Managed LTSS Program
In August 2013, the Louisiana Department of Health and Hospitals (DHH) released a concept paper outlining the initial steps in a process to better manage LTSS in Louisiana. The document provides the initial framework for a discussion with consumers, community members, advocates and the public about the best path forward for implementing MLTSS in Louisiana. (Source: DHH website)
In February 2014, DHH released a MLTSS Implementation Concept Brief to describe its research into states’ MLTSS best practices and solicit feedback about building a framework for transformation to MLTSS. (Source: State website)
Concept Brief
On November 19, 2014, the Louisiana Department of Health and Hospitals (DHH) announced it will fully integrate specialized behavioral health services for Medicaid populations into Bayou Health effective December 1, 2015. Behavioral health services are currently provided by the Louisiana Behavioral Health Partnership (LBHP). The LBHP is also responsible for coordinating behavioral health services for certain non-Medicaid populations; DHH will work with stakeholders to develop a smaller scope management arrangement for these services.
Additionally, the state is planning to implement MLTSS for individuals with age-related or developmental disabilities. Individuals who will receive supports and service through the planned MLTSS will also receive behavioral health services through their network of managed care providers and coordinators. (Source: Louisiana DHH website, 11/19/2014)
On May 6, 2015, the New Orleans Advocate reported that an April 2015 Louisiana Legislative Auditor found the state’s wait time for HCBS (ranging from 2.5 to 10 years) to be significantly longer than the national average (which ranges from 10 to 13 months). The audit was published as Louisiana is moving toward privatizing much of its long-term care services. (Source: The New Orleans Advocate, 5/6/2015)
Louisiana Legislative Auditor Informational Report (4/29/2015)
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On May 1, 2017, the Advertiser reported that a recent bill filed in the Louisiana House would require that the state implement an MLTSS program in order enhance quality of care, expand service options, and promote greater fiscal sustainability for the states’ Medicaid program. The bill, HB 152, directs Louisiana’s Department of Health to submit an application to CMS for a 1915(b) waiver, which is commonly used to implement Medicaid managed care. The bill would also require the state to begin moving towards MLTSS starting in October 1, 2017, and have a fully implemented system on or before October 1, 2018. If implemented, the state will select one or more interested managed care plans via a request for proposals (RFP) process. Representative Bacala, the bill’s sponsor, estimates the state could save as much as $30 million dollars a year under MLTSS, and possibly more. As of this writing, HB 152 had been involuntarily deferred in the Louisiana House Committee on Health and Welfare, which means that the bill can be rescheduled for a committee hearing but only by a vote of two-thirds of the committee members.(Source: The Advertiser 5/2/2017; HB 152 4/10/2017) On March 27, 2018, the Louisiana legislature defeated a bill that would have authorized the state to implement a managed LTSS program for both nursing home and HCBS services. The bill, SB 357, was expected to increase revenues, which could potentially have been used to fund services for the 28,000 individuals that are on a waiting list for HCBS. The vast majority of Louisiana’s Medicaid population receive services under managed care, estimated at 91 percent in 2016. The bill was voted down 6-2 in the Senate Health and Welfare committee. (The Advocate 3/27/2018; Bill 3/27/2018; Kaiser Family Foundation 5/22/2018) |
Bayou Health Reprocurement
On July 28, 2014, DHH issued a Request for Proposals to rebid the Bayou Health managed care program, which launched in 2012. Bayou Health currently serves around 900,000 Medicaid beneficiaries across five health plans – three of which are risk-based MCOs, and two of which are non-risk MCOs which are eligible to receive shared savings payments. The most significant change under the Bayou Health rebid is the elimination of the non-risk MCO program, which currently accounts for 54 percent of Bayou Health enrollees. These roughly 480,000 lives will be translated to risk-based managed care in 2015, which could more than double the $960.7 million spent in fiscal year 2013 on capitation payments to Bayou Health MCOs. Under the new Bayou Health contracts, Louisiana’s Medicaid HCBS waiver participants may be eligible to voluntarily enroll in a Bayou Health MCO. This includes disabled adults and the I/DD population, as well as children on the waiting list for a waiver. Dual eligibles; individuals residing in a nursing facility or intermediate care facility for I/DD; and individuals enrolled in PACE are excluded from Bayou Health MCO enrollment. A separate RFP for a standalone MLTSS program is anticipated later this year. (Source: State DHH website; HMA Weekly Roundup, 8/6/2014)
Request for Proposals (7/28/2014)
On July 30, 2014, the state released an RFI related to Disease Management and Disease Management Services for Medicaid recipients with chronic diseases. The services would include identification of eligible participants; participant outreach and engagement; and direction, coordination, monitoring and tracking of disease management and disease management related services. The key objective for the disease management program is to improve coordination of care and health outcomes and reduce overall costs. Target populations include dual-eligibles; nursing home and adult home residents; and residents enrolled in Medicaid 1915 HCBS waiver services. (Source: State DHH website; HMA Weekly Roundup, 8/6/2014) Request for Information (7/30/2014)
On August 15, 2014, the state released an RFP for the management of behavioral health services in the state through the Louisiana Behavioral Health Program. The purpose of the RFP is to solicit proposals from qualified behavioral health managed care entities to manage behavioral health services that serve adults with SMI and/or substance abuse disorders; children and adults with specialized behavioral health needs; eligible youth involved with the Department of Health and Hospitals, the Office of Juvenile Justice, the Department of Children and Family Services, and/or the Louisiana Department of Education; and a special population of children eligible for the Coordinated System of Care. The goal of this initiative is to increase access to behavioral health services for the populations most in need. Letters of Intent are due on August 25, 2014, and proposals are due on October 8, 2015. (Source: HMA Weekly Roundup, 8/20/2014) Request for Proposals, link no longer available (8/15/2014)
On October 24, 2014, the Louisiana Department of Health and Hospitals (DHH) announced the recommendation of five managed care organizations (MCOs) to administer the next contract period for Bayou Health; all of the health plans selected will operate statewide. The recommended Bayou health plans include: Aetna Better Health of Louisiana; Amerigroup Louisiana, Inc.; AmeriHealth Caritas Louisiana, Inc.; Louisiana Healthcare Connections; and UnitedHealthcare Community Plan. Although several additional steps remain before the MCO contracts are final and the MCOs are ready to begin operations, the new contracts are expected to begin February 1, 2015. Recipients will have the opportunity to choose an MCO during a 60-day annual open enrollment period beginning in November of each year. Current prepaid health plan members will automatically remain with their current health plan if they do not choose an alternative plan. Current shared savings plan members will be auto-enrolled in a plan based on historical MCO relationships and PCP network participation, among other variables. All members have the option to change health plans for up to 90 days after enrollment.
The MCOs will coordinate services for more than 919,000 Medicaid recipients, including: children under age 19 and their parents; adults with disabilities who do not receive Medicare; and pregnant women. Medicaid recipients who will not be covered in MCOs include: dual eligibles; nursing home residents; and individuals enrolled in some specialty service Medicaid programs. Individuals who receive HCBS can voluntarily opt in, but will not be auto-enrolled in a health plan. Individuals who are not enrolled in Bayou Health will continue to receive care through the current FFS system. Dental care and specialized behavioral health services will continue to be managed separately by Managed Care of North America (MCNA) and a specialized behavioral health MCO that is expected to be recommended for a contract award on October 31, 2014. (Source: Louisiana DHH website, 10/24/2014)
On January 22, 2015, CMS approved Louisiana’s State Plan Amendment (effective July 20, 2014) to make non-excluded individuals receiving hospice services mandatory participants in Bayou Health and individuals receiving HCBS waivers voluntary participants in Bayou Health. (Source: Medicaid.gov)
Approved State Plan Amendment (Effective 7/20/2014)
Section 1915(i) HCBS State Plan Option
As of May 2014, CMS has approved the state’s §1915(i) HCBS State Plan Amendment; and the state is currently participating in the HCBS State Plan Option. (Source: Kaiser HCBS State Plan Option website, 5/2014)
Section 1915(k) Community First Choice Option (Withdrawn)
The state planned to replace its current Long-Term Personal Care Services Program with the Community First Choice Option. (Source: Louisiana Register Vol. 38, No.6, 6/20/2012; Notice of Intent, 6/20/2012) However, in August 2013, Louisiana withdrew its application for a Community First Choice State Plan Amendment. (Source: Kaiser CFC State Plan Option website)
Balancing Incentive Program
In March 2013, CMS awarded Louisiana an estimated $69.25 million in enhanced Medicaid funds (a 2% enhanced FMAP rate). (Source: BIP Award Letter, 3/15/2013)
BIP Application, link no longer available (2/8/2013)
Structural Change Work Plan, link no longer available.