§1253.3. Louisiana Behavioral Health Partnership; reporting

A. The Louisiana Department of Health shall submit an annual report for the Coordinated System of Care and an annual report for the Louisiana Behavioral Health Partnership to the Senate and House committees on health and welfare. The report shall be submitted by June thirtieth of each year, and the applicable reporting period shall be for the previous state fiscal year. The report shall include but not be limited to the following information:

(1) The total number of healthcare providers in each parish, broken down by provider type, applicable contracting status, and specialty.

(2) The total number of Medicaid and non-Medicaid members enrolled in each parish.

(3) The total and monthly average number of adult Medicaid enrollees receiving services in each parish.

(4) The total and monthly average number of adults not enrolled in the Medicaid program receiving services in each parish.

(5) The total and monthly average number of children receiving services through the Coordinated System of Care by parish.

(6) The total and monthly average number of children receiving Louisiana Behavioral Health Partnership services outside the Coordinated System of Care by parish.

(7) The total and monthly average number of children not enrolled in the Medicaid program receiving Louisiana Behavioral Health Partnership services outside the Coordinated System of Care by parish.

(8) The percentage of all referrals that were considered immediate, urgent and routine needs and the average length of time to authorize for services by parish.

(9) The percentage of clean claims paid for each provider type within thirty calendar days and the average number of days to pay all claims for each human services district or authority or local government entity.

(10) The five most common reasons for denial of claims and the total number of claims denied according to the cause presented.

(11) The percentage of members asked to and who provide consent for the release of information to coordinate care with the member's primary care physician and other healthcare providers.

(12) The number of outpatient members who received services through the Louisiana Behavioral Health Partnership in hospital-based emergency rooms.

(13) A copy of the statewide management organization's report to the Louisiana Department of Health on quality management, which shall include:

(a) The number of qualified quality management personnel employed by the statewide management organization to review performance standards, measure treatment outcomes, and assure timely access to care.

(b) The mechanism utilized by the statewide management organization for generating input and participation of members, families/caretakers, and other stakeholders in the monitoring of service quality and determining strategies to improve outcomes.

(c) Documented demonstration of meeting all the federal requirements of 42 CFR 438.240 and with the utilization management required by the Medicaid program as described in 42 CFR 456.

(d) Documentation that the statewide management organization has implemented and maintained a formal outcomes assessment process that is standardized, relatable, and valid in accordance with industry standards.

(14) The total amount of funding remitted by the state pursuant to its contract with the statewide management organization during the period addressed by the report, including an itemization of this amount which encompasses, at minimum, the total costs to the state associated with the following cost items:

(a) Payment of claims to providers.

(b) Administrative costs of the statewide management organization.

(c) Profit for the statewide management organization.

(15) An explanation of all changes during the period addressed by the report in any of the following program aspects:

(a) Standards or processes for submission of claims by behavioral health service providers to the statewide management organization.

(b) Types of behavioral health services covered through the statewide management organization.

(c) Changes in reimbursement rates for covered services.

(16) Any other metric or measure that the Louisiana Department of Health deems appropriate for inclusion in the report.

B. Upon the integration of behavioral health services into the Louisiana Medicaid Bayou Health managed care program, or any successor, the final report produced pursuant to this Section for the period starting July 1, 2015, shall be issued by June 30, 2016, or six months following the integration date, whichever occurs later, and subsequent behavioral health reporting shall be included in the report produced pursuant to R.S. 40:1253.2.

Acts 2013, No. 212, §1; Redesignated from R.S. 40:1300.363 by HCR 84 of 2015 R.S.; Acts 2015, No. 158, §1, eff. June 23, 2015; Acts 2017, No. 349, §1; Acts 2018, No. 206, §4.