Article archive / October 1, 2014
Originally published: . Volume 5, No. 14. Source pages: 6.
A Notice of Intent about “Provider Steering” was published in the September Louisiana Register with public hearing to be held on October 29.
The Department of Health and Hospitals, Bureau of Health Services Financing administers the Medicaid Program which provides health care coverage to eligible recipients through Medicaid contracted managed care entities and/or through Medicaid fee- for-service.
The department promulgated an Emergency Rule which adopted provisions prohibiting Medicaid providers and contracted managed care entities from engaging in provider steering in order to ensure the integrity of Medicaid recipients’ freedom of choice in choosing a particular health plan in which to enroll and, when eligible, the freedom of choice in deciding whether or not to receive care through Medicaid fee- for-service.
Definitions include: Provider Steering—unsolicited advice or mass- marketing directed at Medicaid recipients by health plans–including any of the entity’s employees, affiliated providers, agents, or contractors, that is intended to influence or can reasonably be concluded to influence the Medicaid recipient to enroll in, not enroll in, or disenroll from a particular health plan(s).
Provider—any Medicaid service provider contracted with a health plan and/or enrolled in the Medicaid Program.
Health Plan—any managed care organization (MCO), prepaid inpatient health plan (PIHP), prepaid ambulatory health plan (PAHP), or primary care case management (PCCM) entity contracted with the Medicaid Program
The Notice sets out sanctions and appeal processes.
A public hearing on this proposed Rule is scheduled for Wednesday, October 29, 2014 at 9:30 a.m. in Room 173, Bienville Building, 628 North Fourth Street, Baton Rouge, LA.
At that time all interested persons will be given an opportunity to submit data, views or arguments either orally or in writing. The deadline for receipt of all written comments is 4:30 p.m. on the next business day following the public hearing.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.