IDD Participant Enrollment/Integration in Bayou Health Plan - PowerPoint Presentation

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IDD Participant Enrollment/Integration in Bayou Health Plan

Kathy H.

Kliebert

SecretarySlide2

BACKGROUND

Bayou Health Physical Health

Effective 12/1/15 mandatory

SSI recipients under age 19

Family Opportunity Act enrolleesMedicaid enrollees with an OCDD SOA who are not receiving waiver or ICF services“Unless in the Chisholm class (under 21, on Medicaid, and on the registry(“waiting list”) for waiver services.”Waiver recipients (without Medicare) began Bayou Health opt-in in July 2014 and continue with opt-in choiceChisholm Class began Bayou Health opt-in July 1, 2015 and continue with opt-in choice

Behavioral Health Integration

Effective 12/1/15, Magellan will provide services only to CSoC enrolleesSpecialized behavioral services will be provided by one of the five Bayou Health Plans:Aetna Better HealthAmerigroup Real SolutionsAmeriHealth CaritasLouisiana Healthcare ConnectionsUnited Healthcare

LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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What does this mean for me?

Are you already enrolled in Bayou Health?

Are you receiving SSI benefits or enrolled in the Family Opportunity Act program?

Are you residing in an ICF or have Medicare?

Are you receiving HCBS services or on the registry (Chisholm Class member)? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS3Slide4

Individuals Already in Bayou Health

Bayou Health plan will coordinate benefits

Benefits include: Physical health, specialized behavioral health, pharmacy and NEMT

Exceptions:

Children who qualify for and enroll in CSOCMagellan will manage all specialized behavioral services for the CSOC services in coordination with Bayou Health planBayou Health plan will coordinate all remaining servicesHCBS enrollees continue to receive waiver services as they do now

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Individuals New to Bayou Health for Medicaid Benefits

Groups included

Children receiving SSI who had opted out

C

hildren enrolled in the Family Opportunity Act program who had opted outAccess all services through the Bayou Health Plan -- Physical health, specialized behavioral health, pharmacy and NEMT CSoC exception remains the same when enrolledLOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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Individuals New to Bayou Health for Specialized Behavioral Health & NEMT

C

hildren (under 21)residing in an ICF & Medicare

dual

eligibles Bayou Health plan coordinated benefits:Specialized behavioral health services Non-emergency transportation to ANY Medicaid service (waiver, non waiver, dentist, physical or Specialized BH)Continued Medicaid Fee for Service/Medicare:Physical health providersWaiver servicesFacility servicesPharmacy

CSoC exception remains the same when enrolled

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Individuals receiving HCBS services or Chisholm Class members

Bayou Health plan

coordinates benefits if and when you need them:

Specialized behavioral health services

Non-emergency transportation to ANY Medicaid service (waiver, non waiver, dentist, physical or Specialized BH)Children will receive transportation to any provider under EPSDT.CSoC exception remains the same when enrolledYou can CHOOSE to receive your other benefits from your Bayou Health plan too. You can also CHOOSE to return to Fee for Service Medicaid for your other benefits.

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Enrollment Process

Ask your providers what plans they accept

Choose a plan – Bayou Health can help

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ast day to choose a plan for December 1 enrollment is November 6.Participants can enroll: Online at www.bayouhealth.comBy phone at 1-855-BAYOU-4U (1-855-229-6848).By fax at 1-888-858-3875.By mail using an Enrollment Form. In person at the local Medicaid eligibility office.

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Important things to understand

Enrollment in a Bayou Health Plan continues for one year or until the next Open Enrollment period.

Participants

can change plans within the first 90 days after enrollment (Feb 26

th).It is possible to change plans for cause after Feb 26th. Key action point: Ensure that current providers are contracted with the Bayou Health plan that you choose Ask your providers Ask Maximus (enrollment broker)

LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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If a participant doesn’t choose…

Participants

who don’t select a plan will be auto-enrolled in one of the five plans regardless of whether they are currently receiving

specialized behavioral

health services. Any participant who is currently receiving Medicaid specialized behavioral health services through a provider should be strongly encouraged to:Ask their providers which plans they are enrolled in.Ask Bayou Health (the enrollment broker) which plans the providers are enrolled in.LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

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Additional Considerations for HCBS Enrollees and Chisholm Class members

All plans offer care

coordination which can assist with challenges accessing and coordinating services

Plans

contract with non-Medicaid providers & specialists to ensure access to services Plans have the flexibility to pay for services that Medicaid cannot Types of medical equipment or supplies not traditionally allowableEach plan offers a set of value added services All plans offer basic adult dental servicesAll plans offer some type of adult vision servicesAdditional items include weight loss support, cash incentives for participating in wellness programs, and even free cell

phonesNo 12 visit restriction for adults

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