la medicaid coordinated care networks

LA Medicaid Coordinated Care Networks

CCN-P Proposers' ConferenceApril 18, 2011

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 2

Today’s Agenda1. Introductions

2. DHH, and Contractor Roles

3. High Level Overview of Select RFP Subjects

4. Preparing and Submitting Proposals

5. Timeframes Before & After Contract Award Recommendation

6. Resources Available to Proposers

7. Questions and Answers


Contract Support for CCN Program


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


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


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


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


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 44,984 892,122LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS 11

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


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


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.


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)


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


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


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)


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

• No page limits (but consideration for evaluators)• As to format, the only “shall” is that proposal be

written in English


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


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


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)


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)


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


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


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


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


Example of Written 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? (No)

Example RFP 14.8 & 14.9

Provider Credentials

Re credentialing & re-credentialing standards. Can URAC be used as well as NCQA? (Yes)

Example Appendix U N/A Data Use Agreement

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

Example Fair Hearing Companion Guide

N/A Withdrawal 12 Can the written withdrawal request be submitted via e-mail?


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


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


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


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


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

[email protected]: (225) 342-3032 Cell: (225) 241-9508


la medicaid coordinated care networks

Documents

rfp subjectspreparing

qq rfp

stthree year contract

ththree year contract

year optionsresponsible

area b phase

area c phase

cms regional office