LaHIPP Louisiana Department - PowerPoint Presentation

Slide1

LaHIPP

Louisiana Department

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

LaHIPP Background

LaHIPP Program Overview

LaHIPP is a Louisiana post Medicaid enrollment Program

Helps families pay for employer sponsored health insurance when at least one person in the family gets MedicaidMedicaid will pay their copays and deductibles when the provider bills Medicaid secondary for LaHIPP enrolleesHigher reimbursement rate for providers

Someone in the household must be actively enrolled in Medicaid

Someone

in the household must be working and have access to Employer Sponsored Insurance (ESI)A Medicaid Enrollee in the household must be able to enroll or be enrolled in the ESIThe case must be cost effective for LaHIPP to reimburse the health insurance premiumLaHIPP Eligibility Requirements

The Per Member Per Month (PMPM) is compared to the Cost of Participation (COP) to determine the Cost Effectiveness of the LaHIPP case.

If the PMPM is greater in total versus the COP the case is determined to be cost effective.

Cost Effectiveness

For Families:

greater

access to providerspaid out-of-pocket expenses and monthly premiumContinuity of careCOBRA coverageFor Medicaid & Taxpayers:reduction of expenditures for both state and federal dollarsFor Providers:higher reimbursement ratebill Medicaid for the patient responsibilityPrivate Insurance + LaHIPP

= Win-Win-Win

LaHIPP vs non-LaHIPP Reimbursement - Physician

LaHIPP Recipient

Procedure CodeBilled ChargeMedicaid AllowablePatient ResponsibilityMedicaid Payment9921255.0024.1036.00 (ded)36.0083955-QW30.0011.3728.20 (ded)28.20Total85.0035.4764.2064.20

Non-LaHIPP 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

)

11.37Total85.0035.4764.2035.47

LaHIPP vs non-LaHIPP Reimbursement - Inpatient

LaHIPP Recipient

Procedure CodeBilled ChargeTPL Paid AmountMedicaid AllowablePatient ResponsibilityMedicaid PaymentMultiple HRR & B14,788.3710,255.074,593.00478.93478.93

Non-LaHIPP Recipient

Procedure Code

Billed Charge

TPL

Paid Amount

Medicaid Allowable

Patient

Responsibility

Medicaid Payment

Multiple

HR

R & B

14,788.37

10,255.07

4,593.00

478.93

0

The Medicaid Allowable minus the TPL payment is less than zero; therefore, the payment is $0.

DO:

Verify

LaHIPP enrollment Verify ESIFile ESI primary and Medicaid as secondary for LaHIPP EnrolleeDON’T:Collect out-of-pocket costs such as copays, coinsurance or deductibleDelay with LaHIPP forms, especially for newbornsDOs and DON’Ts with LaHIPP

e-MEVS, a web application accessed through

www.lamedicaid.com

Medicaid Eligibility Verification System (MEVS), an automated eligibility verification system using a swipe card device or PC software through vendorsRecipient Eligibility Verification System (REVS), an automated telephonic eligibility verification system, 1-800-776-6323Enrollment Verification

Contact Info

LaHIPP Toll

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