Article archive / January 1, 2014
Originally published: . Volume 5, No. 5. Source pages: 4.
A recent announcement from Louisiana Department of Health and Hospitals (DHH) said the agency adopted an emergency rule, effective Dec. 1, to comply with federal regulations, and protect Medicaid enrollees' right to choose how they receive their healthcare. The emergency rule prohibits providers from “steering” people to certain plans.
Provider steering as any conduct intended to recommend whether or not to enroll in a managed care health plan or Medicaid fee-for- service (legacy Medicaid), or to enroll in a specific managed care health plan over another health plan. This conduct is prohibited by any health care provider enrolled with Medicaid or a managed care health plan, or any Medicaid contracted managed care entity or health plan, including shared savings plans and capitated plans.
Examples of provider steering include, but are not limited to, offering enrollees incentives for selecting one managed care health plan over another plan, and allowing an enrollee to use a provider's fax, office telephone, or computer to enroll into a specific managed care health plan.
Providers may inform enrollees of the health plans they accept and the benefits, services and specialty care services offered through those health plans. However, they must disclose information on all the health plans they accept.
Through the Bayou Health program, enrollees can now choose to receive their healthcare through one of the five managed care health plans or, when eligible, through the Medicaid fee-for-service program. The Emergency Rule supplements the existing Coordinated Care Network Rule.
Sanctions can include disenrollment from the Medicaid Program, recoup of payments, and fines.
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