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Louisiana Department of Health & Hospitals | Bruce Greenstein, Secretary

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BAYOU HEALTH Implementation

Overview

The Department of Health and Hospitals is transforming Medicaid by moving away from a strictly fee-for-service system and effectively coordinating enrollees’ health care. Overall, coordinating care should lead to better access, more choices and improved health for patients, with provider rates no less than those in fee-for-service Medicaid.

BAYOU HEALTH is a new way for most of Louisiana's Medicaid and LaCHIP recipients to receive health care services. The new delivery system will consist of two models:

  • The Prepaid Plan is a traditional capitated, managed care model in which BAYOU HEALTH Plans establish networks of providers. The Health Plans receive a monthly fee for each enrollee covered to provide core benefits and services, with prior authorizations and claims payment handled directly through the entity.
  • The Shared Savings Plan is an Enhanced Primary Care Case Management plan in which the network receives a monthly per-member fee to provide enhanced care management services, with opportunities for providers in that network to share in cost savings resulting from coordinating care. In this model, Medicaid’s fiscal intermediary would continue processing claims.

Benefits
The amount, duration and scope of services provided by BAYOU HEALTH cannot be less than the Louisiana Medicaid State Plan. The prepaid model does allow the flexibility for Health Plans to provide enhanced benefits, or more than the State Plan requires. Dental, pharmacy, hospice, behavioral health services, nursing home care services, personal care services, school-based IEP services and targeted case management are carved-out and are scheduled to remain Medicaid fee-for-service treatments.

Timeline

The state will implement BAYOU HEALTH in three stages, using Louisiana Geographical Service Areas (GSA). Click here to see a map of the regions encompassed in each GSA.

The implementation timeline is dependent on the completion of several steps, including oversight by state and federal entities. Below are anticipated key dates for BAYOU HEALTH implementation.

  • January 16, 2012 - Readiness Brochure Mailed to Enrollees in GSA B
  • February 1, 2012 – Go Live Date for Enrollees in GSA A
  • February 15, 2012 - Choice Letters Mailed to Enrollees in GSA B (Capital area, South Central Louisiana and Acadiana regions)
  • February 27, 2012 - GSA C Provider Contracting Deadline to Ensure Inclusion in Health Plans' Initial Provider Directories
  • March 15, 2012 - Readiness Brochure Mailed to Enrollees in GSA C
  • April 1, 2012 - Go Live Date for Enrollees in GSA B
  • April 16, 2012 - Choice Letters Mailed to Enrollees in GSA C (Southwest Louisiana, Central Louisiana and North Louisiana Regions)
  • June 1, 2012 - Go Live Date for Enrollees in GSA C

Prior to each service area’s go-live date, the state will send information to recipients in those areas, giving them extensive information on their available options, detailed instructions for how to select a BAYOU HEALTH Plan and reminders about their deadlines for selecting a network. There will be multiple opportunities for enrollees to receive personal assistance with their choices, either via telephone or face-to-face.