La. Admin. Code tit. 50 § I-3101

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-3101 - Introduction

A. It is the departments goal to operate a managed health care delivery system that:

1. improves access to care and care coordination;

2. improves the quality of services;

3. promotes healthier outcomes for Medicaid recipients through the establishment of a medical home system of care;

4. provides budget stability; and

5. results in savings as compared to an unmanaged fee-for-service system.

B. Effective for dates of service on or after December 1, 2015, the department will operate a managed care delivery system for an expanded array of services to include comprehensive, integrated physical and behavioral health (basic and specialized) services, named the Bayou Health program, utilizing one model, a risk bearing managed care organization (MCO), hereafter referred to as an "MCO".

C. It is the departments intent to procure the provisions of healthcare services statewide to Medicaid enrollees participating in the Bayou Health program from risk bearing MCOs through the competitive bid process.

1. The number of MCOs shall be no more than required to meet the Medicaid enrollee capacity requirements and ensure choice for Medicaid recipients as required by federal statute.

La. Admin. Code tit. 50, § I-3101

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 37:1573 (June 2011), amended LR 41:928 (May 2015), LR 41:2362 (November 2015).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.