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LDH Resources
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Details:
- Medicaid
- Managed Care
Original Period Certified: July 2022 - June 2023 Actual Period Covered: July 2022 - December 2022 The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
Original Period Certified: January 2022 - December 2022 Actual Period Covered: January 2022 - June 2022 The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate, Act 421 Children's Medicaid Option (CMO), TEFRA
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
Original Period Certified: January 2022 - December 2022 Actual Period Covered: January 2022 - June 2022 The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate
Downloadable Assets:
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Details:
- Legislative & Governmental Relations
- Medicaid
- Managed Care
Managed Care 2.0 Amerigroup Healthy Blue AmeriHealth Caritas Louisiana Healthcare Connections UnitedHealthcare Community Plan Aetna Better Health This report is the seventh in a series produced by the Louisiana Department of Health (LDH or “the Department”) to satisfy statutory reporting requirements intended to ensure the following outcomes are being achieved by Louisiana’s Medicaid Managed Care Program (R.S. 40:1253.2): improved care coordination with patient-centered medical homes for Medicaid enrollees; improved health outcomes and quality of care; increased emphasis on disease prevention and the early diagnosis and management of chronic conditions; improved access to Medicaid services; improved accountability with a decrease in fraud, abuse and wasteful spending; and a more financially stable Medicaid program. Beginning in February of 2012, the original Medicaid Managed Care Program included two models of coordinated care networks: full-risk managed care organizations (MCOs) known as “prepaid health plans,” and primary care case management (PCCM) known as “shared savings plans.” The state contracted with three prepaid and two shared savings plans, and individuals were given the option of choosing the plan that best meet their needs. Not all Medicaid services were available from health plans, and some enrollees continued to receive certain services under the fee-for-service program. In addition, many individuals covered by Medicaid were not eligible to enroll in and receive services from a health plan. LDH has progressively integrated services and populations into the Medicaid Managed Care Program. The following timeline includes major milestones in the growth of the managed care program: Pharmacy benefits were “carved-in” to the prepaid plan benefit package on November 1, 2012. Dental benefits have been provided to all Medicaid populations by a single prepaid ambulatory health plan referred to as a “dental benefits program manager” (DBPM) since July 1, 2014. The delivery model was transitioned from three full-risk MCOs and two shared-savings PCCMs to five full-risk MCOs on February 1, 2015. Hospice benefits were added on February 1, 2015. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) - Personal Care Services were added on February 1, 2015. Retroactive linkages to a Medicaid managed care plan were implemented on February 1, 2015. Specialized behavioral health benefits were added on December 1, 2015. Non-emergency medical transportation and specialized behavioral health services were added on December 1, 2015 for enrollees not entitled to receive physical health services through a MCO. Eligibility for Medicaid services was expanded to include the new adult population on July 1, 2016. Transparency Report Measures and Data This report includes 31 areas of measurement outlined in La. Revised Statute 40:1253.2. This report covers program operations for July 2019 through June 2020 (State Fiscal Year 2020), except for the following measures which are reported on a calendar year basis per the contract between the Department and the managed care entities: Section 7 – Medical Loss Ratio Section 8 – Health Outcomes Section 9 – Member and Provider Satisfaction Surveys Section 10 – Audited Financial Statements The State Fiscal Year 2020 presentation of this report has been updated to consolidate all data elements regarding the Dental Benefits Program into Sections 30 – 40. Information included in this report was collected from multiple sources. To the greatest extent possible, the data are extracted from state systems that routinely collect and maintain operational data on the Medicaid Managed Care Program. When unavailable from state sources, data were collected from the managed care entities or sourced from either routine reporting deliverables1 or ad hoc reports requested specifically for this purpose. The Medicaid Management Information System (MMIS) and the Management Administrative Reporting Subsystem (MARS Data Warehouse or MDW) are maintained by the Medicaid program’s contracted fiscal intermediary, DXC Technologies (DXC), formerly Molina Healthcare. Detailed enrollee and provider information, as well as claims payment data for this report, were extracted from the MARS data warehouse. The state administrative system, called ISIS, maintained by the Office of Technology Services within the Division of Administration, was used to extract information on payments to the MCOs and Dental Benefits Plan Manager. As part of routine operations and as required by the Centers for Medicare and Medicaid Services (CMS), internal policies and procedures for collection of data were validated by the Department’s contracted External Quality Review Organization (EQRO), Island Peer Review Organization (IPRO). In addition to standing operational quality assurances and EQRO reviews, the data included in this report were independently validated by Myers and Stauffer, an audit contractor of the Department. Myers and Stauffer reviewed for reasonability the data extraction code or process that the managed care entities or the Department used to generate data. For data originating from the MARS Data Warehouse or MMIS, Myers and Stauffer generated its own data from encounters or data extracts for each plan and compared its results to the results the Department produced. For data originating from the plans, Myers and Stauffer (MSLC) reviewed plan responses to a survey developed by Myers and Stauffer to document the process the plans used to generate the data, as well as policies and procedures in place to collect, track and report data. Where Myers and Stauffer found inconsistencies above or below the 10% variance threshold established by the Department, they made recommendations to the Department and/or the health plan to improve the method used to collect data. See Appendices XIX and XX for the survey instruments.
Downloadable Assets:
2020 Managed Care Transparency Report Appendix I. Total Number of Health Care Providers (Section 4) Appendix II. Primary Care Service Providers (Section 5) Appendix III. Contracted Providers with Closed Panels (Section 6) Appendix IV. Member Satisfaction Surveys (Section 9) 1. Aetna Appendix IV. Member Satisfaction Surveys (Section 9) 2. AmeriHealth Caritas Louisiana Appendix IV. Member Satisfaction Surveys (Section 9) 3. Healthy Blue Appendix IV. Member Satisfaction Surveys (Section 9) 4. Louisiana Healthcare Connections Appendix IV. Member Satisfaction Surveys (Section 9) 5. UnitedHealthcare Appendix V. Provider Satisfaction Surveys (Section 9) Appendix VI. Annual Audited Financial Statements (Section 10) 1. Aetna Appendix VI. Annual Audited Financial Statements (Section 10) 2. AmeriHealth Caritas Louisiana Appendix VI. Annual Audited Financial Statements (Section 10) 3. Healthy Blue Appendix VI. Annual Audited Financial Statements (Section 10) 4. Louisiana Healthcare Connections Appendix VI. Annual Audited Financial Statements (Section 10) 5. UnitedHealthcare Appendix VII. Number of enrollees who received services from each Managed Care Organization (Section 14) Appendix VIII. Total number of denied claims (Section 19) Appendix IX. Claims paid to out-of-network providers (Section 22) Appendix X. Pharmacy benefits by month (Section 24) Appendix XI.Pharmacy claims denied after authorization (Section 24) Appendix XII. PBM and drug rebate-monthly data (Section 25) Appendix XIII. Adult Expansion Population (Section 26-29) Appendix XIV. Total Number of healthcare providers contracted - DBPM (Section 33) Appendix XV. Member and Provider Satisfaction Surveys - DBPM (Section 34) Appendix XVI. Annual audited financial statement - DBPM (Section 35) Appendix XVII. Total Number of Denied Claims - DBPM (Section 39) Appendix XVIII. Prior Authorization Denials - DBPM (Section 41) Appendix XIX. Myers and Stauffer MCO survey instrument Appendix XX. Myers and Stauffer MCNA survey instrument -
Details:
- Medicaid
- Managed Care
Original Period Certified: January 2021 - December 2021 Actual Period Covered: January 2021 - December 2021 The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
The Louisiana Department of Health (LDH) Medicaid issued a Request for Proposals (RFP) for qualified Managed Care Organizations (MCO) to provide high quality healthcare services statewide to enrollees in the Louisiana Medicaid Managed Care Program, a full risk-bearing health care delivery system. Due to the size, impact and importance of of this RFP, LDH conducted a second scoring session with a new independent team to confirm results. Keywords: Managed Care 3.0, RFP 3000017417, Aetna Better Health, ABH, Healthy Blue, HBL, AmeriHealth Caritas, ACLA, Louisiana Healthcare Connections, LHCC, UnitedHealthcare Community Plan, UHC, Humana Healthy Horizons, HHH
Downloadable Assets:
Request for Proposals (RFP) RFP Attachment C: MCO Covered Services RFP Attachment E: APM Strategic Plan Requirements and Reporting Template RFP Attachment F: Provider Network Standards RFP Attachment G: Table of Monetary Penalties RFP Attachment H: Quality Performance Measures RFP Attachment I: LDH Standard Contract Form (CF-1) RFP Exhibit A: Certification Statement RFP Exhibit B: Material Subcontractor Response Template RFP Exhibit C: Proposal Compliance Matrix RFP Exhibit D: Medicaid Ownership and Disclosure Form RFP Addendum 4: Proposer Inquiries RFP Addendum 5: Schedule of Events Aetna Better Health - Proposal Aetna Better Health - Proposal - Appendix A - Exhibit B: Material Subcontractor Response Template Aetna Better Health - Proposal - Appendix B - Audited Financial Statements Aetna Better Health - Proposal - Appendix C - Exhibit D: Ownership and Disclosure Form Aetna Better Health - Proposal - Quality Response Template NCQA Ratings Aetna Better Health - Proposal - Hudson and Veterans Initiative Response Template AmeriHealth Caritas - Proposal Healthy Blue - Proposal Humana - Proposal Louisiana Healthcare Connections - Proposal UnitedHealthcare Community Plan - Proposal Aetna Better Health - Letter to Proposer AmeriHealth Caritas - Letter to Proposer Healthy Blue - Letter to Proposer Humana - Letter to Proposer Louisiana Healthcare Connections - Letter to Proposer UnitedHealthcare Community Plan - Letter to Proposer Evaluation Documents - Summary Scoresheet - First Team Evaluation Documents - Summary Scoresheet - Second Team Hudson and Veterans Initiative Response Template - Procurement Library Louisiana Medicaid MCO RFP Data Use Agreement - Procurement Library Quality Response Template - Procurement Library Question and Answer Submission Template - Procurement Library Healthy Louisiana Data Book - Procurement Library Healthy Louisiana Data Book Exhibits - Procurement Library Louisiana Medicaid Preferred Language Statewide - Procurement Library OPH Population Health Resources - Procurement Library Potential Enrollment - Procurement Library Chisholm Compliance Guide - Procurement Library DOJ Agreement Compliance Guide - Procurement Library Financial Reporting Guide - Procurement Library Justice-Involved Pre-Release Enrollment Program Manual - Procurement Library Marketing and Member Education Companion Guide - Procurement Library MCO Manual - Procurement Library MCO Quality Companion Guide - Procurement Library MCO System Companion Guide - Procurement Library Batch Pharmacy Encounter System Companion Guide - Procurement Library Medicaid 834 Benefit and Enrollment Transaction Set Companion Guide - Procurement Library State Fair Hearing Companion Guide - Procurement Library Criminal History Records Check of Applicants and Employees - Procurement Library CMS Interoperability and Patient Access Rule - Procurement Library Geo Access Mapping 3.0 (#348) - Geo Access Mapping Attestation Form Geo Access Mapping 3.0 (#348) - Geo Access Mapping Reporting Template Financial Reporting Requirements - Agreed Upon Procedures -
Details:
- Medicaid
Keywords: HCBS, Procurement, RFP, Home and Community Based Services
Downloadable Assets:
RFP Document RFP Addendum 1 - Schedule of Events RFP Addendum 2 - Notification of Protest RFP Addendum 3 - Revised Schedule of Events RFP Addendum 4 - Lift of Stay RFP Addendum 5 - Revised Schedule of Events RFP Addendum 6 - Revised Schedule of Events RFP Addendum 7 - Revised Schedule of Events RFP Attachment G Revised 6.21.2021 RFP Addendum 8 - Written Q & A RFP Exhibit 36 - Major Record Data Counts RFP Exhibit 37 - Path to Employment Questions RFP Exhibit 38 - Data from Current HCBS EVV System RFP Exhibit 39 - OCDD Plan of Care Documents RFP Exhibit 40 - EVV Policy RFP Exhibit 41 - HHCS Record and Data Counts 8.26.21 RFP Addendum 9 - Revised Schedule of Events RFP Addendum 10 - Additional Written Q&A RFP Exhibit 42 - Sample Mailings Required by Contractor Updated 10.12.21 RFP Addendum 11 - Administrative Error Procurement Library - TMSIS Data Elements (OAAS-OCDD) Procurement Library - EPSDT Comprehensive Plan of Care Procurement Library - EPSDT Data Fields Procurement Library - CMS EVV Outcomes Based Certification Criteria Procurement Library - New Opportunities Waiver Flexing Units Procurement Library - OCDD Sharing Across Waivers Detail Procurement Library - Adult Day Health Care Fact Sheet Procurement Library - Adult Day Health Care Fee Schedule Procurement Library - Adult Day Health Care Provider Manual Procurement Library - Adult Day Health Care Waiver Application Procurement Library - Children's Choice Fact Sheet Procurement Library - Children's Choice Fee Schedule Procurement Library - Children's Choice Waiver Application Procurement Library - Children's Choice Waiver Provider Manual Procurement Library - Community Choices Waiver Application Procurement Library - Community Choices Waiver Fact Sheet Procurement Library - Community Choices Waiver Fee Schedule Procurement Library - Community Choices Waiver Provider Manual Procurement Library - EPSDT Support Coordination Handbook Procurement Library - Long Term Personal Care Services and EPSDT Provider Manual Procurement Library - Long Term Personal Care Services Fact Sheet Procurement Library - Long Term Personal Care Services Fee Schedule Procurement Library - New Opportunities Waiver Application Procurement Library - New Opportunities Waiver Fact Sheet Procurement Library - New Opportunities Waiver Fee Schedule Procurement Library - New Opportunities Waiver Provider Manual Procurement Library - Residential Options Waiver Application Procurement Library - Residential Options Waiver Fact Sheet Procurement Library - Residential Options Waiver Fee Schedule Procurement Library - Residential Options Waiver Provider Manual Procurement Library - Supports Waiver Application Procurement Library - Supports Waiver Fact Sheet Procurement Library - Supports Waiver Fee Schedule Procurement Library - Supports Waiver Provider Manual -
Details:
- Medicaid
- Managed Care
Original Period Certified: January 2021 - December 2021 Actual Period Covered: Replaced by July 21, 2021 certification. The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
Original Period Certified: July 2020 - December 2020 Actual Period Covered: July 2020 - December 2020 Expansion and Non-Expansion Rate Certification Addendum The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. 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 state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. 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. Keywords: Managed Care 2.0, Capitation Rate
Downloadable Assets:
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Details:
- Medicaid
Fee-for-Service Transportation Broker Executed Contract
Downloadable Assets:
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Details:
- Medicaid
Keywords: RFP 3000011897
Downloadable Assets:
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Details:
- Medicaid
- Managed Care
Louisiana Medicaid managed care contractors must meet the requirements of their contracts with LDH. If a contractor is non-compliant with contract requirements, LDH may apply administrative actions or assess monetary penalties and intermediate sanctions to obtain the level of performance required for successful operation of the managed care program. Links to archived information related to expired contracts can be found here. Keywords: MCO, health plan, noncompliance, administrative actions, archive, contract, 2.0, non-compliance
Downloadable Assets:
Aetna Better Health Archive Actions January 1, 2020 – December 31, 2022 Aetna Better Health Archive Actions February 1, 2015 – December 31, 2019 AmeriHealth Caritas Archive Actions January 1, 2020 – December 31, 2022 AmeriHealth Caritas Archive Actions February 1, 2015 – December 31, 2019 Healthy Blue Archive Actions January 1, 2020 – December 31, 2022 Healthy Blue Archive Actions February 1, 2015 – December 31, 2019 Louisiana Healthcare Connections Archive Actions January 1, 2020 – December 31, 2022 Louisiana Healthcare Connections Archive Actions February 1, 2015 – December 31, 2019 United Healthcare Archive Actions January 1, 2020 – December 31, 2022 United Healthcare Archive Actions February 1, 2015 – December 31, 2019 Dental Benefit Program Manager Archive Actions MCNA