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LA Medicaid Coordinated Care Networks

CCN-S Proposer’s ConferenceApril 18, 2011

LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 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


Today’s Agenda1. Introductions

2. Participation Requirements

3. Schedule of Events

4. ePCCM Fees

5. CCN Provider Network

6. Proposal Submission and Award

7. Resources Available to Proposers

8. Questions and Answers

INTRODUCTIONFederal Authority

Medicaid Organizational RelationshipsEnrollee Education and Outreach

Enrollment BrokerMandatory Populations

Eligibility


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)

MedicaidCoordinated

Care

Program Operations

MMIS

Eligibility

Financial Operations

Policy and Planning

Medicaid Medical Director

Medicaid Director

Medicaid Operations Relationships


Contract Support for CCN Program

DHH

Actuary (Mercer)

Enrollment Broker (TBD)

Outreach & Education

(TBD)

Fiscal Intermediary

(Molina)

EQRO (TBD)

Accountant (TBD)

Consumer Ombudsman

(TBD)

Quality Baseline (ULM)


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


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


Potential CCN EnrollmentGSA Mandatory Voluntary Total

Area A (Phase 1) 249,953 12,671 262,624

Area B (Phase 2) 304,652 15,443 320,095

Area C (Phase 3) 290,454 16,656 307,110

TOTALS 847,138 44,984 892,122

LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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A/B/D10%

Medicaid Children <

Age 1966%

CHIP Children15%

Parents9%

Mandatory CCN Enrollees by Category


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

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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 GSANote; If an entity is operating as both a CCN-P and CCN-S, they will be treated as one entity for auto

assignment purposes.


PARTICIPATION REQUIREMENTSMandatory RequirementsGeographic Service Areas


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


Geographic Service Areas

SCHEDULE OF EVENTSImportant Dates

Timeline from 7/25 to Go Live DateRequired Approvals


Important Dates in Schedule of Events

Events Date

Deadline for Receipt of Written Questions April 29, 2011 11:00 pm CDT

Deadline for Receipt of Letter of Intent toPropose May 6, 2011 11:00 pm CDT

Deadline for DHH Responses to WrittenQuestions May 23, 2011

Deadline for Receipt of Follow-Up WrittenQuestions May 27, 2011 11:00 pm CDT

Deadline for DHH Responses to Follow-UpWritten Questions June 10, 2011

Deadline for Receipt of Written Proposals June 24, 2011 4:00 pm CDT

Contract Award Announcements July 25, 2011


Timeline From 7/25 to Go Live DateEvent Date

Deadline for CCN Entity to Sign Contract August 8th

Submission of Contract to OCR August 8th

CCN Provider Network Documentation DeadlineGSA A – October 7th

GSA B – November 7thGSA C – January 9th

Submission of Network and Contract to CMS for Approval

GSA A – October 17th

GSA B – January 16thGSA C - March 15th

Choice Letters to Potential EnrolleesGSA A – November 15h

GSA B – December 16th

GSA C – February 15th


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

ePCCM RATES


Enhanced Primary Care Case Management Fee

Mandatory Function TANF/LaCHIP-related

SSI-related

Prior Authorization $ 1.48 $ 2.28

Patient-Centered Medical Home $ 1.12 $ 1.12

Care Coordination $ 0.49 $ 0.49

Case Management and Chronic Care Management $ 2.02 $ 5.90

Customer Service $ 0.45 $ 0.45

Provider Monitoring and Service $ 0.53 $ 0.53

Quality Management and Compliance Monitoring $ 2.60 $ 2.60

Account Management and Overhead $ 3.12 $ 4.79

Total Enhanced Primary Care Management fee $11.81 $18.16

PCP Care Management (pass through) $ 1.50 $ 1.50

Total ePCCM fee $13.31 $19.66

CCN PROVIDER NETWORK


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

PROPOSAL SUBMISSION AND AWARDProposal Format

Proposal SubmissionEvaluation Criteria

Number of Contracts to be AwardedSubmitting Comments/Questions


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

– No page limits (but consideration for evaluators)


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


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Evaluation CriteriaSection Category Total Possible Points

A Mandatory Requirements 0

B Qualifications and Experience 340

C Planned Approach to Project 100

D Member Enrollment and Disenrollment 25

E Chronic Care/Disease Management 100

F Service Coordination 160

G Provider Network 110

H Utilization Management 80

I EPSDT 25

J Quality Management 115

K Member Materials 50

L Customer Service 100

M Emergency Management Plan 25

N Grievance and Appeals 25

O Fraud and Abuse 15

P Claims Management 80

Q Information Systems 200

R Added Value to Louisiana 100

TOTAL 1,650


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)


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


Example of Written Questions/Comments

Submitter Name

Document Reference

(e.g., RFP, RFP

Companion Guide )

Section Number

Section Heading

Page#

Question

Example RFP 1.6.41 Proposer Comments

6 Can questions be submitted in Word instead of Excel?

Example RFP

Example Appendix U N/A Data Use Agreement

1 Can we strike through “will” submit a proposal and substitute “may”?

RESOURCES AVAILABLE TO PROPOSERSProcurement Library

Historical Data


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

http://www.makingmedicaidbetter.com/


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

GENERAL ISSUESCCN Marketing During Procurement

Non-RFP Status Updates


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


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

QUESTIONS


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 CoordinatorRuth Kennedy, Medicaid CCN Project [email protected]: (225) 342-3032 Cell: (225) 241-1437

mailto:[email protected]