LOUISIANA MEDICAID MCO ASSOCIATION LOUISIANA RURAL HEALTH CARE

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LOUISIANA MEDICAID MCO ASSOCIATION LOUISIANA RURAL HEALTH CARE CONFERENCE PANEL PRESENTATION OCTOBER 29, 2019

LOUISIANA MEDICAID MCO ASSOCIATION LOUISIANA RURAL HEALTH CARE CONFERENCE PANEL PRESENTATION OCTOBER 29, 2019

INTRODUCTION OF PANEL PRESENTERS AETNA: Rick Born, CEO AMERIHEALTH CARITAS: Kyle Viator, CEO HEALTHY

INTRODUCTION OF PANEL PRESENTERS AETNA: Rick Born, CEO AMERIHEALTH CARITAS: Kyle Viator, CEO HEALTHY BLUE: Aaron Lambert, CEO LOUISIANA HEALTH CARE CONNECTIONS: Dr. Stewart Gordon, CMO UNITED HEALTH CARE: Angela Olden, COO

STATUS OF 2020 CONTRACTS All five current plans are in the process of entering

STATUS OF 2020 CONTRACTS All five current plans are in the process of entering into emergency contracts which will be effective January 1, 2020 The emergency contracts will be in place until all protests are resolved It is unknown how long protests will last Emergency contracts will not have any substantive changes that affect providers Plans will be operating in a “ business as usual” mode until resolution

CVO IMPLEMENTATION Implementation has been delayed numerous times MCOs developed joint recommendations that were

CVO IMPLEMENTATION Implementation has been delayed numerous times MCOs developed joint recommendations that were submitted to the department and the vendor (Verisys) Vendor is currently working on communication plan to begin engaging providers Department is working with the vendor to establish timelines that will be distributed once developed

CLAIMS PROCESS Most of the information needed on claims process can be found here:

CLAIMS PROCESS Most of the information needed on claims process can be found here: http: //ldh. la. gov/assets/docs/Bayou. Health/Informational_Bulletins/2019/IB 19 -3/IB 19 - 3_revised_10. 7. 19. pdf This bulletin outlines the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) effective Feb. 1, 2019. Unless explicity notated, providers should first seek resolution with the MCO directly, prior to engaging LDH or other third parties.

CLAIMS PROCESS, CONTINUED The informational bulletin covers time requirements and submission information for: Claim

CLAIMS PROCESS, CONTINUED The informational bulletin covers time requirements and submission information for: Claim Reconsideration Claim Appeal Arbitration It also covers the process of Independent review as well as procedures for provider issue escalation and resolution including specific information on MCO and LDH escalation of the issues For issues related to claims or services rendered under fee-for-service Medicaid, contact: DXC Technology (Formerly Molina Medicaid Solutions) 1 -800 -473 -2783 P. O. Box 91024, Baton Rouge, LA 70821

CLAIMS CONTACTS BY MCO For issues related to MCO claims, contact: Aetna 1 -855

CLAIMS CONTACTS BY MCO For issues related to MCO claims, contact: Aetna 1 -855 -242 -0802 Louisiana. Provider. Relations. Department@aetna. com Ameri. Health Caritas Louisiana: 1 -888 -922 -0007 network@amerihealthcaritasla. com Healthy Blue: 1 -844 -521 -6942 or 1 -504 -836 -8888 (Local Network Relations Team) lainterpr@healthybluela. com Louisiana Healthcare Connections: 1 -866 -595 -8133 BRO_PR_Operations@centene. com United Healthcare Community Plan: 1 -866 -675 -1607 southeastprteam@uhc. com

LMMCOA - WORKING FOR A HEALTHY LOUISIANA Working to assure alignment with LDH priorities

LMMCOA - WORKING FOR A HEALTHY LOUISIANA Working to assure alignment with LDH priorities Reducing administrative burden on the department, providers and other key stakeholders Ensuring Financial Stability Building coalitions with stakeholders Providing joint MCO recommendations on policies such as: CVO Drug testing Single PDL HEP C

LMMCOA ACTIVITIES - LEGISLATIVE SUPPORT Worked in both 2018 and 2019 legislative sessions with

LMMCOA ACTIVITIES - LEGISLATIVE SUPPORT Worked in both 2018 and 2019 legislative sessions with LDH legislative team to provide support or opposition to legislative measures Met with LDH and provider groups to review bills and to develop strategies for our mutual objectives Met with legislators prior to and during the session to provide education on Medicaid/ MCOs and to address any concerns Coordinated messaging and testimony to assure accurate information was disseminated

LMMCOA ACTIVITIES – COMMITTEE REPRESENTATION Representation on Critical LDH Priorities TACL – Taking Aim

LMMCOA ACTIVITIES – COMMITTEE REPRESENTATION Representation on Critical LDH Priorities TACL – Taking Aim at Cancer in Louisiana My Choice Steering Committee Shatterproof Rating System State Advisory Committee Community Health Workers Workforce Study Committee

LMMCOA ACTIVITIES - BEHAVIORAL HEALTH Mental Health Rehabilitation Met with key legislators Coordinated meetings

LMMCOA ACTIVITIES - BEHAVIORAL HEALTH Mental Health Rehabilitation Met with key legislators Coordinated meetings with legislators, providers and LDH Engaged individually with providers to resolve specific issues Helped to establish monthly workgroup meetings with OBH, providers and the health plans Behavioral Health Audit coordination with LDH program integrity, Legislative Auditor and AG office Participation in SCR 260 – aimed at exploring carve out of behavioral health services

MCO CONTACTS FOR MCO SPECIFIC QUESTIONS AETNA: Candi Meredith, Provider Relations - Meredith. C@Aetna.

MCO CONTACTS FOR MCO SPECIFIC QUESTIONS AETNA: Candi Meredith, Provider Relations - Meredith. C@Aetna. com AMERIHEALTH CARITAS: Sherry Wilkerson, COO – smwilkerson@amerihealthcaritasla. com HEALTHY BLUE– Dexter Trivett, COO – Dexter. Trivett@healthybluela. com LOUISIANA HEALTHCARE CONNECTIONS – Dr. Stewart Gordon, CMO - Stewart. T. Gordon@louisianahealthconnect. com UNITED – Angela Olden, COO – Angela_olden@uhc. com

QUESTIONS ? ? MY CONTACT INFO: KATHY KLIEBERT LMMCOA kathykliebert@gmail. com 985 -791 -7637

QUESTIONS ? ? MY CONTACT INFO: KATHY KLIEBERT LMMCOA kathykliebert@gmail. com 985 -791 -7637

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