The federal government will require Louisiana to revamp some features of a Jindal administration plan that alters the state’s health-care delivery system for the poor.
The federal Center for Medicare and Medicaid Services wants changes in the criteria used to determine whether companies taking over care coordination would be eligible for “shared savings” payments, state Medicaid deputy director Ruth Kennedy said.
But plans are still on track to begin phasing in the networks statewide in January with the initial rollout in the New Orleans area even with the looming changes, she said.
Shared savings is one of two financial models the state plans to use as it moves to private insurance or other third-party entities to handle health care for Medicaid members. Providers would get a share of whatever is saved.
Under the Jindal plan, groups of physicians, hospitals and other health-care providers — called coordinated care networks — would emphasize preventive and primary care. The networks would receive a monthly fee to provide care and management services. The networks also would share in the cost savings from keeping patients healthier.
Two of the five companies chosen to run coordinated care networks — United Healthcare and Community Health Solutions — would operate under the shared savings financial model.
A third company — Louisiana Physician Connections — is protesting a decision that excludes it from participation.
Because the protest has been filed, the state Department of Health and Hospitals cannot communicate with the successful proposers about the situation.
“I’m not at all concerned about us,” said Kennedy, who is overseeing program implementation. Some minor changes will be required in Louisiana’s shared-savings model, she said.
The Center for Medicare and Medicaid Services, the federal agency that oversees state Medicaid programs, wants Louisiana to include more clinical measures for tracking whether money is saved through reduced hospitalization, emergency room visits or other efficiencies, Kennedy said.
Louisiana used other administrative measures initially to demonstrate accountability, such as clear reporting of clinical measures, Kennedy said.
“We wanted to get (shared savings) money out quickly,” Kennedy said.
State officials should know what CMS specifically wants by next week, Kennedy said.
Meanwhile, Commissioner of Administration Paul Rainwater on Thursday denied a protest filed by Louisiana Physician Connections over its exclusion from participation.
The minority-owned and physician-led LPC had protested the way DHH teams evaluated its proposal. It also challenged Community Health’s selection saying it had not complied with all financial disclosure requirements because it omitted a potential $10 million liability.
“The fact that LPC disagrees with the evaluators’ judgment does not mean that the scoring should be changed,” Rainwater wrote.
On the Community Health issue, Rainwater said, “in the context of this appeal, such a development does not afford relief to LPS. Its score was too low to receive an award.”
The Louisiana Legislative Black Caucus questioned whether Community Health was truthful in its response to the state’s request for proposal in a letter to state Department of Health and Hospitals Secretary Bruce Greenstein.
Caucus chairwoman state Rep. Patricia Smith, D-Baton Rouge, cited recent news articles about a $10 million overpayment the state of South Carolina erroneously gave Community Health.
“The South Carolina Medicaid program said that Community Health Solutions did not generate the amount of shared savings previously determined and is required to pay back the overpayment,” Smith wrote. “Such a serious and significant matter (and one that speaks to this company’s ability to generate shared savings in a coordinated care program for our state) should have been disclosed to and considered by the Department.”
Kennedy said criteria for a proposal did not require Community Health to disclose the South Carolina situation.