On November 16, 2011, Louisiana Department of Health and Hospitals’ (“DHH”) Secretary Bruce Greenstein announced that the Centers for Medicare and Medicaid Services (“CMS”) had approved an amendment to Louisiana’s Medicaid State Plan to implement the Coordinated Care Networks (“CCN”) also known as “Bayou Health.” The movement by DHH toward CCNs began in February, 2011, when DHH issued a Notice of Intent to provide for the implementation of the CCNs. On June 20, 2011, DHH issued the final rules for the CCNs. DHH has since awarded contracts to five private insurers who will administer the CCNs. The Coordinated Care Network Program Prepaid (“CCN-P”) contracts were awarded to:
- Louisiana Healthcare Connections, Inc.
- Amerihealth Mercy of Louisiana, Inc.
- AmeriGROUP Louisiana, Inc.
The Coordinated Care Network Program Shared Savings (“CCN-S”) contracts were awarded to:
- UnitedHealthcare of Louisiana, Inc.
- Community Health Solutions of America, Inc.
The CCN-S is a fee-for-service with shared savings model. The CCN-S provides enhanced primary care case management and contracts with primary care providers to provide primary care. All providers can treat CCN-S patients, but only primary care providers can participate in shared savings. The CCN-P is a risk-bearing managed care organization model, which contracts with primary care physicians, as well as specialists, to participate in its managed care organization.
Implementation of the CCNs is in three phases, based on Geographic Service Area (“GSA”). The first GSA where the CCN will be implemented is Region 1, which includes the New Orleans area, and Region 9- St. Helena, Livingston, Tangipahoa, Washington, and St. Tammany Parishes. Phase 1 will begin on February 1, 2012. Phase 2 of the CCN implementation includes: Region 2- East and West Feliciana, East and West Baton Rouge, Point Coupee, Iberville, and Ascension Parishes. Phase 2 will go into effect April 1, 2012. Phase 3 will go live on June 1, 2012 and include the remaining parishes in the Southwest, Central and North Louisiana regions.
According to DHH, most of the state’s Medicaid and LaCHIP recipients (an estimated 865,000 of the current 1.2 million enrollees in Medicaid) are required to be enrolled in a CCN. The mandatory enrollees will be permitted to choose only one CCN. Choice letters are to be mailed to Medicaid recipients in GSA1 on December 15, 2011. If mandatory enrollees do not select a CCN, an enrollment broker or “choice counselor” will assist the enrollee in finding the CCN that best meets the enrollee’s priorities and preferences. An enrollee will be assigned to the CCN that his/her community care physician has joined. MAXIMUS Health Services Inc. has been awarded the contract to be the CCN enrollment broker. The mandatory recipients cannot be treated by providers who are not enrolled in a CCN unless it is an emergency or the services are not available within the CCN network. Medicaid providers are not obligated to join a CCN and can contract with as many CCNs as they so desire.