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LDH Resources
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Details:
- Medicaid
The Louisiana Department of Health is issuing this RFI for the purpose of gathering information and cost estimates from qualified entities with demonstrated capacity and experience to administer and operate a consolidated Call Center. The information gathered will help inform LDH in developing a comprehensive Scope of Services for a potential future Request for Proposal (RFP).
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- Medicaid
- Managed Care
The Louisiana Department of Health (LDH) has issued a request for information (RFI) for the purpose of gathering information and cost estimates from qualified entities with demonstrated capacity and experience to administer dental administrative services through a third-party administrator (TPA) model. The information gathered will help inform LDH in developing a comprehensive scope of services for a potential future request for proposals (RFP). The third-party dental administrator would be responsible for efficient utilization management, care coordination, provider recruitment and improving oral health outcomes. Other potential roles include, provider network management, claims processing, data and technology integration, and enrollee services.
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- Managed Care
RFP #, DBPM 3.0 (1/1/2021 - present) DentaQuest (DQ) and Managed Care of North America (MCNA)
Downloadable Assets:
DQ Contract DQ Amd 1 DQ Amd 2 DQ Amd 3 DQ Amd 4 DQ Amd 5 DQ Amd 6 DQ Amd 7 DQ Amd 8 DQ Amd 9 DQ Amd 10 DQ Amd 11 DQ Amd 12 DQ Amd 13 DQ Amd 14 MCNA Contract MCNA Amd 1 MCNA Amd 2 MCNA Amd 3 MCNA Amd 4 MCNA Amd 5 MCNA Amd 6 MCNA Amd 7 MCNA Amd 8 MCNA Amd 9 MCNA Amd 10 MCNA Amd 11 MCNA Amd 12 MCNA Amd 13 DQ Amd 15 MCNA Amd 14 MCNA Amend 15 -
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- Medicaid
- Managed Care
Keywords: RFP 3000017417, Managed Care 3.0, Aetna Better Health, ABH, Healthy Blue, HBL, AmeriHealth Caritas, ACLA, Louisiana Healthcare Connections, LHCC, UnitedHealthcare Community Plan, UHC, Humana Healthy Horizons, HHH
Downloadable Assets:
ABH Original ABH Amd 1 ABH Amd 2 ABH Amd 3 ABH Amd 4 ABH Amd 5 ABH Amd 6 ABH Amd 7 ABH Amd 8 ACLA Original Contract ACLA Amd 1 ACLA Amd 2 ACLA Amd 3 ACLA Amd 4 ACLA Amd 5 ACLA Amd 6 ACLA Amd 7 ACLA Amd 8 HBL Original Contract HBL Amd 1 HBL Amd 2 HBL Amd 3 HBL Amd 4 HBL Amd 5 HBL Amd 6 HBL Amd 7 HBL Amd 8 HHH Original Contract HHHAmd 1 HHH Amd 2 HHH Amd 3 HHH Amd 4 HHH Amd 5 HHH Amd 6 HHH Amd 7 HHH Amd 8 LHCC Original Contract LHCC Amd 1 LHCC Amd 2 LHCC Amd 3 LHCC Amd 4 LHCC Amd 4 LHCC Amd 5 LHCC Amd 6 LHCC Amd 7 UHC Original Contract UHC Amd 1 UHC Amd 2 UHC Amd 3 UHC Amd 4 UHC Amd 5 UHC Amd 6 UHC Amd 7 UHC Amd 8 Att A: Model Contract ABH Amd 10 ACLA Amd 10 HBL Amd 10 HUM Amd 10 LHCC Amd 10 UHC Amd 10 ABH Amendment 9 ACLA Amendment 9 HBL Amendment 9 HUM Amendment 9 LHCC Amendment 9 UHC Amendment 9 ABH Amend 11 ACLA Amend 11 Healthy Blue Amend 11 Humana Amend 11 LHCC Amend 11 UHC Amend 11 ABH Amend 12 ACLA Amend 12 HBL Amend 12 HUM Amend 12 LHCC Amend 12 UHC Amend 12 -
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- Medicaid
- Managed Care
- Pharmacy
Keywords: RFP #:3000018331
Downloadable Assets:
Original RFP Document Addendum 1 - Schedule of Events Addendum 2 - Schedule of Events Revised Addendum 3 - Schedule of Events Revised Addendum 4 - Questions and Answers Addendum 5 - CF-1 MCO Manual - Procurement Library MCO Model Contract - Procurement Library Batch Pharmacy Encounter System Companion Guide - Procurement Library MCO Quality Companion Guide - Procurement Library MCO System Companion Guide - Procurement Library Financial Reporting Guide - Procurement Library Marketing and Member Education Guide - Procurement Library Medicaid 834 Benefit and Enrollment Transaction Set Companion Guide - Procurement Library State Fair Hearing Companion Guide - Procurement Library Rx054-PBM Report - Procurement Library Rx055-Pharmacy Report - Procurement Library Rx162-Drug Utilization Review Report - Procurement Library Rx165-Lock-In Report - Procurement Library Rx175-Hep C Report - Procurement Library Rx178-BH and SUD - Procurement Library MCO Historical Table - Procurement Library Q&A Submission Template - Procurement Library Hudson and Veterans Initiative Response Template - Procurement Library Criminal History Records Check of Applicants and Employees - Procurement Library CMS Interoperability and Patient Access Rule - Procurement Library PDL - Procurement Library - Procurement Library Diagnosis Code Chart - Procurement Library State plan reimbursement pages - Procurement Library Medicaid Managed Care Transparency Report - Procurement Library Drug Utilization Review Program Health Plan Advisory - Procurement Library LDH Medicaid POS User Guide - Procurement Library MCO Data - Procurement Library OTS Enterprise Architecture and System Development Requirements - Procurement Library CVS Health - Redacted Technical Proposal Magellan Medicaid Administration, Inc - Redacted Technical Proposal MedImpact Healthcare Systems, Inc - Redacted Technical Proposal -
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- Medicaid
- Managed Care
At the end of 2020, LDH requested input on key elements of the Medicaid managed care contracts. This included feedback on the following areas: Behavioral health integration Child and maternal health outcome improvement Delivery system reform Disaster planning and recovery Department of Justice settlement agreement requirements Fraud, waste, and abuse initiatives Health equity Increased MCO accountability Keywords: Managed Care 3.0, Aetna Better Health, ABH, AmeriHealth Caritas, ACLA, Healthy Blue, HBL, Louisiana Healthcare Connections, LHCC, UnitedHealthcare Community Plan, (UHC)
Downloadable Assets:
Aetna Better Health Feedback AmeriHealth Caritas Louisiana Baton Rouge Neonatal Associates, Inc. - Infamedics Behavioral Health Group Center for Hope Children and Family Services, LLC Coalition of Louisiana Addiction Service & Prevention Providers (CLASPP) Community Pharmacists' Impact on Healthcare Spending Community Pharmacy Care Management Easterseals Louisiana Franciscan Missionaries of Our Lady Health System Gina Lindsey - Behavioral Health Provider Green and Healthy Homes Initiative Greenpath International Inc Healthy Blue HousingLOUISIANA Housing NOLA Humana Health Benefit Plan of Louisiana, Inc. Iberia Pediatrics Integrated Community Pharmacy Medication Use Support Services Louisiana Addiction Treatment Providers (LATP) Louisiana Center for Health Equity Louisiana Chapter of the American Academy of Pediatrics Louisiana Commission on Perinatal Care and Prevention of Infant Mortality Louisiana Community Pharmacy Enhanced Services Network Louisiana Independent Pharmacies Association Louisiana Partnership for Children and Families Louisiana Psychiatric Medicine Association Louisiana Public Health Institute & Partnership for Achieving Total Health Louisiana Rural Mental Health Alliance Louisiana State Medical Society Maternal Fetal Medicine MD Merakey Pennsylvania Odyssey House Louisiana (OHL) Office of Public Health-Bureau of Family Health (OPH-BFH) Unite Us UnitedHealthcare Community Plan of Louisiana Volunteers of America Southeast Louisiana -
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- Medicaid
- Managed Care
Request for Proposals (RFP) for Managed Care Single Transportation Broker and Fee-for-Service Transportation Broker MediTrans, One Bunch, Southeastrans, Veyo, We Lift
Downloadable Assets:
Single Transportation Broker RFP MediTrans Proposal Response - Technical Business Proposal (Redacted) MediTrans Proposal Response - Hudson and Veteran Initiative Response One Bunch Proposal Response Southeastrans Proposal Response - Business and Technical Proposal (Redacted) Southeastrans Proposal Response - Proposal Coversheet and Addenda Southeastrans Proposal Response - Appendix A Southeastrans Proposal Response - Appendix B (Redacted) Southeastrans Proposal Response - Appendix B (Redacted) Southeastrans Proposal Response - Appendix C Southeastrans Proposal Response - Appendix D Southeastrans Proposal Response - Appendix E (Redacted) Southeastrans Proposal Response - Appendix F (Redacted) Southeastrans Proposal Response - Appendix G Veyo Proposal Response - Technical and Business Proposal (Redacted) Veyo Proposal Response - 2017 and 2018 Audited Financial Statements (Redacted) Veyo Proposal Response - 2019 and 2020 Audited Financial Statements (Redacted) We Lift Proposal Response - Business Proposal We Lift Proposal Response - Cost Proposal We Lift Proposal Response - Cover Letter We Lift Proposal Response - Table of Contents We Lift Proposal Response - Technical Proposal Single Transportation Broker RFP Technical Evaluation Attachment A, Certification Statement - Procurement Library Attachment B, Proposal Compliance Matrix - Procurement Library Attachment C, Electronic Vendor Payment Solution - Procurement Library Hudson and Veterans Initiative Response Template - Procurement Library Louisiana Medicaid Transportation Broker RFP Data Use Agreement - Procurement Library Louisiana Medicaid 837 Health Care Claim Companion Guides - NEAT - - Procurement Library Louisiana Medicaid 837 Health Care Claim Companion Guides - NEMT (non-ambulance) - Procurement Library Louisiana Medicaid HIPAA 5010A General Companion Guide - Procurement Library MCO Manual - Procurement Library MCO System Companion Guide - Procurement Library Medicaid Services Manual (Medical Transportation chapter) - Procurement Library Fee for Service Call Center Metrics - Procurement Library Managed Care Organization Call Center Metrics - Procurement Library Addendum 1 - Schedule of Events - Procurement Library Addendum 2 - Schedule of Events - Procurement Library Addendum 3 - Propose Inquiries - Procurement Library -
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- 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 -
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- 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
Keywords: RFP 3000011897
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Details:
- Medicaid
- Managed Care
DBPM RFP 2019
Downloadable Assets:
Rural Parish Map - DBPM Procurement Library 2019 Dental Services Manual - DBPM Procurement Library 2019 Grievance, Appeal and State Fair Hearing Report - DBPM Procurement Library 2019 State Fair Hearing Companion Guide - DBPM Procurement Library 2019 DBPM Systems Companion Guide - DBPM Procurement Library 2019 Financial Reporting Guide Instructions - DBPM Procurement Library 2019 Financial Reporting Template - DBPM Procurement Library 2019 Financial Reporting Guide - Annual Disclosures - DBPM Procurement Library 2019 Louisiana Standardized Credentialing Application Form - DBPM Procurement Library 2019 Council for Affordable Quality Healthcare (CAQH) standardized credentialing form - DBPM Procurement Library 2019 Monthly Member Education Reporting Template - DBPM Procurement Library 2019 Reporting Templates - DBPM Procurement Library 2019 Medicaid Ownership and Disclosure Form - DBPM Procurement Library 2019 LDH Policy 47.1 - Criminal History Records Check of Applicants and Employees - DBPM Procurement Library 2019 Data Use Agreement - DBPM Procurement Library 2019 Dental Benefit Program - Enrollee Handbook Templates - DBPM Procurement Library 2019 Question and Answer Submission Template - DBPM Procurement Library 2019 DentaQuest USA - Business Proposal (Redacted) - DBPM RFP 2019 DentaQuest USA - Compliance Matrix - DBPM RFP 2019 DentaQuest USA - Certification Statement - DBPM RFP 2019 DentaQuest USA - Veteran Initiative and Hudson Small Entrepreneurship Program - DBPM RFP 2019 DentaQuest USA - Appendix VII Medicaid Ownership Disclosure Form (redacted) - DBPM RFP 2019 DentaQuest USA - Appendix V Electronic Vendor Payment Solution - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2016 DentaQuest LLC Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2016 DentaQuest USA Insurance Company Inc. STAT Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2017 DentaQuest LLC Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2017 DentaQuest USA Insurance Company Inc. STAT Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2018 DentaQuest LLC Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Audited Financial Statements - 2018 DentaQuest USA Insurance Company Inc. STAT Audited Financial Statements - DBPM RFP 2019 DentaQuest USA - Louisiana DOI Certificate of Authority - DBPM RFP 2019 DentaQuest USA - Board Resolution - DBPM RFP 2019 DentaQuest USA - Medicaid Dental Litigation (redacted) - DBPM RFP 2019 DentaQuest USA - Organizational Chart (redacted) - DBPM RFP 2019 DentaQuest USA - Medicaid Dental Benefit Program Implementation Plan (redacted) - DBPM RFP 2019 DentaQuest USA - Actuarial Value of Proposed Value Added Services (redacted) - DBPM RFP 2019 DentaQuest USA - Subcontractor Commitment Letters (redacted) - DBPM RFP 2019 DentaQuest USA - Regulatory Actions (redacted) - DBPM RFP 2019 Liberty Dental Plan Proposal - DBPM RFP 2019 MCNA Proposal - DBPM RFP 2019 Summary Scoresheet - DBPM RFP 2019 MCNA Original Contract MCNA Amendment 1 MCNA Amendment 2 -
Details:
- Medicaid
Keywords: RFP # 30000012241
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