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Louisiana Awards Medicaid Managed Care Contracts With Enhanced Focus On Behavioral Health Integration

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By OPEN MINDS Circle

On February 11, 2022, the Louisiana Department of Health (DOH) announced its intent to award Medicaid managed care organization (MCO) contracts to five MCOs: CVS/Aetna Better Health, AmeriHealth Caritas, Anthem/Healthy Blue, Humana, and Centene/Louisiana Healthcare Connections. In total, the contracts are valued at about $9 billion annually. The MCO contracts will run for three years beginning on July 1, 2022, with an option to extend up to two more years. The MCOs will manage physical and behavioral health services for the state’s 1.7 million Medicaid members.

Compared to the current MCO contracts, the new contracts will include an increased focus on increasing behavioral health integration. The contracts will also have a greater focus on improving continuity of care across settings. Both intensified competencies—behavioral health integration and continuity-of-care—are intended to help the state meet the terms of a June 2018 federal settlement agreement about care for people with serious mental illness (SMI). The settlement agreement calls for Louisiana DOH to ensure that managed care enrollees with SMI receive the most appropriate care in the least restrictive setting.

The integration goals focus on bringing behavioral health assessment and treatment into primary care settings. The five MCOs will be responsible for offering provider organizations incentives and data to track progress on building greater care coordination, transparency, and communication between primary care and behavioral health provider organizations. The MCOs must offer tools, guidance, and financial incentives to help improve behavioral health and physical health integration within provider organization networks to develop the skill and infrastructure needed to schedule joint appointments, develop shared care plans, conduct effective brief assessments, integrate records, make and follow up on referrals, co-locate services and track outcomes. The incentives will be based on the level of integration between physical health, behavioral health, and social determinants of health.

The continuity-of-care goals focus on ensuring that members with behavioral health disorders receive the most appropriate service intensity in the least restrictive setting. The MCOs will be responsible for coordinating care for members with co-occurring medical and behavioral disorders, and how the MCO will promote care transitions between inpatient services, residential services, and outpatient care. They will also be responsible for helping members who use emergency department services schedule follow‐up care with a primary care professional and/or appropriate contracted behavioral health specialists. Additionally, the MCOs will be responsible for ensuring continuity and coordination of care for enrollees who have been screened positive or determined as having need of specialized medical health services, or who may require inpatient/outpatient medical health services. These activities must include referral and follow‐up for enrollee(s) requiring behavioral health services.

On June 23, 2021, the state released the request for proposals (RFP 3000017417), with proposals due by September 3, 2021. The state received bids from the five incumbents and from Humana. A bid submitted by incumbent UnitedHealthcare was not selected.

The RFP sought responses from MCOs with at least seven years of experience serving Medicaid populations of 1.5 million or more beneficiaries. The technical proposals were evaluated on a 1,500-point scale. Additionally, up to 12% of total points were reserved for MCOs certified as small entrepreneurships, or that intended to subcontract with one or more small entrepreneurships, through the Veteran‐Owned and Service‐Connected Disabled Veteran‐Owned Small Entrepreneurships (Veteran Initiative) and Louisiana Initiative for Small Entrepreneurships (Hudson Initiative).

As of March 1, 2022, the technical proposal evaluation scores had not been released. The 15 components in the technical proposal evaluation and the potential points were as follows:

  1. Proposer organization and experience: 90 points
  2. Enrollee value-added benefits: 60 points
  3. Population health: 90 points
  4. Health equity: 90 points
  5. Care management: 90 points
  6. Case scenarios: 120 points
  7. Network management: 90 points
  8. Provider organization support: 90 points
  9. Utilization management: 90 points
  10. Quality: 150 points
  11. Value-based payment: 100 points
  12. Claims management and systems and technical requirements: 70 points
  13. Program integrity: 100 points
  14. Physical and specialized behavioral health integration: 90 points
  15. Louisiana veteran and/or Hudson initiative: 180 points

Since January 1, 2020, due to a procurement problem, Louisiana DOH has had emergency MCO contracts with Aetna Better Health, AmeriHealth Caritas Louisiana, Healthy Blue, Louisiana Healthcare Connections, and United Healthcare Community Plan. In August 2019, following a competitive procurement Louisiana DOH selected AmeriHealth Caritas Louisiana; Healthy Blue; Humana Health Benefit Plan of Louisiana; and UnitedHealthcare Community Plan. However, the awards were protested, and on August 21, 2020, Louisiana DOH cancelled the procurement, which ended the pending protest appeal.

For more information, contact: Michelle McCalope, Communications, Louisiana Department of Health, Post Office Box 629, Baton Rouge, Louisiana 70821-0629; Email: Michelle.McCalope@la.gov; Website: https://www.ldh.la.gov/