La HIPP Background v La HIPP Louisiana Department

La. HIPP Background v La. HIPP • Louisiana Department of Health (LDH) sought to improve access to care and manage costs by increasing enrollment in the La. HIPP program. • La. HIPP will be re-launched April 2017. v Act 269 - “The Baby Bill” v • Intended to enroll high cost newborns to employer sponsored insurance plans • Improved access to specialty care The Children’s Health Insurance Program Reauthorization Act (CHIPRA) Provides employees and dependents special enrollment rights if: Eligible for premium assistance through La. HIPP

La. HIPP Program Overview v. La. HIPP is a Louisiana post Medicaid enrollment Program v. Helps families pay for employer sponsored health insurance when at least one person in the family gets Medicaid v. Medicaid will pay their copays and deductibles when the provider bills Medicaid secondary for La. HIPP enrollees v. Higher reimbursement rate for providers

La. HIPP Eligibility Requirements v Someone in the household must be actively enrolled in Medicaid v Someone in the household must be working and have access to Employer Sponsored Insurance (ESI) v A Medicaid Enrollee in the household must be able to enroll or be enrolled in the ESI v The case must be cost effective for La. HIPP to reimburse the health insurance premium

Cost Effectiveness The Per Member Per Month (PMPM) is compared to the Cost of Participation (COP) to determine the Cost Effectiveness of the La. HIPP case. If the PMPM is greater in total versus the COP the case is determined to be cost effective. COP PMPM Wrap Costs Admin Costs Premium Medicaid MC O Premium Co sts

Private Insurance + La. HIPP = Win-Win For Medicaid & Taxpayers: ü reduction of expenditures for both state and federal dollars For Providers: ü higher reimbursement rate ü bill Medicaid for the patient responsibility Medicaid Providers For Families: ü greater access to providers ü paid out-of-pocket expenses and monthly premium ü Continuity of care ü COBRA coverage Families

La. HIPP vs non-La. HIPP Reimbursement - Physician La. HIPP Recipient Procedure Code Billed Charge Medicaid Allowable Patient Responsibility Medicaid Payment 99212 55. 00 24. 10 36. 00 (ded) 36. 00 83955 -QW 30. 00 11. 37 28. 20 (ded) 28. 20 Total 85. 00 35. 47 64. 20 Non-La. HIPP Recipient Procedure Code Billed Charge Medicaid Allowable Patient Responsibility Medicaid Payment 99212 55. 00 24. 10 36. 00 (ded) 24. 10 83955 -QW 30. 00 11. 37 28. 20 (ded) 11. 37 Total 85. 00 35. 47 64. 20 35. 47

La. HIPP vs non-La. HIPP Reimbursement - Inpatient La. HIPP Recipient Procedure Code Billed Charge TPL Paid Amount Medicaid Allowable Patient Responsibility Multiple HR R&B 14, 788. 37 10, 255. 07 4, 593. 00 478. 93 Medicaid Payment 478. 93 Non-La. HIPP Recipient Procedure Code Billed Charge TPL Paid Amount Medicaid Allowable Patient Responsibility Multiple HR R&B 14, 788. 37 10, 255. 07 4, 593. 00 478. 93 The Medicaid Allowable minus the TPL payment is less than zero; therefore, the payment is $0. Medicaid Payment 0

DOs and DON’Ts with La. HIPP DO: ü Verify La. HIPP enrollment ü Verify ESI ü File ESI primary and Medicaid as secondary for La. HIPP Enrollee DON’T: X Collect out-of-pocket costs such as copays, coinsurance or deductible X Delay with La. HIPP forms, especially for newborns

Enrollment Verification 1. e-MEVS, a web application accessed through www. lamedicaid. com 2. Medicaid Eligibility Verification System (MEVS), an automated eligibility verification system using a swipe card device or PC software through vendors 3. Recipient Eligibility Verification System (REVS), an automated telephonic eligibility verification system, 1 -800 -776 -6323

Contact Info La. HIPP Toll free: 1 -855 -618 -5488 Fax number: 1 -855 -618 -5486 Email: La. HIPP@la. gov Website: www. ldh. la. gov/lahipp