LA Medicaid Coordinated Care Networks

1. LA Medicaid Coordinated Care Networks CCN-S Proposer’s Conference April 18, 2011

2. Purpose of Proposers’ Conference • Obtain clarification of RFP Requirements • Opportunity to ask relevant questions regarding the RFP • 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 Participation Requirements Schedule of Events ePCCM Fees CCN Provider Network Proposal Submission and Award Resources Available to Proposers Questions and Answers LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

4. introduction Federal Authority Medicaid Organizational Relationships Enrollee Education and Outreach Enrollment Broker Mandatory Populations Eligibility

5. Federal Authority 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 Contracts will be submitted to CMS for approval upon DHH certification of Network Adequacy State Plan Amendment will be submitted after Final Rule is published (Early July) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

6. Medicaid Operations Relationships

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

8. CCN Enrollment Broker • RFP to be released as early as April 25th • Contract to begin August 1st • Three year contract with 2 one year renewal options • Responsible for Choice Counseling, Enrollment and Disenrollment in CCN • Telephone hotline for enrollees and potential enrollees • Assemble and distribute member choice packets • Will send 834 transaction to CCNs LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

9. Enrollee Outreach and Education Contractor • Companion contract to Enrollment Broker contract • One year contract • Brand Development • Introduction of CCN Program to Medicaid Recipients • Readiness kit (Health Care Literacy and Health Care Check) • Collaborate with Community-Based Organizations LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

10. Potential CCN Enrollment LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

11. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

12. Eligibility Facts • 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 due to 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. 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 family member is enrolled • 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

14. Participation requirements Mandatory Requirements Geographic Service Areas

15. CCN Participation Requirements • Meet PCCM definition as defined in 42 CFR § 438.2 • Certified by Secretary of State to do business in La (RS 12:24) • Have the capability to pre-process claims • Meet minimum net worth, performance and surety bond requirements • No actual or perceived conflict of interest • Minimum capacity of 75,000 members per GSA • Successfully awarded a Contract with DHH LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

16. Geographic Service Areas LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

17. Schedule of events Important Dates Timeline from 7/25 to Go Live Date Required Approvals

18. Important Dates in Schedule of Events LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

19. Timeline From 7/25 to Go Live Date LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

20. 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 Requesting Department • 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 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

21. epccm Rates

22. Enhanced Primary Care Case Management Fee LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

23. Ccn Provider network

24. Provider Networks • Contracts must be offered to: • Office of Public Health (STD,TB, HIV services) • FQHCs and RHCs (Hospital-based and Free Standing) • School Based Health Clinics (that meet PCP definition) (at the same terms and conditions as other PCP network providers) • 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 • Must demonstrate network adequacy to DHH by deadline date specified in Schedule of Events LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

25. Proposal submission and award Proposal Format Proposal Submission Evaluation Criteria Number of Contracts to be Awarded Submitting Comments/Questions

26. Proposal Format • Proposal Prohibition (Section 20.9.3) Cannot submit multiple proposal for CCN-P model including as prime contractor and subcontractor • Appendix BB should be used as Guide/Checklist/ Table of Contents • Must be in English and on standard 8 ½” x 11” paper • Text no smaller than 11 point font • Nopage limits (but consideration for evaluators) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

27. Proposal Submission • Should clearly indicate proposed GSA areas • Mandatory requirements should be in a separate binder and labeled • Technical requirements should be in separate binder and clearly labeled • Attachments should only be provided as requested in Appendix BB and clearly labeled • Submit an original plus 10 copies • Strongly encouraged to submit an electronic copy of entire proposal and all attachments on flash drive or CD • Certification Statement must accompany Proposal LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

28. Evaluation Criteria LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

29. Number of Contracts to Be Awarded Up to three (3) awards per GSA One CCN-S contract per entity regardless of number of GSAs for which they are awarded a contract Proposals recommended for contract award must have minimum score of 1,320 points End date aligned for all contracts (12/31/14) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

30. Submitting Written Comments/Questions 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 answers until deadline for proposals LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

31. Example of Written Questions/Comments LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

32. Resources Available to Proposers Procurement Library Historical Data

33. www.MakingMedicaidBetter.com • Separate Area for CCN-P and CCN-S procurements • Appendices for the 2 RFPs are numbered differently • Links to RFPs, Appendices (many in Word, Excel, or Adobe fillable form format) and Companion Guides • Procurement Library • CCN Provider Recruitment • Medicaid Enrollment • Quality Measures • Medicaid Baseline Quality Data • Data Book • Medicaid Policy, Procedure and Legislation • Traditional Medicaid Provider Information • Addendums to RFP(as applicable) • Written Responses to Questions • Any changes to Schedule of Events LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

34. Historical Claims Data • 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 may be • Picked up in person • Mailed via certified mail, return receipt requested • Fed Ex’d if requestor provides Fed Ex mailer or account number LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

35. General issues CCN Marketing During Procurement Non-RFP Status Updates

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

37. 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 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

38. questions

39. Questions • Remember that spontaneous answers during the Proposer’s Conference are NOT considered official. • Please follow up with your question in writing in an Excel file. • RFP Coordinator Ruth Kennedy, Medicaid CCN Project Director Ruth.Kennedy@la.gov Phone: (225) 342-3032 Cell: (225) 241-1437 LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS