordinated care a Health Plan offers throughout her pregnancy. Enrollees still have the opportunity to change their plans after initial enrollment.
Effective Nov. 1, 2012, members of the three Prepaid Bayou Health Plans (Amerigroup, LaCare and Louisiana Healthcare Connections) began receiving pharmacy benefits as part of their coordinated services. The Health Plans have more flexibility in their coverage and can offer enhancements such as more prescriptions to adult patients or coverage of over-the-counter medications. Members of Community Health Solutions and United Healthcare Community Plan will continue to receive their pharmacy benefits through legacy Medicaid.
LaCHIP Affordable Plan enrollees became the newest Bayou Health members on Jan. 1, 2013. These children, whose family income exceeds eligibility for regular LaCHIP but is below 250 percent of the Federal Poverty Level, can now benefit from Bayou Health's coordinated care and robust provider network.
The Way Ahead
As Bayou Health enters year two, transition shifts to management and monitoring results and expectations are high. Reporting on more than 35 performance measures and a minimum of two State-approved, formal Performance Improvement Projects will keep the focus on quality outcomes and illustrate Bayou Health's successes and challenges. Evaluation by an independent external quality review organization also will grant an unbiased perspective.
As the Bayou Health Program matures, DHH and its partners will work to ensure a health care delivery system of the highest quality and strive for continued success.
The Affordable Care Act: What Louisianians Need to Know
Congressional enactment of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (also known as the Affordable Care Act, or ACA) includes major changes to how eligibility is determined for Medicaid applicants, beginning in 2014.
Income eligibility for child-related Medicaid programs and the federally facilitated exchange (discussed in more detail below) will be determined using the Modified Adjusted Gross Income (MAGI) method. The household size will be determined by how a family files their taxes in most cases. For example, currently step-parents and their income are not counted when determining a child's eligibility. In the new MAGI system, a mother, her child and a stepfather filing together would be counted as a family of three with all income counting. Traditional disregards and deductions, such as child care expenses up to $90 per working individual, will not be allowed under MAGI. Families will receive a five percent (5%) reduction on the countable gross income when determining eligibility for assistance.
MAGI and the new household definitions will apply to:
Parents and Caretaker relatives;
Pregnant Women; and
Children under 19 years of age.
Existing eligibility requirements will continue to apply for other groups, including:
Individuals receiving Medicaid as a result of other federal or state assistance programs (Supplemental Security Income, Family Independence Temporary Assistance Program (FITAP), Foster Care);
Individuals age 65 or older;
Individuals claiming to be blind or disabled;
Individuals enrolled in Medicare; and
Individuals requiring long-term care or home and community-based services.
ACA also gives individuals the ability to compare and enroll in qualified health plans with the creation of insurance Exchanges (now referred to as "marketplaces" by HHS). Through the Exchange, individuals can find health plans that cover essential health care benefits equal to a typical employer health plan. Anyone may enroll in a health plan through the exchange. Exchange participants with income (individual or family unit, using the MAGI method) above 100% and up to 400% of the Federal Poverty Level may also be eligible for assistance with insurance premiums or out-of-pocket costs in the form of a tax credit.
Louisiana has elected for a federally-facilitated Exchange. If an individual is determined not to be eligible for Medicaid under MAGI and is not excluded from the MAGI methodology based on his/her eligibility group, the state will transfer the application to the Exchange for consideration of other health insurance programs.
Louisiana Medicaid will receive recipient and applicant data through a federal information "hub." This hub will be a single source of data from federal agencies such as the Social Security Administration, the Department of Homeland Security and the Internal Revenue Service. This information will be used to verify income, citizenship, and more. In some cases, applicants will not have to provide documentation, resulting in real-time eligibility decisions.
Visit www.healthcare.gov for the latest news on the Affordable Care Act.
New PRISM System Will Use Taxonomy Codes to Identify Provider Type, Specialty
Taxonomy codes will replace the "Provider Type/Specialty/Subspecialty" currently used in the Molina MMIS claims system when DHH transitions to its new system, PRISM (Provider Recipient Integrated System for Medicaid,) in fall 2014.
Taxonomy is a 10-character alphanumeric code used to identify provider type and area of specialization for health care providers. For example, 208D00000X is the taxonomy code for a General Practice Physician. Taxonomy codes are administered at the federal level by Health and Human Services (HHS).
During PRISM online enrollment, providers will choose a provider type and specialty. The PRISM system will display a taxonomy code(s) based on the information you entered. If you cannot enroll online and must enroll using paper, information will be provided in the Provider Enrollment Packets accessed through the Providers link on the PRISM website. Please note that paper enrollment could significantly delay payments to providers.
A complete list of taxonomy codes and descriptions are located at The Washington Publishing Company. This list is updated twice per year.
All taxonomy-related questions should be directed to the PRISM Provider Enrollment Unit using the "Request More Info" button on the right-hand side of the PRISM home page. Please submit your question and a Provider Enrollment specialist will respond to you promptly. Effective Feb. 28, providers also may call 1-888-780-7858 with taxonomy-related questions.
Medicaid Provider Q & A Calls Continue Each Wednesday
DHH staff is available to answer questions related to Medicaid, the Bayou Health Program and provide guidance to providers from all disciplines every Wednesday at noon via our weekly conference call.
Pre-registration is not required. To join the call:
1. Dial 1-888-278-0296
2. Enter Access Code - 6556479#
All callers will be in "Listen Only" mode at the beginning of each call as staff disseminate any necessary announcements. At the appropriate time, callers will be instructed how to "unmute" their line in order to ask a question.
Provider relations representatives from PRISM are currently participating in the call each Wednesday to address any questions relative to re-enrollment or other aspects of the PRISM transition.
Representatives from the five Bayou Health Plans are not required to participate in the weekly conference call. Providers are encouraged to contact the Health Plans directly with health plan specific issues. Informational Bulletin 12-27 at www.MakingMedicaidBetter.com provides guidance and contact information to escalate an issue up to the executive level for each health plan.
Questions related to specialized behavioral health will not be addressed on the Wednesday provider calls. Those questions can be brought up Thursdays at noon during a provider conference call hosted by Magellan of Louisiana. The call-in number is 1-888-205-5513. The access code is 827176.
State Health Secretary Selected for National Commission on Long-Term Care
Senate Republican Leader Mitch McConnell (R-Ky.) has selected Louisiana Department of Health and Hospitals Secretary Bruce D. Greenstein to be a member of the recently created National Commission on Long-Term Care. Greenstein is the only representative thus far from Louisiana appointed to the bipartisan, 15-member commission, which is tasked with studying how to effectively reform long-term care supports and services and submitting recommendations to Congress.
"I want to thank Leader McConnell for the opportunity to serve and offer a state-based perspective on this critical topic," Greenstein said. "In just 15 years, one in every five Americans will be aged 65 or older. They are aging into a system that spends hundreds of billions of dollars a year and delivers uneven results. We must work across state lines and levels of government to create a long-term system that meets their needs and looks like it was designed on purpose."
The Long-Term Care Commission will have six months once all appointments are made to examine how best to reform and restructure these services for the elderly and people who have disabilities and their caregivers, then develop a comprehensive report on recommended changes.
The commission will look at how long-term care is delivered, both in home/community and institutional settings, who provides these services and how they are funded, to better define the appropriate roles of Medicare, Medicaid and private insurance in covering long-term care.
The last time a national committee convened to review the country's long-term care system was the Pepper Commission, which was created more than 20 years ago. This Congress created the Long Term Care Commission in January as part of the American Taxpayer Relief Act of 2012 (H.R. 8), the bill package that avoided the fiscal cliff. The President and both Democratic and Republican Congressional leadership will appoint members to the commission. Commission members are selected to represent a variety of health care stakeholders, including recipients, providers, caregivers, insurance and state Medicaid programs.
Greenstein has extensive professional experience in the health care field, in both the public and private sectors. He previously served in the federal Department of Health and Human Services during the George W. Bush Administration, where he oversaw states' Medicaid programs and led the federal government's Medicaid state reform efforts. Prior to becoming DHH Secretary in 2010, he was Microsoft Corp's managing director of worldwide health.
Greenstein will not receive any compensation for his service on the commission, but will be reimbursed for necessary travel to participate in meetings, hearings and other commission activities.
Two state and congressional leaders focused on health care issues praised the appointment.
"As a physician and member of Congress, I recognize that there is perhaps no greater issue in health care policy than securing the future of our nation's aging population," said U.S. Congressman Bill Cassidy, LA-06. "I've been impressed by Bruce's tenure as Louisiana's health secretary, and his willingness to tackle tough issues which have no easy solutions and his resume of experience will be key assets as this commission tackles this complex issue."
"As a practicing optometrist and Chair of the Senate Health and Welfare Committee, I understand how important it is for Louisiana to be part of the vision in charting the course for our country's long-term health care system," said Sen. David Heitmeier. "With the high number of Baby Boomers in our state who will soon need many of these services, it is important that we make decisions now about how to best provide care to seniors and other people who need long-term supports. I am pleased Bruce will be a voice at the table on the national level to demonstrate Louisiana's health care leadership."
The director of the National Academy for State Health Policy (NASHP), where Greenstein currently serves as a member of the executive committee, also commended his appointment to the commission.
"States are at the forefront of providing needed long-term care services for America's elders and people with disabilities," said Alan Weil, executive director of NASHP. "I am thrilled that Secretary Greenstein will have a seat at the table for these very important discussions."
Responses to Long Term Services and Supports Request For Information Available Online
On November 29, 2012, the DHH issued a Request for Information (RFI) seeking creative, innovative and viable strategies that would assist Louisiana with restructuring the organization and delivery of Medicaid services to individuals receiving Medicaid-funded Long Term Services and Supports (LTSS).
By January 28, 2013, DHH received sixteen (16) responses from the following companies and non-profit organizations:
Aetna Better Health
Amerigroup Louisiana, Inc.
Community Health Solutions of Louisiana
The Council on Quality and Leadership
Louisiana Healthcare Connections
Louisiana Nursing Home Association
Magellan Health Services
UnitedHealthcare Community Plan
WellCare Health Plans, Inc.
Louisiana Health Care Quality Forum
Each response can be viewed on the website, www.MakingMedicaidBetter.com, under Medicaid News. The link is titled, "Responses to Long Term Services and Supports Request for Information."
By releasing the RFI and receiving responses, DHH has made no commitment to issuing a Request for Proposal (RFP) for LTSS.