Mercer Rate Letters

About Rate Certification Letters

  • The Louisiana Department of Health (LDH) has contracted with Mercer Government Human Services Consulting to develop actuarially sound capitation rate ranges for the Healthy Louisiana program (formerly Bayou Health).
  • Rate certification letters certify universal rates for a given time period, e.g., a contract year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCOs), as the actual rates are MCO-specific, reflecting the universal rates in the rate letter adjusted for the health risk of each MCO’s unique membership.
  • Original rate letters are often replaced with revised rate letters for the same time period. Revisions are necessary whenever there are programmatic changes (e.g., changes in services or populations covered) that impact rates effective within the original rate letter time period. Revisions may cover the entire period or only part of the period (going forward from the effective date of a program change prior to the end the period).
  • Sometimes a rate letter is supplemented with an issue-specific companion certification. For example, the Affordable Care Act (ACA) Primary Care Physician (PCP) enhanced payment, which was an add-on to PMPMs paid in 2013 and 2014 as required by Section 1202 of the Affordable Care Act, had its own certification letter.
  • Actual rates paid to the MCOs can change independent of the rate letter. Specifically, rates are risk adjusted twice a year. If there are no program changes during the rate period, then the original rate letter would stand while the original rates would be replaced with the mid-year risk adjusted rates.

 

NOTES FOR UNDERSTANDING THE TABLES BELOW:

* All published rate certifications are provided in the tables below.  Any rate certification that was subsequently revised and superseded by another rate certification is noted with “Not applicable” or the date of the replacement certification in the column labeled “Actual Period Covered” and shaded in light gray.

* When the “Actual Period Covered” differs from the “Original Period Certified,” the revised end date for the “Actual Period Covered” is displayed in red, italic text.

 

 

Healthy Louisiana / Bayou Health 2.0 (Feb 2015 – Jan 2018)

Risk-bearing MCO Rate Certification Letters

Certification Date

Original Period Certified

Actual Period Covered

March 13, 2017 February 2017 – January 2018 February 1, 2017 - present
February 17, 2017 December 2015 December 2015
SPECIALIZED BEHAVIORAL HEALTH
February 17, 2017 December 2015 December 2015
NEMT SERVICES
February 17, 2017 December 2015 December 2015
PHYSICAL HEALTH
February 17, 2017 July 2015 – November 2015 July 1, 2015 – November 30, 2015
February 17, 2017 February 2015 – June 2015

February 1, 2015 – June 30, 2015

September 13, 2016 December 2015 – January 2016 January 2016                             SPECIALIZED BEHAVIORAL HEALTH
September 13, 2016 December 2015 – January 2016 January 2016
NEMT SERVICES
September 13, 2016 December 2015 – January 2016 January 2016
PHYSICAL HEALTH
September 12, 2016 July 2016 – January 2017 July 1, 2016 – present
NON-EXPANSION
September 12, 2016 February 2016 – January 2017 February 1, 2016 – June 30, 2016

July 15, 2016

July 2016 – January 2017

July 1, 2016 – January 31, 2017
EXPANSION ONLY

February 26, 2016

February 2016 – January 2017

Replaced by September 12, 2016 certification

November 20, 2015

December 2015 – January 2016

Replaced by February 17, 2017 certification

November 4, 2015

December 2015 – January 2016

Replaced by February 17, 2017 certification

October 15, 2015

December 2015 – January 2016

Replaced by February 17, 2017 certification

October 12, 2015

July 2015 – January 2016

Replaced by February 17, 2017 certification

October 15, 2015

February 2015 – January 2016

Replaced by February 17, 2017 certification

August 11, 2015

July 2015 – January 2016

Replaced by October 12, 2015 certification

January 31, 2015

February 2015 – January 2016

Replaced by October 15, 2015 certification

August 29, 2014

February 2015 – January 2016

Replaced by January 31, 2015 certification

 

Family Planning Addendum

Certification Date

Original Period Certified

Actual Period Covered

April 15, 2016

February 2016 – January 2017

February 1, 2016 - present

March 23, 2015

February 2015 – January 2016

February 1, 2015 – January 31, 2016

 

Bayou Health 1.0 (Feb 2012 – Jan 2015)

Prepaid Rate Certification Letters

Certification Date

Original Period Certified

Actual Period Covered

November 6, 2014

September 2014 – January 2015

September 1, 2014 – January 31, 2015

November 6, 2014

July 2014 – August 2014

July 1, 2014 – August 31, 2014

November 6, 2014

April 2014 – June 2014

April 1, 2014 – June 30, 2014

September 17, 2014

September 2014 – January 2015

Not applicable

August 8, 2014

July 2014 – January 2015

Not applicable

December 19, 2013

January 2014 – June 2014

January 1, 2014 – March 31, 2014

November 6, 2013

July 2013 – December 2013

July 1, 2013 – December 31, 2013

June 28, 2013

July 2013 - December 2013

Not applicable

January 17, 2013

January 2013 – June 2013

January 1, 2013 – June 30, 2013

January 14, 2013

January 2013 – June 2013

Not applicable

October 15, 2012

November 2012 – December 2012

November 1, 2012 – December 31, 2012

September 14, 2012

November 2012 – December 2012

Not applicable

September 14, 2012

August 2012 – December 2012

August 1, 2012 – October 31, 2012

September 10, 2012

October 2012 – December 2012

Not applicable

August 10, 2012

August 2012 – December 2012

Not applicable

July 11, 2012

July 2012 – December 2012

July 1, 2012 – July 31, 2012

January 25, 2012

February 2012 – December 2012

February 1, 2012 – June 30, 2012

June 15, 2011

January 2012 – December 2012

Not applicable

April 8, 2011

January 2012 – December 2012

Not applicable

 

Affordable Care Act (ACA) Primary Care Physician (PCP) Add-On

Certification Date

Original Period Certified

Actual Period Covered

August 8, 2014

July 2014 – December 2014

July 1, 2014 – December 31, 2014

April 1, 2014

January 2014 – December 2014

January 1, 2014 – June 30, 2014

December 23, 2013

January 2014 – June 2014

Not applicable

November 6, 2013

July 2013 – December 2013

July 1, 2013 – December 31, 2013

November 6, 2013

January 2013 – June 2013

January 1, 2013 – June 30, 2013

 

Family Planning Addendum

Certification Date

Original Period Certified

Actual Period Covered

March 23, 2015

February 2015 – January 2016

February 1, 2015 – January 31, 2016

April 3, 2015

September 2014 – January 2015

September 1, 2014 – January 31, 2015

April 3, 2015

July 2014 – August 2014

July 1, 2014 – August 31, 2014

April 3, 2015

April 2014 – June 2014

April 1, 2014 – June 30, 2014

December 3, 2014

September 2014 – January 2015

Not applicable

August 8, 2014

July 2014 – January 2015

July 1, 2014 – March 31, 2014

July 24, 2014

January 2014 – June 2014

January 1, 2014 – June 30, 2014

November 6, 2013

July 2013 – December 2013

July 1, 2013 – December 31, 2013

November 6, 2013

January 2013 – June 2013

January 1, 2013 – June 30, 2013

November 7, 2013

November 2012 – December 2012

November 1, 2012 – December 31, 2012

 

Shared Savings Benchmark Letters

Benchmark Letter  Date

Original Period

Actual Period Covered

March 24, 2015

July 2014 - January 2015

July 1, 2014 - January 31, 2015

April 25, 2014

January 2014 – June 2014

January 1, 2014 – June 30, 2014

February 28, 2014

July 2013 – December 2013

July 1, 2013 – December 31, 2013

February 28, 2014

February 2013 – June 2013

February 1, 2013 – June 30, 2013

June 20, 2013

February 2013 – June 2013

Not applicable

April 30, 2013

January 2013

January 1, 2013 – January 31, 2013

August 22, 2012

August 2012 - December 2012

August 2012 - December 2012

January 31, 2012

February 2012 – December 2012

February 2012 – July 2012

June 15, 2011

January 2012 – December 2012

Not applicable

April 8, 2011

January 2012 – December 2012

Not applicable