SLS 16RS-576 ORIGINAL
2016 Regular Session
SENATE CONCURRENT RESOL UTION NO. 9
BY SENATOR MILLS
HEALTH/HOSPITALS DEPT. Directs the Department of Health and Hospitals to evaluate
and report on the number of Bayou Health plans that are necessary and appropriate before
releasing another RFP to procure such plans.
1 A CONCURRENT RESOL UTION
2 To authorize and direct the Department of Health and Hospitals to evaluate and report on the
3 number of Bayou Health plans that are necessary and appropriate before releasing
4 another RFP to procure such plans.
5 WHEREAS, the Department of Health and Hospitals launched Bayou Health in 2012
6 as a new model of providing Medicaid services to Louisiana residents through the use of
7 managed care organizations; and
8 WHEREAS, prior to implementing Bayou Health, the Medicaid program operated
9 on a fee-for-service system where providers had one entity to bill for services rendered to
10 Medicaid recipients; and
11 WHEREAS, since its inception, the department has twice issued Requests for
12 Proposals (RFP), in both 2011 and in 2014, and subsequently contracted with five health
13 management organizations both times; and
14 WHEREAS, this has been an issue of constant frustration in the provider community
15 as networks, contracting, billing, prior authorizations, preferred drug lists, and many other
16 components of care are now in six different silos made up of five Bayou Health plans and
17 the population remaining in fee-for-service; and
18 WHEREAS, health care providers are having to spend a considerable amount of time
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SLS 16RS-576 ORIGINAL
1 maneuvering through all five Bayou Health plans and the burden has only increased since
2 pharmacy, dental and more recently, behavioral health care have all been rolled into Bayou
3 Health; and
4 WHEREAS, the burden on recipients has also generated much frustration as many
5 are not aware of their plan or the providers and services covered under their plan until they
6 are issued a denial, and then they find it quite complicated to resolve without having to go
7 to their legislator; and
8 WHEREAS, although many individuals have expressed concern with the use of five
9 health plans to administer Bayou Health, the actual number of Bayou Health plans is
10 currently completely within the discretion of the Department of Health and Hospitals; and
11 WHEREAS, Louisiana Medicaid recipients need to have access to health care
12 providers, but those same providers are steadily exiting the program due to inadequate
13 provider rates and the overwhelming burden of dealing with five Bayou Health plans; and
14 WHEREAS, before another RFP is issued in Summer 2017, and before any attempt
15 to exercise an extension of any of the current contracts is made, a thorough evaluation should
16 be conducted by the Department of Health and Hospitals to ensure that they are meeting the
17 needs of Louisiana Medicaid recipients in the most appropriate manner that is not unduly
18 burdensome on the providers who administer their care.
19 THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby
20 direct the Department of Health and Hospitals to evaluate and report on the number of
21 Bayou Health plans that are necessary and appropriate before releasing another RFP to
22 procure such plans or exercising any option to extend the term of the current plan contracts.
23 BE IT FURTHER RESOLVED that in conducting its evaluation, the department
24 shall consider the minimum number of health plans that would be allowed by the Centers
25 for Medicare and Medicaid Services (CMS), the number of health plans in other states that
26 have Medicaid managed care, and the minimum number of plans that would be needed to
27 appropriately manage the population of recipients.
28 BE IT FURTHER RESOLVED that in developing the report, the department should
29 consider such factors as complaint history and satisfaction with any of the five plans based
30 on recipient and provider complaints.
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SLS 16RS-576 ORIGINAL
1 BE IT FURTHER RESOLVED that the department shall include any other such
2 information as is necessary in evaluating this issue and submit a report of its findings and
3 recommendations to the Louisiana Legislature no later than January 1, 2017.
4 BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
5 secretary of the Department of Health and Hospitals.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SCR 9 Original 2016 Regular Session Mills
Directs the Department of Health and Hospitals to evaluate and report on the number of
Bayou Health plans that are necessary and appropriate before releasing another RFP to
procure such plans.
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