MEDICAID UPDATE: New CCN Implementation Timeline Released
The Louisiana Department of
Health and Hospitals (DHH) announced several key dates regarding the
implementation of Coordinated Care Networks (CCNs) today in its Making
Medicaid Better enewsletter. In lieu of the President's Update, LSMS is
sending this vital information to all of its members today. The October
President's Update will be forthcoming.
10.6.2011 State Approves CCN Contracts, Provider Handbooks
The Department of Health and Hospitals (DHH) has
moved one step closer to implementation of Coordinated Care Networks
this week with final approval from the state Division of Administration
(DOA) to contract with all five entities recommended to administer CCNs.
Contracts for CCNs have now been fully executed
with Amerigroup of Louisiana, Amerihealth Mercy of Louisiana and
Louisiana Healthcare Connections for CCN-Prepaid plans, and Community
Health Solutions of America and UnitedHealthcare of Louisiana for
CCN-Shared Savings plans.
With approval of the final contracts by DOA, each
CCN has moved into the readiness review phase of the implementation
process. During this phase, operations will be reviewed by DHH staff and
the DHH External Quality Review Organization, IPRO, and the CCNs will
demonstrate network adequacy. A review of systems and financials will
also be conducted by Mercer. The contracts will also be reviewed by the
Centers for Medicare and Medicaid Services (CMS), the federal agency
that monitors the state's Medicaid Program. Once reviews are complete
and provider networks are established, CCNs can begin enrolling Medicaid
recipients in their networks, with the first group in Geographic
Service Area A (the greater New Orleans and Northshore areas) "going
live" Feb. 1, 2012.
Also, this week, DHH has approved and posted online provider handbooks for
each of the CCNs. Handbooks serve as a written resource for health care
providers regarding each CCN and their policies, procedures, services
and protocols. Details on provider rights and responsibilities, prior
authorization and referral processes, medical necessity standards,
chronic care management programs, quality performance requirements,
grievance and appeals procedures and much more are included. A link to
the CCN handbooks can be found on the Making Medicaid Better Web site by
clicking here.
DHH schedules provider Q & A calls
DHH will host a series of conference calls Oct.
11, 12 and 13 to answer provider questions about the implementation of
CCNs. Medicaid staff directly involved in CCN development will be on the
call to answer questions. A brief introduction and update
of the CCN implementation will be provided by Medicaid staff, but the
bulk of the conference call will be devoted to provider questions and
answers.
DHH is asking that providers participate in the
call for their provider type and Geographic Service Area (GSA), as noted
below, to accommodate the limited number of call-in lines and ensure
the most efficient use of call time. The conference call schedule is as
follows:
|
Tuesday, October 11
|
10 to 11 a.m. - Hospitals Only (Statewide)
4 to 5 p.m. - Physicians (GSA "A" - Regions 1 & 9)
5:30 to 6:30 p.m. - Hospitals Only (Statewide) |
|
Wednesday, October 12
|
2 to 3 p.m. - All Other Providers ( GSA "A" - Regions 1 & 9)
4 to 5 p.m. - Physicians (GSA "B" - Regions 2, 3 & 4) |
|
Thursday, October 13
|
Noon to 1 p.m. - Physicians (GSA "C" - Regions 5, 6, 7 & 8)
4 to 5 p.m. - All Other Providers (GSA "B" - Regions 2, 3 & 4)
5:30 p.m. to 6:30 p.m. - All Other Providers (GSA "C" - Regions 5, 6, 7 & 8) |
If you are unable to participate on your
region's assigned date and call time, you may call in on another date.
The call-in information for all calls is:
DHH is asking that all participants register here for the conference call of their choice by close of business Oct. 10.
Due to limited call in lines, this will help ensure that all interested
parties have an opportunity to participate. At the time of
registration, providers will have the opportunity to submit questions or
issues they would like addressed during the meeting.
DHH to release companion guides for CCN quality, systems
DHH will issue four new guides this week
providing written instruction for CCNs on the quality and systems
aspects of CCN implementation and ongoing management. The Quality Companion Guide
will provide CCNs with guidance on core quality improvement activities,
performance improvement projects, performance measure specifications
and validation processes. TheQuality Companion Guide was drafted by
DHH's External Quality Review Organization, IPRO.
Earlier this week, DHH issued a revision to the
Shared Savings and Prepaid Systems Companion Guides (two separate
guides), outlining the requirements for data exchanges and file formats.
The guides address the roles of all related parties involved in data
processing, including the DHH Fiscal Intermediary (Molina), the
Enrollment Broker (Maximus), CCNs and DHH. The guides also include
details on encounters, claims submissions, payment, reporting, coding
(denials, descriptions, edits, corrections, and resubmissions),
electronic data interchange testing and systems certification.
Systems issues are also addressed in DHH's recently released 834 Companion Guide,
which addresses the file exchange requirements of the Enrollment Broker
(Maximus) in conjunction with the CCNs, DHH and the DHH Fiscal
Intermediary (Molina).
Announcements
ADVOCATE CONFERENCE REGISTRATION:
Spaces are still available for non-profit and
health care advocacy groups wishing to participate in DHH's day-long,
CCN Advocates' Conference. The event will take place Friday, Oct. 14
from 9 a.m. to 4 p.m. at the Holiday Inn at 9940 Airline Drive in Baton
Rouge. Click here to register.
The conference is specifically designed for
community-based organizations and other advocates who work with Medicaid
and LaCHIP recipients. Because providers cannot assist recipients in
enrolling (as they are contractors of specific plans and this presents a
potential conflict of interest), this conference is not for health care
providers. There is no cost to attend and lunch will be served. Seating is limited to 300.
Provider Q and A
Q. What is the deadline for
providers to sign a contract with a CCN in order to be assured inclusion
in the initial printing of the CCN's provider directory?
A. The CCN implementation schedule has been updated to adjust for the Feb. 1, 2012 go live date. For
providers to be included in the initial CCN provider directory, all
providers must meet the contacting deadline for their Geographic Service
Area as follows:
- GSA A - Oct. 31, 2011
-
GSA B - Dec. 30, 2011
-
GSA C - Feb. 27, 2012
Q. A CCN is urging me to contract
with them. They have informed me that, if I do not contract with them,
they will make a total of three attempts to contract with me. If I
refuse all three times, they can later pay me 90% of the Medicaid
fee-for-service (FFS) rate as an out-of-network provider. Is this
accurate?
A. A CCN must reimburse an
out-of-network provider 100% of the Medicaid FFS rate for emergency
services. For services that do not meet the definition of emergency
services, a CCN is not required to reimburse non-network providers more
than 90% of the published Medicaid FFS rate in effect on the date of
service. The CCN must first demonstrate it has attempted to contact the
provider three times with the intention to contract with the provider
before reimbursing at the 90% rate. However, these three documented
attempts cannot begin before October 4, 2011, the date all CCNs
contracts were executed by the state.
All attempts to contract with a provider must be
made in good faith, by the CCN, in writing. This can include
correspondence that outlines contract negotiations between the parties,
including rate and contract term disclosure. The potential network
provider has 10 calendar days to accept, reject or fail to respond to
the request, verbally or in writing.
LSMS Director of Legal Affairs Greg Waddell is
available to assist physicians who have questions regarding CCN
contracts. He is available by email at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
or by phone at 800.375.9508. Read more from the LSMS... |
