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LA Medicaid Coordinated Care Networks

LA Medicaid Coordinated Care Networks. CCN-P Proposers' Conference April 18, 2011. Purpose of Proposers’ Conference. Obtain clarification of RFP Requirements Opportunity to ask relevant questions regarding the RFP and procurement

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LA Medicaid Coordinated Care Networks

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  1. LA Medicaid Coordinated Care Networks CCN-P Proposers' Conference April 18, 2011

  2. Purpose of Proposers’ Conference • Obtain clarification of RFP Requirements • Opportunity to ask relevant questions regarding the RFP and procurement • Spontaneous answers today are unofficial—should still submit in writing • Only written answers are considered official LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  3. Today’s Agenda Introductions DHH, and Contractor Roles High Level Overview of Select RFP Subjects Preparing and Submitting Proposals Timeframes Before & After Contract Award Recommendation Resources Available to Proposers Questions and Answers LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  4. Contract Support for CCN Program LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  5. CCN Enrollment Broker • RFP to be released as early as April 25th • Three year contract to begin August 1st • Three year contract with 2 one year options • Responsible for • choice counseling • member choice packets • enrollment and disenrollment in CCN • Will send 834 transaction to CCNs LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  6. Outreach and Education Contractor Companion contract to Enrollment Broker contract One year contract Creating brand and identity Readiness kits (prior to mailing choice letters) Media placement LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  7. CCN-P RFP General Information Incorporates the many comments already received regarding the July 2010 “Provider Agreement” and February 2011 Notice of Intent Prior CCN-P Policy & Procedures Guide has been completely merged into RFP Forty-two (42) appendices numbered A -QQ RFP makes references to four CCN Companion Guides (Quality Guide still to be developed) Many similarities but also many differences from CCN-S RFP LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  8. Federal Authority for CCN-P La intends to implement CCNs through Section 1932 (a) (1) (A) State Plan Amendment In ongoing discussions with CMS Regional Office and CMS Central Office State Plan Amendment will be submitted after Final Rule is published (Early July) Contracts will be submitted to CMS for approval upon DHH certification of Network Adequacy LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  9. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  10. Potential CCN Enrollment LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  11. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  12. Some Notes on Eligibility 12 months continuous eligibility for enrollees under age 19 Rapid certification of PW applications (3 calendar day average) No assets test for parents, but very low income threshold (~ 11%FPL) Low rate of churning for failure to complete the annual renewal process (paperless renewal process) For seniors and people with disabilities, La is a “1634 State”—anyone determined eligible for SSI is eligible for Medicaid as well LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  13. CCN Participation Requirements • Certificate of Authority or License from DOI • Medicaid risk bearing entity per Title 22:1016 • By 7/15/11 • Certified by Secretary of State to do business in La (RS 12:24) • No conflict of interest • Minimum capacity of 75,000 members per GSA • URAC or NCQA certification or will apply at earliest possible point • Awarded contract by DHH that is approved by OCR and CMS LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  14. CCN Auto Assignment Algorithm • Goal is 75% or Higher Proactive Selection • In event of automatic assignment, absolute algorithm is: • Previous CCN (N/A at transition) • CCN in which last CommunityCARE 2.0 PCP is a network provider • If not in CommunityCARE, CCN in which historic Medicaid provider as ascertained by Medicaid claims data is a network provider • CCN in which current or historic provider of a family member is enrolled as a network provider • Round robin between all CCN-P and CCN-S entities in the GSA Note: If an entity is operating as both a CCN-P and CCN-S, they will be treated as one entity for auto assignment purposes. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  15. CCN-P Provider Networks • Contracts at Medicaid reimbursement rate and methodology must be offered to: • Office of Public Health (OPH) • FQHCs and RHCs (Hospital-based and Free Standing) • Rural Hospitals as defined in Rural Hospital Preservation Act • School Based Health Clinics certified by OPH • LSU Safety Net Hospitals • Encouraged to offer contracts to other significant traditional providers (STP) during initial two years of program • Not necessary to actually submit Letters of Intent or Contracts with Proposal (but must be available on request) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  16. CCN-P Co-Pays (= None) Currently no co-pays in La Medicaid for CCN core benefits and services La Medicaid co-pays limited to prescription drugs Any additional co-pays which would become applicable to CCNs will require 2/3 vote by Legislature LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  17. CCN-P Capitation Rates • Rates established by contract actuary Mercer • 180 different rate bands based on combination of • Age (7 bands) • Gender (2 bands) • Eligibility Category (5 bands, including Maternity Kick Payment) • DHH Geographic Region (9 bands ) • Risk Adjustment applied beginning 4th month of operations in GSA • GME is not included in the rates and will not be reimbursed by CCNs LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  18. Medical Loss Ratio (MLR) • Adaptation of ACA MLR policy for commercial insurers (45 CFR, Part 158) • Detailed information in Appendix H • Annual MLR Report due by June 1st for MLR Reporting Year (CY) • Any refund due to DHH by August 1st or interest begins to accrue • Reporting instructions included in Financial Reporting Companion Guide (Page 27, Section 3.06) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  19. Preparing the CCN-P Proposal Section 21.7—Proposal Prohibition Cannot submit multiple proposal for CCN-P model including as prime contractor and subcontractor Use Appendix KK as Guide/Checklist/Table of Contents Nopage limits (but consideration for evaluators) As to format, the only “shall” is that proposal be written in English LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  20. Added Value Component of CCN-P Proposal • 200 total points • 100 points for added value to enrollees • 100 points for added value to providers • Spreadsheets must be completed in entirety • Actuary must certify the determined actuarial value LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  21. Submitting the CCN-P Proposal Original plus 10 copies Electronic copy of entire proposal and all attachments on flash drive or CD Electronic copy will be loaded on Share point site and used extensively during evaluation process Line in Sand” Deadline: 4 PM CDT 6/24/11 to Mary Fuentes at 5th Floor of Bienville Bldg, 628 N 4th Street, Baton Rouge Certification Statement (Appendix A) must accompany Proposal LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  22. CCN-P Proposal Scoring 1900 possible points—DHH reserves right to not award Contract for proposals scoring fewer than 1500 points Team approach—proposers will be assigned certain Sections to score Individual review of assigned proposal section; consensus scoring Total possible points for each element indicated on the Evaluation & Proposal Form (Appendix KK) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  23. Number of Recommendations for CCN-P Contract Awards Three (3) Per GSA Proposals recommended for contract award must have minimum score of 1500 points One Contract per entity regardless of number of GSAs in which they are awarded a contract State level performance measures, MLR End date aligned for all contracts (12/31/14) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  24. Key Dates in Schedule of Events Deadline for Written Questions—4/29 DHH Written Responses—5/23 Deadline for Round 2 of Written Questions—5/27 Deadline for DHH Written Responses—6/10 Deadline for Proposals 6/24 Announcement of Recommended Awards is now scheduled for 7/25/11 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  25. Timeline From 7/25 and Go Live Date Deadline for CCN Entity to Sign Contract- 8/8 Submission of Contract to OCR 8/8 Key implementation dates for each phase are included in Schedule of Events Deadline for Area A Network Completion -10/7 Submission of Phase 1 Network and Contract to CMS for Approval 10/17 Choice Letters for Area A -11/15 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  26. Office of Contractual Review (OCR) Approval Procurement Support Team (PST) is advisory group to OCR Director for certain contracts Created in both statute and rule; R.S.39:1496 and LAC 34: V, Subchapter C. Representative from AG Office, Legislative Fiscal Office, OCR, and DHH Will review both the selection process and subsequent contracts prior to OCR approval Short time window—goal is to have Contracts “picture perfect” for their review by 8/8 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  27. Submitting Written Comments RFP definition of “comments: “comments, questions, defects, objections, or any other matter requiring clarification or correction “ Applicable to RFP, Appendices including pro forma contract and Companion Guides Two “rounds” of comments and written responses DHH reserves right to amend previously posted answers until deadline for proposals LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  28. Example of Written Comments LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  29. www.MakingMedicaidBetter.com • Separate areas for CCN-P and CCN-S procurements • Links to RFP, Appendices (many in Word, Excel, or Adobe fillable form format) and Companion Guides • Procurement Library • Non-binding Notices of Intent to Propose • Eligibility data, Quality baseline data for existing PCCM Program • Policies, Medicaid rates and payment methodologies • Slide Decks for 4/18 Proposer’s Conference and 4/19 Rate and Technical/Systems meetings will be posted • Addendums to RFP • Written Responses to Questions • Any changes to Schedule of Events LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  30. Historical Claims Data • Same data set used by Mercer in establishing rates • SFY 09 and 10—potential CCN population and services (plus pharmacy) only • SAS7BDAT format • Need storage drive, non-binding Letter of Intent to Propose, and Data Use Agreement • Drive with data loaded can be-- • Picked up in person • Mailed via certified mail, return receipt requested • Sent via Fed Ex if requestor provides Fed Ex mailer or account number LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  31. Marketing During Procurement • Brand awareness and provider recruitment activities are allowed • Sponsorships • Billboards • Ads by prospective proposers • No direct or indirect marketing to potential members • Continue to provide opportunity for review of any written materials including websites by DHH LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  32. Non-RFP Related CCN Status Update • Ongoing communication with CMS • Status of Administrative Rulemaking • Oversight Report for CCN Notice of Intent submitted on 4/8/11 • `Last possible date for oversight hearing is 5/8/11 (30 days from submission of report) • Final Rule incorporating changes to be published in La Register either May 20th [or could be delayed to June 20th= • SB 207 pre-filed by Senator Mount requires DHH to submit annual reports concerning the CCN Medicaid initiative beginning in 10/13 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

  33. Questions • Remember that spontaneous answers during the Proposer’s Conference are unofficial • Please follow up with your question in writing in Excel worksheet format • RFP Coordinator: • Ruth Kennedy, Medicaid CCN Project Director Ruth.Kennedy@la.gov Phone: (225) 342-3032 Cell: (225) 241-9508 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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