leading transformation · 2011. 10. 18. · a catalyst for better health. through smarter...

LEADING TRANSFORMATION:Our FY 2012 Priorities for a Healthier Louisiana

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Table of Contents

Message from Secretary Bruce D. Greenstein

Executive Summary .......................................................................................... 1

Health Care in Louisiana Today ........................................................................ 2

Business Review ................................................................................................ 6

General Overview........................................................................................ 6

Core Management Functions..................................................................... 7

Office of Aging and Adult Services (OAAS)................................................ 8

Office of Behavioral Health (OBH)............................................................. 9

Office for Citizens with Developmental Disabilities.................................. 9

LouisianaMedicaid...................................................................................11

Office of Public Health..............................................................................12

Transformational Priorities ..............................................................................15

Building Foundational Change for Better Health Outcomes..................15

Promoting Independence through Community-Based Care................. 36

Managing Smarter for Better Performance............................................ 47

Message from Secretary Bruce D. Greenstein

Dear Friends:A well-performing government, at every level, is an important part of a successful society. Where failure has occurred is when public institutions begin counting success as simply continuing to exist. The world is changing, particularly around health care. We cannot afford to just exist and churn out the same processes and outcomes of each previous year. We believe in Louisiana’s potential. In particular, I believe in this agency’s potential to be a catalyst for better health. Through smarter management, executable work

plans, measurable goals and consistent accountability, we can begin to change the way that health care is financed and delivered in our state. The Louisiana Department of Health and Hospitals (DHH) is an $8 billion enterprise with close to 9,000 employees. We have service lines and responsibilities that stretch across the health and health care spectrum. While it is an organization filled with dedicated people, we have lacked the structure to plan executable goals and effectively measure and manage our progress. I do not pretend that this business plan alone will solve our state’s health challenges. What it does say — and I think this is incredibly important — is that the government agency charged with the mission of protecting and promoting the health of the people of this state is, in many areas, challenging the notion of “business as usual.” I invite you to examine the plan thoroughly. Within, you will find a thoughtful analysis of our state’s current health status, including both the challenges and opportunities we have before us. We’ll explore DHH’s current impact as the state’s health care agency, including a business review of our critical functions and an honest look at our performance. The heart of this plan is a detailed description of the department’s top policy and programmatic priorities for health care. These 20 Transformational Priorities are our “big bets.” Through these priorities and commitments, DHH is holding itself accountable for the execution of the responsibilities bestowed upon us by people of this state. We pledge to ensure that we are spending the dollars that you, the taxpayer, have entrusted to us with the highest levels of integrity, efficiency and effectiveness. It is no secret that our state lags in many health rankings and indicators, but we should not accept 49th place in perpetuity. Our potential is so much more and we will only achieve success by working together and taking responsibility.

Warm regards,

Our FY 2012 Priorities for a Healthier Louisiana

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Executive SummaryLouisianafacesnumerouschallengeswhen

itcomestoimprovingourhealthcaresystem.However,thesuccessesofboththecurrentsystemandtheDepartment’seffortsduringthepastyeararenoteworthy.TheFY2011businessplanwasthefirstofitskindforDHH.Itspublicationwasthefirststepinanefforttointroduceapredictablerhythmintothebusinesscycleofthedepartment.DHHleadershiphasuseditasaguideandaccountabilitytooltoensurethattheday-to-dayworkisalignedwiththeprioritiessetforth.DepartmentleadershipgatheredinFebruarytoconductmid-yearreviewsessionstomeasureprogressandsetgoalsforyear-endclose-outs.

GoalsthatcarriedforwardfromtheFY2011planincludeacontinuedefforttostreamlineoperations,improveservices,measureoutcomes,ensureefficientspendingandimplementcommunity-basedexpansion.FromthesethemesemergedTransformationalPrioritiesthatrepresentthoseprioritieswiththehighestpotentialimpact.

ThesetransformationinitiativesaregroupedintothreemajorareasandrepresenttheDepartment’sfocusin2012.Whiletheydon’trepresentthefullbookofbusinessofthedepartment,thegoalwithinthisbusinessplanistopresenttheDepartment’stoppriorities.Otherswillemergethroughouttheyear,andDHHleadershipencouragesresidentsandstakeholderstorespondwiththeirownbigideasandprioritiesforhealthcareinLouisianatoday.

The three themes guiding the Department’s work are:

9BuildingFoundationalChangeforBetterHealthOutcomes

9PromotingIndependencethroughCommunity-basedCare

9ManagingSmarterforBetterPerformance

Building Foundational Change for Better Health Outcomes

BecauseofthesignificantchallengesLouisianafacesinhealthoutcomesandthehealthstatusofitscitizens,itisnosurprisethatthelargestsection

ofthisbusinessplanisaroundrebuildingsystemsthatchallengethestatusquowithalaser-likefocusonimprovinghealthoutcomes.

Thenineinitiativesunderthisthemeareallaboutmakingsignificantchange,notmerelytinkeringaroundtheedges.Allarealreadyunderwayinsomeformoranother,andthedeliverablessetundereachonerepresentthecriticalphasesofimplementationthisfiscalyear.Theyare:

�MedicaidCoordinatedCareNetwork(CCN)Program

�Louisiana’sVisionforHealthInformationTechnology

�GreaterNewOrleansCommunityHealthConnection(GNOCHCClinics)

�MedicaidManagementInformationSystem(MMIS)

�LouisianaBehavioralHealthPartnership(LBHP)

�CoordinatedSystemofCare(CSoC)

�IntegratingBehavioralHealthBusinessPracticesandTreatmentApproaches

�IntegratingPublicHealthandPrimaryCare

�LouisianaBirthOutcomesProject

Promoting Independence through Community-Based Care

Fordecades,institutionalcarehasbeenthepredominantapproachtolong-termcareservicesinLouisiana.Inrecentyears,theDepartmenthasbeensettinguptheinfrastructureandvaluestructuretoprovidecitizenswithdevelopmentaldisabilitiesaswellastheagingpopulationmorerobustindependentlivingoptions.

Eachoftheprioritiesinthisthemecarriesthatworktothenextlevelwithadetailedplanformakingthesetransitionssustainableandmorerobustwithincreasedoptionsandsupports.Theyare:

�RedesigningtheCommunity-BasedLong-TermCareInfrastructure

�RightBalancingInstitutionalandCommunity-BasedLong-TermCare

LEADING TRANSFORMATION

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�EmploymentFirstInitiativeforCitizenswithDevelopmentalDisabilities

�SustainableHome-andCommunity-BasedSupportsandServices

�SystemsRebalancingforPeoplewithDevelopmentalDisabilities

�StrengtheningtheHome-andCommunity-BasedInfrastructure

Managing Smarter for Better Performance

Withabudgetof$8.2billionandaworkforceofnearly9,000employees,managingsmartwithaccountabilityandtransparencyisahallmarkpriorityfortheDepartment.Eachoftheprioritiesinthisthemeisfocusedonimprovingservicestoconstituents,usingtechnologymoreeffectivelyorprotectingprecioustaxpayerresources.Theyare:

�LouisianaElectronicEventRegistrationSystem(LEERS)

�Louisiana’sDisasterDataCollectionSystemforHealthCareFacilities-EMSTAT

�CombattingFraudandAbuse

�EatSafeLouisiana

�DHHInformationTechnology

HEALTH CARE IN LOUISIANA TODAY Louisianahasalonghistoryofhealth

challengesthatpersisttoday.Thesechallengesareillustratedincountlessstudies.MostcommonlycitedonessuchastheUnitedHealthFoundation,theCommonwealthFundandtheAnnieE.CaseyFoundationallplacedLouisiana49thintheirmostrecentoverallhealthrankings.Thereareanumberoffactorsthatmakeupthatranking–someasfarreachingaslevelsofpovertyandeducationandsomemorecloselyalignedtothestate’shealthcaresystemanddirecthealthoutcomes.

Forthepastthreeyears,theDepartmenthasmadesignificantandfoundationalchangestobeginthelongprocessofimprovingthehealthoutcomesforthepeopleofLouisiana.Significantchallengesremain,buttheroadtoimprovingthoseisbeingpavedwithaseriesofinitiatives–manyofwhicharealreadyseeingimprovedoutcomesandmanymoreofwhichareoutlinedinthepagesofthisbusinessplan.

Thoseinitiativesalreadyunderwayhaveincreasedaccesstocareforallresidents,especiallychildren;enhancedaccountabilityandtransparency;andaretransformingtheprovisionofhealthcareservicestoamoreefficientandeffectivesystemthatputspeoplefirstandbureaucracieslast.

Increasing access

Theroleofhealthinsurancecoverageandaccesstocarecannotbeoverlookedwhenconsideringhealthoutcomes.Wholecoveragedoesn’talwaystranslatetoaccess;weknowthatitisoneofmanyfactorsthatmustbeconsideredbecausetheabilitytoaccesspreventivecareisproventoheadoffchronicconditionsthathauntmanyLouisianaresidents.It’salsoonefactorthestatehasseensignificantimprovementsinduringrecentyears.From2007to2009,thenumberofuninsuredchildrenandadultsinLouisianahasbeenonasteadydecline,accordingtothe2009LouisianaHealthInsuranceSurvey(LHIS).ThenumberofuninsuredchildrenandadultsinLouisianahasdeclinedto5percentand20.1percent,respectively.Whilethissuccessisnoteworthy,Louisianians,likeresidentsin


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statesacrossthecountry,continuetoexperiencedisparitiesandinequalitiesinaccesstoinsurancebasedonrace,income,education,andage.

OneapproachalreadyunderwayandoutlinedfurtherintheTransformationalPrioritiessectionofthisbusinessplantoaddressthesedisparitiesistheGreaterNewOrleansCommunityHealthConnection(GNOCHC).TheDepartmenthasworkedwithlocalandfederalofficialstosustainanetworkofprimaryandbehavioralhealthcareclinicsthatgreworganicallyintheaftermathofHurricaneKatrinainthefour-parishgreaterNewOrleansmetropolitanarea.TheGNOCHCinitiativeprovidesprimaryhealthcareservicesthrough39primaryandbehavioralhealthclinicsoperatedby19organizations.Thisinnovativemodelcanserveasanexamplefortherestofthestateandcountryasleaderslooktoexpandaccesstointegratedcommunity-basedprimarycaresettings.

Andit’snotjustintheNewOrleansarea.Thestatehasmadeinvestmentsinprimaryandpreventivecareclinicsstatewidewith17newruralhealthclinicscertifiedsinceJan.1,2008,and41newfederallyqualifiedhealthcenters.

DHHalsohelpedlocalgovernments,hospitalsandotherhealthcareprovidersmaximizehealthcaredollarsandpreserveaccesstocareforMedicaidpatientsthroughaseriesofnew“UpperPaymentLimit”(UPL)programsthatwillbeexpandedinthecomingfiscalyear.Already,theseprogramshaveestablishedpublic-privatehospitalspartnershipstoprovidehealthcareservicestothepoorandneedy,resultingin$195.9millionadditionalfundsto28hospitalsacrossthestate.InJuly,Gov.BobbyJindalsignedHB1,whichprovidesmorethan$102millioninexpenditureauthorityforDHHtopaylocalpublichospitalsandambulanceservicesthroughtheUPLprogramsinFY2012.

Transforming the health care delivery systems

Again,weknowthroughcountlessstudiesthathavinganinsurancecardorMedicaidcoveragealonedoesnotguaranteeaccessnorimprovedhealthoutcomes.Forinstance,29percentofLouisiana’spopulation(about1.2millionpeople)obtainshealthcarecoveragethroughtheMedicaidprogramthat,despitespendingnearly$7billion

(morethan$2billioninstatefunds)ayear,hasgenerallyshownlittle,ifany,improvementinhealthoutcomesforitsenrollees.

WhiletheAmericanCancerSocietynotesthatLouisianahasamongthehighestratesofbreastcancerdeathsintheUnitedStates,only40percentofeligibleMedicaidwomenwerescreenedlastyearforthedeadlydisease.Only56percentofeligibleMedicaidwomenreceivedrecommendedcervicalcancerscreeningand,infact,fewerthan10percentofadultsintheMedicaidprogramevenhadapreventivevisitlastyear.Despiteratesofdiabetesamongadultshavingnearlydoubledfrom1997to2007(5.2percentto10.1percent),only66percentofMedicaid-covereddiabeticstestedtheirbloodsugarlevelin2008

Afterdecadesofrunningafee-for-serviceMedicaidsystemthatfocusesonvolumeovervalue,thestateisimplementingCoordinatedCareNetworks(CCNs)acrossthestateinFY2012.Theprimaryobjectiveofthereformistoimprovehealthoutcomes–aresultseeninotherstatesthathaveembarkedonsimilarMedicaidcoordinatedcareinitiatives.Bybettermanagingchronicandcostlyconditions,DHHexpectsareductioninsomeofthemorecostlyhealthcareservicessuchasunnecessaryhospitalizationsandemergencyroomvisits.Inadditiontoimprovinghealthoutcomes,CCNsareexpectedtosave$135millioninthefirstfullyearofimplementation.YoucanreadmoreaboutCCNsintheTransformationalPrioritiessectionofthisdocument.

Insimilarfashion,DHHislaunchingacomprehensiveredesignofLouisiana’sbehavioralhealthsystemtoimprovecoordinationandaccesstomentalhealthcareandaddictivedisorderstreatment.TheLouisianaBehavioralHealthPartnership(LBHP)isanewapproachtothedeliveryandfinancingofbehavioralhealthservicestoLouisiana’schildrenandadultsthroughanintegratedpublicbehavioralhealthsystemthatdrawsonthestrengthsofthepublicandprivatesectors.LikeCCNs,theconceptofthePartnershipistofocusservicesandcareonqualityratherthansimplypayingforquantity.AspartoftheLouisianaBehavioralHealthPartnership,DHHisworkingjointlywiththreeotherstateagenciestoimplement


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aCoordinatedSystemofCare(CSoC)foryouthwithsignificantbehavioralhealthneedsthatwillimprovecoordinationacrossmultipleagenciessothatchildrenandfamiliesreceiveoneplanofcarethatmoreeffectivelyorganizesresourcesandbetterleveragesstatefunding.YoucanreadmoreaboutthePartnershipandCSoCinTransformationalPrioritiessectionofthisdocument.

ThesetwoinitiativesarejustthenextlogicalstepinatransformationthathasbeenoccurringinbehavioralhealthforthepastseveralyearsinLouisiana.Historically,thestatehasreliedheavilyontheDisproportionateShareHospital(DSH)Programtofundbehavioralhealthcare.TheperverseincentivesoftheDSHProgram,whichhasalsohistoricallybeenusedtofundthestate’spublichospitalsafetynetsystem,forcespeopleintoinstitutionalsettings,whetherit’saccessingcarethroughemergencyroomsorintolargestate-runin-patientpsychiatricsettings.Thishascreatedabiastowardinstitutionalcarethathaskeptmoneyfromprimaryandpreventivecare.

But,thishasbeenchanging.Thestatehasbeenshiftingdollarsandenhancingcommunity-basedservicesthatallowpeopletostaywiththeirfamiliesandintheircommunities.Inthepastthreeyears,thistransitionhasallowedanadditional2,725individualswithbehavioralhealthcareneedstoreceiveservicesandaccessprivatecommunity-runoptionsratherthanthelargestate-runinstitutionalsetting.

Amongthesafetynethospitals,thestatehasalsoenteredintoahistoricagreementestablishingapublic/privatepartnershipbetweenLSU’sEarlK.LongandOurLadyoftheLakeinBatonRougetoleverageprivateresourcestoservetheunderservedwhilealsoenhancingacademicmedicalopportunities.

Liketheefforttoenhancecommunity-basedoptionsforpeoplewithbehavioralhealthneeds,DHH’sOfficeforCitizenswithDevelopmentalDisabilitieshascontinuedtopursuepoliciesthatpromotethemostintegratedsettingappropriatetotheneedsofLouisianaresidentswithdevelopmentaldisabilities.InFY2011,continuedimplementationofresourceallocationpolicesthatestablishesanindividualbudgetbasedon

needshasnettedanestimatedplansavingsofmorethan$26.5million,whilealsoempoweringindividualstolivefullerlivesmoreintegratedintotheircommunities.Further,DHHhasworkedtoclose,consolidate,downsizeortransitiontoprivatemanagementstate-runcommunityhomesandpublicsupportsandservicescenters.Lastfiscalyearsawthesuccessfulclosureofonelargeandonesmallcenterand14communityhomes,ofwhichthreecommunityhomesconvertedtoflexiblewaiverservicesandfivewhichservedpeoplewithcomplexmedicalneedsprivatizedthroughcooperativeendeavoragreements.Additionally,onecenterprivatizedthroughacooperativeendeavoragreement.Thesepolicieshavebeencoupledwithperson-drivenplanningandcarefulindividualassessmentofcurrentcenterresidentstodetermineappropriatecasesfortransitiontocommunity-basedsettings.InFY2011,DHHsuccessfullytransitioned302individualsfrominstitutionaltocommunitysettings,providinggreateropportunitiestobeapartofeverydayactivitiesthatweallenjoy,suchasfamilyrelations,communityengagement,workoptionsandculturalenrichmenttobuildbetterqualityoflife.

OneofthemostdifficultstatisticsinLouisiana’shealthcareoutcomesisaroundinfantmortalityandprematurity.Louisianaranks48thininfantmortalityaccordingtotheUnitedHealthFoundation(UHF).TheUHFreportcardforLouisianashowsthat11.2percentofinfantsinLouisianawerebornatalowbirthweightand16.6percentofbirthswereunder37weeksgestation.Becausethestatepaysforabout70percentofthebirthsinLouisiana,inadditiontotheheavytolltheseoften-preventableoutcomesplaceonfamiliesandcommunities,theyalsocoststatetaxpayersasmuchas$200millionannually.Toaddressthissituation,in2010,DHHannouncedthebeginningsoftheBirthOutcomesInitiative.Onekeycomponentoftheprogramistoendthedeliveryofinfantsbeforethe39thweekofgestationunlessmedicallynecessary.OnJuly13,2011,DHHSecretaryGreensteinannouncedthecommitmentof20LouisianahospitalstoDHH’s39-WeekInitiative.Sincethen,anadditionaltwohospitalshavesignedontothepledge.Aspartofthisinitiative,DHHalsoexpandedtobaccoscreeningforeligiblepregnantwomenandmade


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availableforthefirsttimetoMedicaidcoveredmoms,alife-savingdrugproventopreventrepeatpretermbirths.

Enhancing accountability and transparency

Sincelatesummer2010,theDepartmenthasexpandeditseffortstoreachouttohealthcareproviders,consumers,taxpayersandcommunitiesacrossthestatetoseekfreshideasandfeedbackonprogramsandpolicies,aswellassharegreateramountsofinformationabouttheDepartment’seffortstoimprovehealthandhealthcareacrossthestate.Whetherthroughanaggressivenewmediaprogramorcommunitymeetings,theDepartmenthasinitiatedanewapproachtoachievegreatertransparencyandinteractionwiththoseimpactedmostbyitsdailyfunctionsanddecisionmaking.

Evenbeforethen,theStatelaunchedaConsumerRighttoKnowinitiativethatisprovidingqualitydataforanumberofdifferenttypesofprovidersatthehealthfinder.la.govwebsite.Thisfirst-of-its-kindinitiativegivesconsumersinformationtheyneedtomakeinformeddecisionsaboutnursinghomes,hospitalsandahostofothercareproviders.Italsointroducesaccountabilityforthoseprovidersbymakingqualityresultspublic.Morerecently,DHHlaunchedtheEatSafe.La.GovwebsitethatgivesresidentsfoodsafetyinformationandopenaccesstotheinspectionsDHHsanitariansconductofeveryretailfoodestablishmentinthestate.

ForcriticaltransformationaloverhaulssuchasCoordinatedCareNetworksinMedicaidand

theLouisianaBehavioralHealthPartnership,theDepartmentanditsleadershiphaveheldmorethan20communityforumsacrossthestatetoprovideinformation,engageinanin-depthdiscussionandofferanswerstoquestionsfromproviders,consumersandadvocates.ThesetwotransformationsarefundamentallyalteringandimprovingthewayLouisianaisadministeringMedicaidandbehavioralhealthservicesandthuscreatedmanyquestions,muchdiscussionanddebateand,mostimportantly,anopportunityforconsumers,providers,policymakersandadvocatestohaveaconstructiveandactionableconversationaboutbringingLouisiana’shealthcaresystemintothe21stcentury.Thousandsofpeopleparticipatedinthediscussionatthesecommunitymeetingsandonline,andmanycontinuetostayengagedintheconversationthroughsocialmediaanddirectcommunicationwiththeDepartment.AsaresultoftheCCNcommunityforumsacrossthestateandcountlessmeetingswithproviderandconsumergroups,theDepartmentwasabletomakeadditionalenhancementstoitsoriginalrobustproposaltooverhaulLouisiana’sMedicaidprogram.ThedialogueonMedicaidreformresultedinastrongerplanforLouisiana.

Challenges remain

Whilethestateisworkingonsystemsandthebuildingblocksofbetterhealth,DHHofficialsareacutelyawarethatthesystemisonlypartofthepicture.Thestatecontinuestobelimitedbyotherhealthandsocialdeterminantsthatcannotbequicklyaddressedandwilltakesustainedeffort,involvingmorethangovernment,toimprove.

AccordingtoUHF’s2010America’sHealthRankings,33.9percentofLouisiana’spopulationwasobese,thefourthhighestrateinthecountryandupfrom28.9percentjustayearearlier.ToomanyLouisianiansarealsonotengagingintherecommendedlevelofphysicalactivity.In2007,61percentofLouisiana’sadultpopulationreportedinadequatephysicalexercise,givingLouisianathedistinctionofhavingthe2ndleastactiveadultpopulationinthecountry.OnepositivesignhasbeenthatwhileratesofsmokinginLouisianastillremainhigherthanthenationalaverage(20.5vs.18.3percent),theserateshavesteadilydeclined


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forthepastthreeyearsforwhichdataisreported(morethan2percentagepointsoverallandmorethan6percentagepointsamong18-24yearoldsinthelastyearalone).

Thesedeterminantsofhealthtranslateintounnecessarychronicdiseaseanddeaths.TheBehavioralRiskFactorSurveillanceSystemrevealedthat1in5Louisianaresidentsreportedbeingtoldtheyhaveachronichealthproblem.AccordingtoUHF’s2010America’sHealthRankings,Louisianaalsosuffersfromhighratesofcancerdeaths(220.1per100,000people)andcardiovasculardeaths(334.8per100,000people).TheCommonwealthFund’s2009StateScorecardrankedLouisiana49thforthemortalityrateamenabletohealthcarewith137.2deathsper100,000,comparedtoanationalaverageof89.9.

Lackofaccesstopreventivecare,afragmentedMedicaidsystem,perversefinancingmechanismsandhighratesofunmanagedchronicdisease,hasledtohighratesofavoidablehospitaluseandrelatedcosts.AccordingtotheCommonwealthFund,LouisianahasthehighestratesofavoidablehospitalizationsamongMedicarerecipientsandhospitaladmissionsforhomehealthpatients.Accordingtoclaimsdata,44percentofchildrenwithasthmainMedicaidvisitedtheemergencyroomlastyear.Morethan16,590childreninCommunityCARE(Louisiana’sprimarycarecasemanagementprogram)hadfourormoreERvisitsinFY2010.InFY2009,Louisianaemergencyroomssaw546visitsper1,000inpopulation,rankingitsixthinthenationandwellabovethenationalaverageof415.Thisoverrelianceonin-patientand

emergencyroomcareiscostlyanddivertsdollarsawayfromlessexpensiveandmoreeffectiveprimarycaresettings.

Thesestatisticspresentacriticalchallengetothestate’shealthcareleadersandpolicymakerswhomusthaveanswerstoourtroublingquestions:Whatisdrivingtheseoutcomes?Howishealthcarechanging?Andmostimportantly,whatcanwedotoimproveourhealthoutcomes?

Business ReviewGeneral Overview

ThemissionoftheDepartmentofHealthandHospitals(DHH)istoprotectandpromotehealthandtoensureaccesstomedical,preventiveandrehabilitativeservicesforallresidentsoftheStateofLouisiana.Ourresponsibilitiesincludetheprovisionofthestate’ssafetynethealthinsuranceplan(Medicaid),aswellasservicesforpublichealth,behavioralhealth,agingpopulationsandpeoplewithdevelopmentaldisabilities.

InFY2012,DHHhas8,458authorizedpositions.Theseemployeesaredividedamongnineadministrativeregionsandincludestaffatthreestatesupportsandservicescenters,onegrouphome,threementalhealthhospitals,68parishhealthunits,threespecialtyclinics,regionalofficesacrossthestate,andpublichealthofficesinNewOrleansandheadquartersinBatonRouge.Together,theDHHteammanagestheongoingprovisionofhundredsofprogramsandinitiativesthroughanannualbudgetthat,inFY2012,totals$8.25billion.

Leadership and Management

TheOfficeoftheSecretaryprovidesprimaryleadershipanddirectionfortheDepartmentandisresponsibleforthecoordinationofstatewideprograms,servicesandoperations.Itestablishesgoalsandobjectivesfortheconductofbothroutineandspecialdepartmentaloperationsandprovidestechnicalsupportservices.AppointedbytheGovernor,theSecretaryservesastheexecutiveheadandchiefadministrativeofficerofDHHandhastheoverallresponsibilityforthepoliciesofthedepartmentandfortheadministration,controlandoperationofthefunctions,programsandaffairsof


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thedepartment.BruceD.GreensteinisthecurrentsecretaryofDHH,andhasbeeninthatpositionsinceSeptember2010.ReportingdirectlytotheSecretaryaretheDeputySecretary,UndersecretaryandStateHealthOfficer/DHHMedicalDirector.

TheDeputySecretaryoverseestheprogrammaticfunctionsoftheDepartmentanddirectlysupervisestheofficesofPublicHealth,BehavioralHealth,CitizenswithDevelopmentalDisabilitiesandAgingandAdultServices.KathyKliebertisthecurrentDeputySecretaryofDHH,andhasbeeninthatpositionsinceJanuary2011.TheUndersecretaryisessentiallytheChiefFinancialOfficerofDHHandoverseesthestateMedicaidprogramaswellasseveralfunctions,includingbudget,financialplanning,purchasing,humanresources,accountingandcontracts.JerryPhillipsiscurrentUndersecretaryofDHH,andhasbeeninthatpositionsinceFebruary2009.TheMedicalDirectorisresponsibleformedicalconsultationonavarietyofhealthcarepolicyissues,includinghealthcareprogramsandqualityofcareissues.TheMedicalDirectoralsoservesastheDepartment’sliaisonwithmedical,nursing,pharmacy,andalliedhealthprofessionalsaswellaswithprofessionalassociationsandorganizationsthroughoutthestate.TheMedicalDirector’sOfficealsohousestheOfficeofEmergencyPreparednessforDHH.TheStateHealthOfficeisresponsibleforensuringthatthestatesanitarycodeisenforced,aresponsibilitythatheimplementsthroughtheprogrammaticOfficesofPublicHealth.Dr.JimmyGuidryisthecurrentStateHealthOfficerofLouisiana,andhasbeeninthatpositionsinceJanuary2000.

Core Management Functions

Contracts and Procurement Support:TheDivisionofContractsandProcurementSupportisresponsibleforallpurchasing,contractandleasemanagement,procurement,propertymanagement,telecommunicationsservices,vehiclefleetservices,mailoperationsandcopiermanagementfortheDepartment.

Emergency Preparedness: DHH’semergencypreparednessfunction,ledbytheDHHMedicalDirector,coordinatestheresponseofpublichealthandmedicalassetsduringastate-declared

disastersuchasahurricane,chemical,biological,radiological,nuclearandexplosive,masscasualtyandmassfatalityevents.Emergencypreparednessstaffcanmobilizeinstantcommunicationssystemswithfirstrespondersandhealthcarefacilitiestoensureresponseassetsareutilizedanddeployedinaneffectiveandtimelymanner.

Fiscal Management:Throughfinancialmanagement,paymentmanagementandsupportservices,theDivisionofFinancialManagementdirectsacomplexfiscalprocessforDHHtoensurethatavailablefinancialresourcesareusedproperlyandefficientlyinaccordancewithstateandfederalrules,guidelinesandlaws.

Governor’s Council on Physical Fitness and Sports:ThemissionoftheCouncilistoencouragephysicalfitnessandactivityinthecitizensofLouisianabydeveloping,fosteringandcoordinatingrelevantservices.TheCouncilfulfillsthismissionbyprovidinginformationonphysicalfitnessandsportsthroughbrochures,mediaeventsandfitnessactivities;servingasaclearinghouseforinformationrelativetosportsandphysicaleducation;conductingfitnessseminarsforseniorgroups;sponsoringphysicalfitnessandsportsworkshops,clinicsandconferences;andinitiatingastatewideawardsprogramtorecognizeschoolsthathavefitness-basedphysicaleducationprograms.

Health Economics:TheDivisionofHealthEconomicsprovidespolicysupportservicestotheDepartment’sexecutivelevelmanagersandprovidesanalytical,datamanagementandresearchsupporttoallofficesoftheDepartment.TheDivisionplaysakeyroleindesigningandcompletingmaterialsforpresentationtolegislativecommitteesandworkswithMedicaidduringtheannualbudgetcycletopresentacompletepackageofinformationandanalysisforabroadaudience.TheDivisionhasdevelopedandmaintainsacollectionofdatabasesrelatingtoprogrameligibility,healthservicesutilizationandMedicaidexpenditureforecasting.TheDivision’sstaffworkswithalldepartmentofficestodeepentheDepartment’sdatabase,informationmanagementandanalyticalresources.

Human Resources:TheDivisionofHumanResources,TrainingandStaffDevelopment


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implementsandmonitorsdepartmentalhumanresourcepoliciestoensureuniformemploymentandworkplacepracticesregardingclassificationandwages,trainingandstaffdevelopment,employmentandpromotions,employeerelationsanddiscipline,recruitmentandbenefits.

Information Technology:Primarilymanagingandadministeringhardware,software,andIT-relatedservices,theDivisionofInformationTechnologyassistsitscustomersinthepropergovernanceandbusinessprocessesaffectingallsectorsofthestate’spopulationfromahealthcareperspective.

Legal Services:TheBureauofLegalServicesprovidesprofessionallegalcounsel,representationandservicestotheDepartment.Thebureau’sresponsibilitiesincludehandlinglitigation,providingadviceandcounsel,overseeingadministrativehearings,policyandcontractreview,recoupment,judicialcommitmentsandinterdictions,aswellashandlingcivilserviceandpersonnelissuesandensuringcompliancewithhealthinformationprivacyregulationsandpublicrecordslaws.

Legislative and Governmental Relations: TheLegislativeandGovernmentalRelationsteamservesastheprimaryliaisonbetweentheDepartmentandmembersoftheLegislatureandotherlocalandstateelectedofficials.LGRprovideshealthcareinformationtoelectedofficialsandcoordinatesalllegislativeactivities,whichincludereviewingandtrackingalllegislationthatmayimpacthealthcareorDHH,bothasitmovesthroughtheprocessandduringtheimplementationphaseafterpassage.

Media and Communications: TheBureauofMediaandCommunicationsisresponsibleforobtaining,compiling,preparinganddistributingdepartmentinformationtoLouisianaresidents,membersofthenewsmediaandstakeholdersacrossmanydifferentchannels.TheBureaumanagesmediarelations,printpublications,newmediaandtheDHHwebsite,aswellasservesasaconsultanttoallprogramoperationstoensureadequate,timelyinformationisdistributedtothepublic.

Minority Health Access: TheBureauofMinorityHealthAccessworkstoimprovethehealthstatusofmedicallyunderserved

populationsinLouisiana,includingracialandethnicminorities.TheBureauparticipatesinstatepolicydevelopment,coordinationofplanning,programming,monitoring,andevaluationandcoordinationofminorityhealthactivities.Theprogramusesmulti-culturalapproachestoenhancethedesignanddeliveryofhealthcareservicestominorities.

Planning and Budget: TheDivisionofPlanningandBudgetdirectsandmanagesthebudgetprocessandcoordinatesoperationalplanning,strategicplanningandperformance-basedbudgetingactivitiesfortheentireDepartment.

Office of Aging and Adult Services

TheOfficeofAgingandAdultServices(OAAS)wascreatedin2006andbringstogetherallofthelong-termcareprogramsthatserveseniorcitizensandpeoplewithadult-onsetdisabilities.OAASalsooverseestheoperationofAdultProtectiveServicesandtheVillaFelicianaMedicalComplex.Duringthepastyear,theofficesuccessfullytransitionedJohnJ.HainkelJr.HomeandRehabCentertoanon-profitprivateproviderthathaslongbeenaffiliatedwithitsoperation.OAASadministersnursingfacilityadmissions,developsnewlong-termcareprogramsandimplementsotherhealthcarereformrecommendations.OAASalsoadministershome-andcommunity-basedlong-termcareservices(HCBS)throughMedicaidwaiver(permissiontooperateoutsideoftraditionalprogramframework),stateplanandstate-fundedprogramsforindividualswhoareelderlyorhavedisabilities,helpingthemtoremainintheirhomesandcommunities.Theprogramsincludethefollowing:

Elderly and Disabled Adult Waiver: TheElderlyandDisabledAdult(EDA)WaiverProgramprovidescoverageforcertainservicesinthehomeorcommunitytoseniorsandadultswithdisabilitieswhoqualify.Thiswaiverwillbereplacedbythenew,morecomprehensiveCommunityChoicesWaiverinOctober2011.

Adult Day Health Care Waiver: TheAdultDayHealthCareprogramprovideshealthandsocialservicestoadultsinasupportiveandsafesettingduringpartofaday.


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Waiver Program: Elderly & Disabled Adult Waiver Adult Day Health Care Waiver

Number of people receiving services (filled slots) 4310 754

Total cost of program (SGF and total)

SGF: $25,839,763

Total: $102,376,242

SGF: $1,840,685

Total: $7,292,731

Long-Term Personal Care Services: TheLong-TermPersonalCareServicesprogramprovidescoveragethroughtheMedicaidstateplantohelpwithactivitiesofdailylivingsuchasbathing,dressing,transferring,toiletingandeatingforpeoplewhoqualifyforassistanceundertheprogramguidelines.

Program for All-Inclusive Care for the Elderly (PACE):Thisprogramcoordinatesandprovidesallneededpreventive,primary,acuteandlong-termcareservicesfortheelderlytocontinuelivingintheircommunitieswhileenhancingtheirqualityoflife.

Facility-Based Programs:Louisiananursingfacilitiesprovide24-hourcareforrehabilitative,restorativeandongoingskilled-nursingcaretopatientsorresidentsinneedofassistancewithactivitiesofdailyliving.Individualsqualifymedicallyforlong-termcarefacilityservicesiftheymeetthelevelofcarecriteriaforadmissiontoanursingfacility,haveanorderfromaphysicianlicensedinLouisianaforadmissionintoanursingfacility,andarescreenedpriortoadmissionforahistoryoractivetreatmentofmentalillnessand/ordevelopmentaldisabilitiesaccordingtofederalregulations.

Adult Protective Services (APS):APSisresponsibleforinvestigatingandarrangingforservicestoprotectadultswithdisabilities,ages18-59,whoareatriskforabuse,neglect,exploitationorextortion.APSclientsmayincludepeoplewhohavedevelopmentaldisabilities,mentalillnessorsubstanceabuseproblems,aswellasthosewithmedicalproblemsorphysicaldisabilities.

Traumatic Head and Spinal Cord Injury Trust Fund:OAASadministerstheTraumaticHeadandSpinalCordInjuryTrustFund,incoordinationwithanadvisoryboard.Thisprogramprovidesflexible,individualizedservicesandassistancetoLouisiana

citizenswhohavesufferedatraumaticheadorspinalcordinjury.

Office of Behavioral Health

Act384ofthe2009LegislativeSessiondirectedDHHtomergetheOfficesofMentalHealthandAddictiveDisordersintothenewlycreatedOfficeofBehavioralHealth(OBH),whichoperatesnowonatotalbudgetofabout$340million.

OBHoverseesthestate’sthreefree-standingstatepsychiatricinpatientfacilities:CentralLouisianaStateHospital(CLSH),EasternLouisianaMentalHealthSystem(ELMHS)andSoutheastLouisianaStateHospital(SELH).Collectively,theyoperate708hospitalbeds,including330adultforensicbeds,214adultcivilbeds,114adultacutebedsand50juvenilebeds.Inaddition,thehospitalseitherdirectlyorthroughcontractoperate52bedsincommunityhomes,an82-bedresidentialSecureForensicFacilityand133lessrestrictivetreatmentbeds.

OBHdirectlyoperatesbehavioralservicesinfiveregionsofthestate,withservicesintheadditionalregionsadministeredbylocalgoverningentities(LGEs).Statewide,thereare77outpatientclinics,33AccesstoRecovery(ATR)vendors,392directservicecontractsand62community-basedpreventionproviders.

OBHprovidestreatmentandrecoverysupportservicesforpeoplesufferingfrommentalillnessand/oraddictionstodrugs,alcoholorgambling.Servicesincludescreeningandassessmenttoascertaintheappropriatelevelandtypeofcareneeded.Theselevelsofcareinclude24-hourinpatientandresidentialtreatment,intensiveandnon-intensiveoutpatientcare,community-


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andadults.Somespecializedservicesofferedinoutpatientsettingsaremedicationmanagement,specializedbehavioralhealthcounselingandtherapy(suchasmulti-systemictherapy)andspecializedgroupandindividualtherapiesforco-occurringdisorders.

Early Childhood Supports:Thisisamulti-agencypreventiveandinterventionprogramthatpromotesapositiveenvironmentforlearning,growthandrelationshipbuildingforchildren.CrisisResponseServicestoaddresstheneedsofchildrenandadultsincludeLouisianaSpirit,ChildAdolescentResponseTeam(CART)andclinic-basedbehavioralhealthcrisisservicesavailable24hoursperday,sevendaysperweek.

Access to Recovery (ATR): Thisprogramprovidesclientswithchoiceamongsubstanceabuseclinicaltreatmentandrecoverysupportproviders.Recoverysupportservicesincludealcoholanddrug-freesocialactivities,angermanagement,carecoordination,childcare,familyeducation,jobreadiness,lifeskills,pastoralcounseling,recreationaltherapy,spiritualsupport,transitionalhousingandtransportation.

Community-Based Services

Community-Based: Thesetypesofservicesprovidetreatmentandsupportforindividualstofunctionasindependentlyaspossibleinthecommunity.Interagencyservicecoordinationallowsprovidersfrommultipleagenciestoworktogethertoprovideacoordinatedplanofcareforchildren,adolescentsandtheirfamilies.School-basedhealthcenters(SBHCs)providebehavioralhealthservicesinschoolsettings.Adultservicesincludeevidence-basedprogramssuchasAssertiveCommunityTreatment(ACT),IntensiveCaseManagement(ICM),PermanentSupportiveHousing(PSH)andForensicAftercareServices(FAS)forthoseindividualsthecourtshavepermittedtobedischargedfromaforensichospital.

Addictive Disorder Populations of Focus: OBHensuresthatpregnantwomenandwomenwithdependentchildrenandinjectingdrugusersaregivenpreferenceinadmissiontotreatmentfacilities.Inaddition,allclientswithaddictivedisordersarescreenedforriskbehaviorsand

basedrecoveryandsupportaswellascrisisservices.OBHalsohasregionalpreventionofficesthroughoutthestatethatoffervariousservicestodecreaseandpreventaddictivedisorders.Throughstrategicmethodsincludingschool-baseddelivery,braidingresources,fee-for-servicecontractsandcostbands,withnoincreaseinfunding,thenumberofchildrenreceivingasubstanceabusepreventionprogramserviceexpandedfrom6,485inFY2006to77,171inFY2011,whichisa1,090percentincrease.

Inpatient & Residential Services

Detoxification Treatment: Theseservicesincludesocialdetoxificationinaresidentialsetting,medicallysupporteddetoxinanon-hospitalsettingandmedicallymanageddetoxinahospitalsetting.Inpatienttreatmentsprovidesecurehospitalsettingsinwhichindividualscanreceivecomprehensiveandintensebehavioralhealthserviceswithagoaltowardstabilizationandreturntothecommunity.Levelsofinpatienthospitalcareincludeacuteandintermediate.

Forensic Hospitalization: Thisserviceprovidesasecureinpatientenvironmentforthoseindividualsthecourthasorderedintotreatmentasaresultofhavingabehavioralhealthdisorderandbeingchargedwithacrime.Individualsareprovidedbehavioralhealthtreatmentuptothepointatwhichthecourtdeterminestheycanbesafelyreturnedtocourtfortrialorreturnedtothecommunity.

Residential Treatment:Thislevelofcareprovidesservicesforthoseindividualswhoneedaddictivedisordertreatmentinastructuredenvironment24/7.Therearefoursubcategoriesofintensityrangingfromlow-intensityresidentialtreatmenttomedically-monitoredintensiveinpatientservices.HalfwayHouses/Three-QuarterWayHousesfocusonre-socializationandencourageindividualstoresumeindependentlivingandfunctioninginthecommunity.

Facility-Based Outpatient Treatment Services

Outpatient & Intensive Outpatient Treatment:Theseservicesareprovidedforaddictivedisorders,mentalillnessandco-occurringdisordersforchildren,adolescents


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residentialservicesandcommunity-basedservicesforchildrenandadultswithdevelopmentaldisabilities.OCDDservesasthesinglepointofentryintothedevelopmentaldisabilitiesservicesystemandprovidescommunity-basedservicesthroughitsregionalofficesorlocalgoverningentities.OCDDalsodirectlysupervisestheadministrationofthestate’sthreesupportsandservicescentersandonegrouphome.

Throughfourhome-andcommunity-basedwaiverprograms,OCDD,inpartnershipwithLouisianaMedicaid,isabletoofferindividualsgreaterflexibilitytochoosewheretheyliveanduseservicesandsupportsthatbestmeettheirneeds.

Children’s Choice Waiver: Thiswaiverofferssupplementalsupportforchildrenthroughage18wholiveathome,withtheirfamiliesorwithafosterfamily.

New Opportunities Waiver (NOW): Thiswaiverofferspeopleage3yearsoldandolder,whootherwiserequireaninstitutionallevelofcare,servicesthatprovidethemtheopportunitytoremainintheircommunities.

Supports Waiver:Thiswaiveroffersfocusedindividualizedvocationalandemploymentservicesforpeople18yearsoldandolder.

Residential Options Waiver:Thiswaiverofferspeopleofallagesservicesdesignedtosupportthemtomovefrominstitutionalcaretocommunity-basedsettings.

offeredanHIVtest.OBHalsoroutinelymakestuberculosisservicesavailabletoeachindividualreceivingaddictiontreatmentandmonitorsTBtreatmentservicedelivery.

Louisiana Behavioral Health Partnership (LBHP): Inanefforttoenhanceservicequality,facilitateaccesstocareandeffectivelymanagecosts,theDepartmentisrestructuringthecurrentservicedeliverymechanismsbydevelopingandimplementingacomprehensivesystemforbehavioralhealthservices.LBHPwillserveanestimated150,000adultsandchildrenwithseriousmentalillness,emotionaldisordersoraddictivedisorders.Acomponentofthisinitiative,theCoordinatedSystemofCare(CSoC),willaddressthespecialneedsofchildreninorat-riskofout-of-homeplacement.ThisintensivewraparoundservicedeliverymodelisbeingdevelopedinconjunctionwiththeDepartmentofChildrenandFamilyServices,theDepartmentofEducationandtheOfficeofJuvenileJustice.Moreinformationabouttheseinitiativesisfoundwithinthetransformationalprioritiessectionofthisdocument.

Office for Citizens with Developmental Disabilities

TheOfficeforCitizenswithDevelopmentalDisabilities(OCDD)iscommittedtoensuringqualityservices,supports,informationandopportunitiesforchoicetoLouisianianswithdevelopmentaldisabilitiesandtheirfamilies.OCDDoverseespublicandprivate

Waiver Program: Children’s Choice New Opportunities Waiver

Supports Waiver Residential Options Waiver

Number of people receiving services (filled slots)

980 7491 1718 25

Total cost of program (SGF and total)

SGF: $2,147,749

Total: $10,525,600

SGF: $76,957,629

Total: $377,150,841

SGF: $2,584,516 SGF

Total: $12,666,093

SGF: $219,138 SGF

Total: $1,073,943


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OCDDalsoadministersseveralotherprogramsaimedatsupportingindividualswithdevelopmentaldisabilitieslivingwithinthecommunity.

EarlySteps: Thisprogramprovidesservicestofamilieswithinfantsandtoddlersupto3yearsoldwhohaveamedicalconditionlikelytoresultinadevelopmentaldelayorwhohavedevelopmentaldelays.EarlyStepsservicesaredesignedtoimprovethefamily’scapacitytoenhancetheirchild’sdevelopmentandareprovidedinthechild’shome,childcareenvironmentoranyothercommunitysettingtypicalforthisagegroup.

Cash Subsidy: Thisprogramassistschildrenwiththemostseveredisabilitiestostayinthehomewiththeirfamilies.CashSubsidyprogramfundscoverextraordinarycostsassociatedwithraisingachildwithadisability.

Individual and Family Support:Flexiblefundingismadeavailablethroughaprioritizationprocessbasedonindividuallevelofneedandriskofhealthandsafetyorout-of-homeplacement.Thesefundsallowchildrenandadultswithdevelopmentaldisabilitiestoliveintheirownhomesorwiththeirfamiliesintheirhomecommunity.

Community Support Services:Communitysupportsandservicesareprovidedforpeoplewhoneedintensivetreatmentintervention,suchaspsychologicalservices,nutritioncounselingandfamilycounselingtolivesuccessfullyinthecommunity.

Resource Centers:OCDDResourceCentersaredesignedtobuildthecapacityofcommunityproviders.Servicesprovidedincludetrainingopportunities,trainingcurriculumdevelopment,provisionofresourcematerials,resourceguides,peerreviewsandprogramreviews.

Supports and Services Centers:TheDHH-operatedsupportsandservicescentersprovidearesidentialsetting,ongoingevaluation,planning,24-hoursupervision,coordinationandintegrationofhealthandrehabilitativeneeds.OCDDoperatesonegrouphomeandthreesupports&servicescenters(formerlycalleddevelopmentalcenters).

�LeesvilleResidentialandEmploymentServicesCenter(grouphome)

�NorthlakeSupportsandServicesCenter

�NorthwestSupportsandServicesCenter�PinecrestSupportsandServicesCenter�CenterforHealthCareInnovationandTechnology

Center of Health Care Innovation and TechnologyTheCenterofHealthCareInnovationand

Technology(CHCIT)researches,developsandassistswithimplementationofnewinitiativeswithintheDepartment.Thisteamisresponsibleforthecoordinationanddevelopmentoflegislativereports,policypapersandotherpublicdocumentsissuedbytheDepartment.CHCITisresponsibleformonitoringandcoordinatingtheDepartment’seffortsrelatedtotheAffordableCareAct(ACA)andotherchangesinfederallaw.

CHCITalsomonitorsfederallawandpolicy,monitorsmajorhealthsystemchangesacrossthestateandcountryandworkswitheachDHHofficetoensurethemaximizationofresourcesandeffectivesystemstocollectandanalyzedata.CHCITalsohousesthepositionofHealthInformationTechnologyCoordinator,whomonitorsanddirectstheworkbeingdonethroughaseriesofgrantsintendedtoenhancetheuseofinformationtechnologyinLouisiana’shealthcarecommunity.CHCIThasfourprimaryfunctions:policy,healthinformationtechnology,technologyintegrationandanalytics.

Louisiana MedicaidMedicaidisthestate’shealthcoverageprogram

forlow-incomeresidentswhomeetcertaineligibilityqualifications.AdministeredthroughDHH’sBureauofHealthServicesFinancing,Medicaidisfundedinpartnershipbetweenthefederalandstategovernment.MedicaidhasanFY2012budgetofjustmorethan$7billion,ofwhichjustmorethan$2billionisstatefunds.Theprogramprovidesmedicalbenefitssuchasphysician,hospital,laboratory,x-ray,long-termcareandnursinghomeservicestoapproximately1.2millioneligibleresidents,themajoritybeingchildrenunderage19.

InadditiontotraditionalMedicaid,theMedicaidprogramoffersdifferenttypesofcoveragefordifferenteligibilitycategories.Someoftheseinclude:

Louisiana Children’s Health Insurance Program (LaCHIP)offershealthinsurancetochildrenfrom


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workingfamilieswhereparentsearnupto200percentofthefederalpovertylevel(about$3,675monthlyforafamilyoffour).

LaCHIP Affordable PlancoverschildrenwhoseparentsearntoomuchtoqualifyforLaCHIP,butearnbelow250percentoffederalpovertylevel.

Medicaid Purchase PlanhelpspeoplewithdisabilitieskeepMedicaidbenefitstheyqualifyforwhiletheywork.

Louisiana Health Insurance Premium Payment (LaHIPP)programmaypayallorpartofthehealthinsurancepremiumsforinsuranceavailablethroughyourjobifthatismorecosteffectivethanlettingyouoryourrelativeremainonMedicaid.

Family Opportunity Act Medicaidletshigher-incomefamilieswhohavechildrenwithdisabilitiesbuyintotheMedicaidprogramforhealthcarecoverage.

LaMOMS offersno-costhealthcoveragetopregnantwomenforallprenatalanddeliverycare.

TAKE CHARGEoffersno-costhealthcoveragetoLouisianawomenages19-44whodon’thavehealthinsurance,earnbelow200percentoffederalpovertylevelandneedaccesstofamilyplanningservices.

Breast and Cervical Cancer Program,operatedthroughtheLSUHealthSciencesCenterWomen’sPreventiveHealthProgram,providesno-costhealthcoveragefortreatmentofbreastandcervicalcancer.

Long-Term Care Servicesoffersqualifiedindividualseitherinafacilityorintheirhomes.

Medicare Savings Program willpayMedicarepremiumsandrelatedexpensesforseniorcitizenswhomeetcertainqualifications.

Seniors Health Insurance Program (SHIP),runbytheLouisianaDepartmentofInsurancethroughagrantfromtheHealthCareFinancingAdministration,offershealthinsurancecounselingandinformationtoseniorcitizens.

Medicaidiscurrentlyoperatedunderatraditionalfee-for-servicepaymentstructure,withmorethan750,000ofitsenrolleesreceivingmodestcaremanagementthroughthestate’sprimarycarecasemanagement(PCCM)programcalledCommunityCARE.CommunityCAREwillendin2012asanewapproachtoservicedelivery--

CoordinatedCareNetworks(CCNs)--arephasedinacrossthestatetoprovidecomprehensivecaremanagementtoenrollees.SeemoreabouttheCCNprogramintheTransformationalPrioritiessection.

Office of Public Health

TheOfficeofPublicHealth(OPH)protectsandpromotesthegeneralhealthofLouisianaresidentsandiscenteredonpopulation-basedhealthconcerns.Thisincludesimplementationandenforcementofthesanitarycode,provisionsofpersonalandenvironmentalhealthservicesinparishhealthunits,seweragetreatmentanddisposal,supplementalfoodprograms,emergencypreparednessandotherfunctionsaffectingthepublic’shealth.OPHalsomonitorstheaspectsofenvironmentalqualityandpollutioncontrolthatapplytopublichealthandwhicharespecificallyassignedtoDHH.

OPHoverseesmorethan50programsandinitiativesthroughsixcenters:recordsandstatistics,environmentalhealth,communityandpreventivehealth,communitypreparedness,primarycareandruralhealthandemergencymedicalservices.

Vital Records and Statistics:Thiscenteroverseesoperationsrelatedtothemaintenance,certification,saleandpreservationofbirth,death,marriageandothervitalrecords.VitalRecordsisimplementingtheLouisianaElectronicEventRegistrationSystem(LEERS),aweb-basedvitalrecordsregistrationsystemthatincludesthebirth,death,fetaldeath,marriage,divorceandinducedterminationofpregnancymodules,whichareintegratedwithastate-of-the-artbusinessmoduleandanimagingsystemforscanningandsavingapproximately10millionarchivedrecords.

Center for Environmental Health:Thiscenterisresponsiblefortheimplementation,promulgationandenforcementoftheLouisianaStateSanitaryCode;promotingthecontroland/orreductionofacuteandchronicdiseasescausedbyunsafeenvironmentalconditions;developingandenforcingenvironmentalprotectionregulations;investigatinghealthhazards;providingleadershipinprogramsthatallowforthepreventionandcontrolofdisease;andsettingstandardsforexcellenceby


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Bureau of Primary Care and Rural Health (BPCRH):BPCRHprovidestechnicalassistancetocommunities,federallyqualifiedhealthcenters,physicianpractices,ruralhealthclinicsandsmallruralhospitals.Additionally,theBureauworkstosupporteffectiveclinicalpracticesandhealthcareorganizations.TheBureaucurrentlyprovidesservicesthroughsixunits:HealthSystemsDevelopment,RecruitmentandRetentionServices,PracticeManagementConsulting,HealthInformationServices,theStatewidePharmacyAccessInitiativeandChronicDiseasePreventionandControl.Together,staffmembersworkacrossunitstoprovideacontinuumofservicestoestablish,enhanceandsustainhealthcareservicesforallLouisianaresidents.

BureauofEmergencyMedicalServices:ThisofficeisresponsiblefortheimprovementandregulationofemergencymedicalservicesinLouisiana.Theyaremandatedtopromulgateandenforcerules,regulationsandminimumstandardsforcourseapproval,instruction,examinationandcertification.Theyarealsoresponsiblefordevelopingastateplanforthepromptandefficientdeliveryofemergencymedicalservicesthrougheducation,examination,andcertificationofallEMSpersonnelinLouisiana.

Human Services Districts and Authorities

AuthorizedbytheLouisianaLegislature,humanservicesdistrictsarelocallygovernedpublicagenciescommittedtoenhancingthequalityoflifeofindividualsfacedwiththechallengesofmentalhealth,addictivedisorders,developmentaldisabilitiesandtheirrelatedbehaviors.Intheregionstheyserve,theyreplacetheservicesnormallyofferedbyDHHregionalofficesofBehavioralHealthandCitizenswithDevelopmentalDisabilities.TheDistrictsoffercomprehensivesystemsofcarewhichprovideresearch-basedprevention,earlyintervention,treatmentandrecoverysupportservices.TheDistrictscombinerelevantresourcestofostercommunitycollaborationresultinginadynamicandcomprehensivesystemofservicedelivery.

Therearecurrentlyfivehumanservicesdistrictsservingdifferentareasofthestate.

�MetropolitanHumanServicesDistrict(OrleansParish)

beingcustomer-focused,responsive,accessibleandefficient.Throughtheemployof206statesanitarians,OPHconductsinspectionsoffacilitiesincludingretailfoodestablishments,communitywater,privatesewerageandwatersystems,foodmanufacturers,tanningfacilities,milkandmilkproductprocessingfacilities,commercialseafoodprocessors,andinstitutionssuchasschools,daycares,nursinghomes,hospitals,andplacesofincarceration.StatesanitariansalsomonitoreightmillionacresofLouisianaoystergrowingwaters,includingoystersamplingandtesting.

Center for Community Health:Thiscenterprovidesserviceswhichaimtominimizetheoccurrenceofdiseaseanditsconsequences.TheCenterprovidesnursingandpharmacyservicesthroughasystemofregionalofficesandparishhealthunits,preventivehealthservicesandscreening,andensuresoptimumpre-hospitalemergencymedicalservices.Thisincludesreducingexposuretohealththreats,detectingandtreatingdiseasesinearlystages,andalleviatingtheeffectsofdiseaseandinjury.Thisisdonethroughavarietyofprograms,includingchildren’sspecialhealthservices;hearing,speechandvision;familyplanning;geneticdiseases;maternalandchildhealth;nutritionservices;immunizations;sexuallytransmitteddiseasecontrol,includingHIV/AIDS;andtuberculosiscontrol.

Center for Community Preparedness (CCP): CCPusesanall-hazardsapproachtointegratestateandlocalpublichealthjurisdictionsforresponsetopublichealththreats.TheCenterisorganizedaccordingtotheNationalIncidentManagementSystem,IncidentCommandStructure(ICS).ComponentsofICSincludecommand,administration&finance,logistics,operationsandplanning.Thisstructureallowsforefficientmanagementbyintegratingprocesses,personnel,communicationsandequipmentonaday-to-daybasis,aswellasduringemergencies.ProgramsundertheCenterinclude:emergencypreparedness&response,pandemicflu,trainingandexercises,strategicnationalstockpile(SNS),citiesreadinessinitiative,CHEMPACK,healthalertnetwork(HAN),volunteermanagement,communityoutreach,emergencymedicalsocialservices,andworkforcedevelopment.


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environmentthathaslittletonocoordination,unevenqualityofcare,inequitableaccesstocareandunpredictablecosts.Putplainly,patientsseetheirhealthcareproviders,providersbillthestateandLouisianasimplypaysthebill,allthewhiledoinglittletocoordinatecare.Ourhealthcaresystemwasdesignedtoprovideepisodicandacutecareforheartattacks,pneumonia,appendicitis,stroke,flu,accidentsandotherconditionswherepeoplebreak,thenmend.3

Thesystemwasnotdesignedtopromoteandmaintainhealth.AccordingtotheUnitedHealthFoundation’s2010America’sHealthRankings,Louisianaranks49thinthenationbasedon22healthdeterminantsandhealthoutcomesmeasures.4AccordingtoAnnieE.CaseyFoundation’s2010KIDSCOUNTDataBook,Louisianaranks49thinthenationbasedon10measuresthatprofilethewell-beingofchildren.5

Louisiana’schallengeistwofold:designingandimplementingasystemofcarethatwillbeabletoimproveitshealthoutcomesandmovingourstatefromthebottominhealthrankings,whiledoingsointhecontextofcontinuedbudgetdeficitsandeffortstostreamlinegovernment.

Basedonextensiveresearchandstakeholderinput,DHHistransitioningLouisiana’sMedicaidprogramtoamanagedcaredeliverysystemthroughthedevelopmentofCoordinatedCareNetworks(CCNs).DHHhascarefullystudiedtheexperiencesofotherstates,identifyingbestpracticesandpracticestobeavoided,andhasconsultedwithexpertsandstakeholdersacrossthestateandthecountry.TheDepartmenthasusedthose“lessonslearned”todeveloptwomodelsofcoordinatedcarethatrepresentthebestevidencedpracticesforimprovinghealthoutcomes,increasingaccesstoqualitycareandprovidingfiscalsustainability.AlargebodyofevidenceexistsregardingthebenefitsoftheMedicaidcoordinatedcaremodel.TheLewinGroup’sreport,Medicaid Managed Care Cost Savings—A Synthesis of 24 StudiesconcludesthatMedicaid

�JeffersonParishHumanServicesAuthority

�CapitalAreaHumanServicesDistrict

�FloridaParishHumanServicesAuthority

�South-CentralLouisianaHumanServicesAuthority

TRANSfORmATIONAL PRIORITIESThese20transformationalprioritiesare

groupedunderthreecommonthemes:

�BuildingFoundationalChangeforBetterHealthOutcomes

�PromotingIndependencethroughCommunity-BasedCare

�ManagingSmarterforBetterPerformance

Building foundational Change for Better Health OutcomesMedicaid Coordinated Care Networks (CCNs)

Background

AccordingtoaU.S.GovernmentSpendingReport,Louisianaspent$7.4billionin2010onhealthcare.1Louisiana’sMedicaidprogramcurrentlyprovidescoverageforapproximately25percentofitspopulation,2reimbursesforapproximately70percentofthestate’sbirthsannually,andaccountsforapproximately30percentofthehealthcaredollarsspentinLouisiana.Ithasahugeimpactonourhealthoutcomes,butourstatemissesacriticalopportunitytomakeasignificantpositiveimpact.Today,LouisianahasafragmentedMedicaidservicedeliverysystemthatoperatesalmostexclusivelyinafee-for-servicesystem


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Coordinated Care Network – Shared Savings (CCN-S)isanenhancedprimarycarecasemanagement(ePCCM)program.TheCCN-Senrolleesarelinkedtoaprimarycarecasemanager,whowillreceive$13.31or$19.66monthlyasamanagementfeeforeachmemberbasedontheriskcategoryoftheenrollee.TheCCN-Sprimarycareprovidersserveasthe“medicalhome”forprimarycareandprovidecoordinationofmedicallynecessaryservices.TheCCN-Smustmeetperformanceoutcomestoreceiveanysharedsavings.

Coordinated Care Network – Prepaid (CCN-P)isacomprehensivefullriskprepaidMedicaidmanagedcareprogram.CCN-Pplansarepaidaper-member-per-month(PMPM)capitatedrateandareresponsibleforprovidingand/orarrangingforalloramajorityofMedicaid-coveredservicesfortheirenrollees.PlansacceptingfullriskwillincreaseMedicaidbudgetpredictabilityandimproveaccesstospecialtycare.CCN-Pplanswillbeabletonegotiaterateswithspecialists.TheCCN-Pmustmeetstrictnetworkadequacyrequirementsandperformanceoutcomesorbesubjecttofinancialdisincentives.

BothCCNmodelswillincorporateoutreachandeducationtopromotehealthybehaviors,includingseekingandparticipatinginappropriatehealthcarethatincorporatesearlyscreeninganddetection,increasedpersonalresponsibilityandself-management.EachofthefollowingelementsofbetterhealthisintegraltotheCCNdesign.

�DiseaseManagement–Astrongfocusonintensivecasemanagementandimprovedcoordinationofcareforhighcostindividuals.

�PreventiveServices–Recognitionthatpreventiveserviceswilldetectmedicalproblemsbeforetheyoccurorbeforetheybecomeacute.

�PrimaryCareandEmergencyServices–Itisprojectedthatwithincreasedprimarycareaccess,therewillbeacorrespondingdecreaseinemergencydepartmentcare.

managedcareprogramscanyieldsavingswhileimprovingaccesstoandcontinuityofcare.

Goal

TheoverallgoaloftheCCNprogramistoimprovehealthcareservicedeliverythatresultsinbetterhealthoutcomesforMedicaidandLaCHIPenrollees.TheofficialRequestforProposalsforCCNs,issuedApril11,2011,containedthefollowingspecificgoals:

�Improvecoordinationofcare;

�Establishapatient-centeredmedicalhomeforMedicaidrecipients;

�Improvehealthoutcomes;

�IncreasequalityofcareasmeasuredbymetricssuchasHEDIS;

�Emphasizediseasepreventionandmanagementofchronicconditions;

�Diagnoseearlierandtreatacuteandchronicillness;

�Improveaccesstoessentialspecialtyservices;

�Promotehealthybehaviors;

�Increasepersonalresponsibilityandself-management;

�Reducetherateofavoidablehospitalstaysandreadmissions;

�Decreasefraud,abuseandwastefulspending;

�Providegreateraccountabilityforthedollarsspent;

�Yieldamorefinanciallysustainablesystem;and

�Createanetsavingstothestatecomparedtotheexistingfee-for-serviceMedicaiddeliverysystem.

Program Strategy & Operations

Louisiana’stransitiontoCCNsincludestwocoordinatedcaremodels.Bothmodelswillprovideapatient-centeredmedicalhomeandagreaterarrayofcarecoordinationfunctions,includingutilizationmanagement,caremanagement,quality,managementofchronicillness,meaningfuluseofelectronichealthrecordsandaccountabilitythroughthereportingofperformancemeasures.Thetwomodelsare:


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�100percentofexpeditedserviceauthorizationdeterminationsaremadenolaterthan72hoursafterreceiptoftherequestforservice.

Toensuretimelyclaimsprocessingandpayment,

�99percentofclaimsarepre-processedbytheCCNandsubmittedtothefiscalintermediarywithin24hoursofreceiptfromprovider(CCN-S);and

�90percentofallcleanclaimsofeachprovidertypearepaidwithin15businessdaysofthedateofreceiptand99percentarepaidwithin30calendardaysofthedateofreceipt(CCN-P).

ToencourageappropriateresolutionofmembergrievancesattheCCNlevel(CCN-SandCCN-P),

�10percentorlessofgrievancedecisionsappealedtothestatefairhearinglevelperiodareoverturned.

Louisiana’sactuary,Mercer,projectssavingsforcorebenefitandservicesprovidedthroughtheCCNswillbe$24millionforFY2012and$135millionforFY2013.

DELIvERABLES h Host advocate summit October 2011

h All CCN contracts to CMS for approval October 2011

h Launch education and outreach campaign November 2011

h GSA A (phase 1) provider networks submitted to CMS for approval November 2011

h GSA A choice letters mailed and enrollment in CCNs begins December 2011

h GSA B (phase 2) contracts and provider networks submitted to CMS for approval January 2012

h GSA A “Go Live” for CCN core benefits and services February 2012

h GSA B choice letters mailed and enrollment in CCNs begins February 2012

h Complete execution of provider agreements with CCNs in all areas of the state March 2012

h GSA C (phase 3) contracts and provider networks submitted to CMS for approval March 2012

h GSA B “Go Live” for CCN core benefits and services April 2012

�PaymentReform–RecognizingandreimbursingforthevalueofservicesforwhichMedicaiddoesnotcurrentlyreimburse.Paymentstructureandincentiveswillrewardadherencetoevidence-basedcarethatincreasesqualityandreducesunnecessarymedicaltreatments(e.g.,adoptionanduseofelectronichealthrecords).

�QualityProviders–MetricsandstandardswillbeusedtoevaluateparticipatingprovidersandMedicaidwillprovideresourcesandtoolstohelpthemimprovetheirservices,therebyimprovinghealthcareoutcomes.

�HealthDisparities–FocusingonpreventiveservicesforallMedicaidandLaCHIPenrolleesandtargetingdiseasesandareaswiththemostacutehealthproblemscanbegintoreducetheracialandgeographicdisparitiesinhealthcareaccessandquality.

ThenewCCNswillprovidecoordinationofcare;greateraccountabilityforthedollarsspent;greaterhealthpromotionanddiseaseprevention;andincreasedaccesstoessentialspecialtyservicesanddiagnosisandtreatmentofacuteandchronicillnesses.

Select Performance Objectives and Measures for FY 2012:

Toencouragememberchoiceandresponsibility(CCN-SandCCN-P),

�70percentormoreofneweligibleswillproactivelychoosetheirownCCN.

Toensuretimelyaccesstoappropriateservices(CCN-SandCCN-P),

�95percentofcallstoprimarycarephysicians(PCPs)duringandafterregularbusinesshoursarereturnedwithin30minutesofthecall(24hoursperday,7daysperweek);

�80percentofstandardserviceauthorizationdeterminationsaremadewithintwobusinessdaysofobtainingappropriatemedicalinformationthatmayberequiredregardingaproposedadmission,procedureorservicerequiringareviewdetermination.100percentaremadenolaterthan14calendardaysfollowingreceiptoftherequestforserviceunlessanextensionisapprovedbyDHH;and


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creatinganetworkofhealthinformationsharing,providersshouldgainefficiencythroughproductivityandareductionintheburdensofdocumentationofduplicativeproceduresand/ortests.Thiswillyieldimprovedqualityofcarebyenablingbetterclinicaldecisionsupportatthepointofcareandgivingproviderstheabilitytoaccesstherightinformationfortherightpatientattherighttime.Ultimately,thiswillleadtosaferenvironmentsforcarebyreducingcasesofmisdiagnosisor,attimes,fataldrug-to-druginteractionsandallergicreactions.

Louisiana Medicaid EHR Incentive Program: TheMedicaidEHRIncentiveProgramprovidesincentivepaymentstoeligibleprofessionals,eligiblehospitalsandcriticalaccesshospitalsastheyadopt,implement,upgradeordemonstratemeaningfuluseofcertifiedEHRtechnologyintheirfirstyearofparticipation.Theywillreceiveadditionalpaymentsfordemonstratingmeaningfuluseforuptofiveremainingparticipationyears.Eligibleprofessionalscanreceiveupto$63,750overthesixyearstheytoparticipateintheprogram.

LouisianabeganitsMedicaidEHRIncentivePrograminMarch2010,andonJanuary7,2011becamethefirststateinthecountrytoprocessanincentivepaymenttoaFederallyQualifiedHealthCenterandthethirdstatetopayaMedicaidEHRIncentivepayment.AsofAugust19,2011,LouisianaMedicaidhadpaidmorethan$40.2milliontoeligibleprovidersandhospitalsacrossthestate,makingLouisianaanationalleaderinincentivepayments.

Crescent City Beacon Community (CCBC): TheCrescentCityBeaconCommunityprogramoriginatedasa$13.5milliongrantawardedtotheLouisianaPublicHealthInstitute(LPHI)bythefederalOfficeoftheNationalCoordinator(ONC).CCBCisoneof17beaconcommunitiesacrosstheU.S.withanemphasisonpopulationhealthimprovementthroughclinicaltransformationandqualityimprovementwithtechnologyasthekeyenabler.TheprogramprovidesfundingfortheselectedcommunitiestobuildandstrengthentheirHITinfrastructureandexchangecapabilities.ItalsosupportsthesecommunitiesatthecuttingedgeofEHRadoptionandHIEtopushthemtoanewlevelofsustainablehealthcarequalityandefficiency.

h GSA C choice letters mailed and enrollment in CCNs begins April 2012

h GSA C “Go Live” for CCN core benefits and services June 20121U.S.GovernmentSpending,http://

usgovernmentspending.com/spend.php?span=usgs302&year=2010&view=1&expand=10&expandC=&units=b&fy=FY2012&local=s&state=LA&pie=#usgs302.

2MedicaidEnrollmentasaPercentofTotalPopulation,2007,KaiserFamilyFoundation,Statehealthfacts.org,http://www.statehealthfacts.org/profileind.jsp?cmprgn=20&cat=4&rgn=38&ind=199&sub=52

3ANewBlueprintforHealthCareReform(anExecutiveSummary),LouisianaBusinessGrouponHealth,June,2006.

4America’sHealthRankings:Louisiana,2010.UnitedHealthFoundation.http://www.americashealthrankings.org/yearcompare/2009/2010/LA.aspx

5KidCountDataCenter:Louisiana.AnnieE.CaseyFoundation,2010.http://datacenter.kidscount.org/data/bystate/StateLanding.aspx?state=LA

6MedicaidManagedCareCostSavings–ASynthesisof24Studies,PreparedforAmerica’sHealthInsurancePlans,TheLewinGroup,July2004,UpdatedMarch2009.

Louisiana’s vision for Health Information Technology Background

TheDepartmentofHealthandHospitalsisworkingcloselywithpartnersandstakeholdersstatewidetoexecuteLouisiana’svisionforHealthInformationTechnology(HIT).TheuseoftechnologytoimprovecareisoneofthefourcorebusinessobjectivesoftheDepartment,andHITmakesitpossibleforhealthcareproviderstobettermanagepatientcarethroughsecureuseandsharingofhealthinformation.ThisinitiativeincludesfourseparateprojectsthatcollectivelymakeupthefoundationofLouisiana’sHITagenda.

�LouisianaMedicaidElectronicHealthRecord(EHR)IncentiveProgram

�CrescentCityBeaconCommunity(CCBC)

�LouisianaHealthInformationExchange(LaHIE)

�LouisianaHealthInformationTechnology(LHIT)ResourceCenter

Throughtheimplementationoftheseprograms,Louisianaseekstopositivelyimpactthequality,safetyandefficiencyofhealthcare.ByincentingandassistingintheadoptionofEHRsystemsand

http://www.statehealthfacts.org/profileind.jsp?cmprgn=20&cat=4&rgn=38&ind=199&sub=52



http://www.americashealthrankings.org/yearcompare/2009/2010/LA.aspx



http://datacenter.kidscount.org/data/bystate/StateLanding.aspx?state=LA




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providedbasedonthosecriteria.LaHIEenvisionsprovidingsupportforprovidersinthefollowingareas:electronicprescribing;electroniclaborderinganddeliver;qualityreporting;electroniceligibilitydetermination;patientaccesstohealthinformation;exchangingclinicalinformationincludingsummarycarerecordsfortransitionsincare;providingreportingcapabilitiestoDHH’sOfficeofPublicHealth(OPH);andmaintainingrequiredlevelsofprivacyandsecurity.

LHCQFhasselectedOrionHealthtobeLouisiana’sHIEVendor.Currently,effortsarebeingmadetoadoptabusinessplanandanexecutionplanforPhaseI“go-live,”whichwilltakeplaceinearlyNovember.PhaseIincludesbaseHIEfunctionalitysuchasdemographics,encounters,allergies,laboratoryresults,radiologyandtranscribeddocumentsharing.Additionally,PhaseIwilladdressthemasterpatientindex,consentmanagement,transactionlogging,audittrail,providerdirectoryandaclinical/HIEportalamongmanyotherareas.

Louisiana Health Information Technology Resource Center (HITRC):TheNationalHealthInformationTechnologyExtensionProgramconsistsofHealthInformationTechnologyRegionalExtensionCenters(RECs)andanationalHealthInformationTechnologyResourceCenter(HITRC).RECsareintendedtosupportandservehealthcareproviderstohelpthemquicklybecomemeaningfulEHRusers.

InApril2010,theLHCQF,asthestatedesignatedentity,wasawarded$6.2milliontoestablishtheRECPrograminLouisiana.TheLouisianaHITRCischargedwithensuringprimarycarecliniciansgetthehelptheyneedtouseEHRswiththegoalofprovidingoutreachandsupportservicesto1,042priorityprimarycareproviderstoachievemeaningfulusebyApril1,2014.InSeptember2010,anadditional$768,000wasawardedtoexpandthatgoaltoinclude64criticalaccessandruralhospitalsintheireffortstoadoptcertifiedEHRtechnology.TwoadditionalawardswereannouncedinFebruary2011.LHCQFwasawardedanadditional$384,000forcriticalaccessandruralhospitalsandanother$408,973inRECfundingforeligibleprofessionals.

TheprogramwillalsodemonstratehowothercommunitiescanuseHITtoachievesimilargoals.

LPHIinitiallyservedastheleadapplicantintheBeaconproposaltoONCandnowservesastheaggregateProjectManagement,Assurance&FiduciaryAgentonbehalfoftheCCBC.ThecurrentmembersofthisgrowingcollaborativeincludeInterimLSUPublicHospital;OchsnerHealthSystem;Community-basedhealthcenters;TulaneMedicalCenter;MetroNewOrleans’School-Basedhealthcenters;LouisianaPublicHealthInstitute;Children’sHospitalandTouroInfirmary.

CCBC’spartner-approvedinterventionsareindiabetesandcardiovasculardisease.TheBeaconhopestoimprovequalityofcareforchronicpatientsinpatient-centeredmedicalhomestoimpactpopulationoutcomesforchronicdisease.ItwillaccomplishthisgoalbyimplementingmutuallyagreeduponstandardsofcareinEHRandclinicworkflowandacaremanagementmodel.TheBeaconalsohopestoreducehealthcarecostsbydecreasingpreventableemergencydepartmentandin-patientvisitsthroughbettercoordinationofcare.

Louisiana Health Information Exchange (LaHIE):Lastyear,thefederalOfficeoftheNationalCoordinator(ONC)withintheUnitedStatesDepartmentofHealthandHumanServices(HHS)announcedStateHealthInformation(StateHIE)ExchangeCooperativeAgreementProgramawardsto56states,eligibleterritoriesandqualifiedstatedesignatedentities.Louisianawasawarded$10.6millionthroughitsstatedesignatedentity,theLouisianaHealthCareQualityForum(LHCQF).TheprogramfundsLouisiana’seffortstorapidlybuildcapacityforexchanginghealthinformationacrossthehealthcaresystem.TheLHCQFseekstoemployHITtoenableimprovementsinhealth,minimizevariationsincareandaddressdisparitiesinhealthcaredelivery.

TheLouisianaHealthInformationExchange(LaHIE)willleverageexistingHIEcapacityamongprovidersthathavefunctionalandcertifiedEHRsinplaceandthatarereadytoengageinsharingofhealthinformation.LaHIEwillmonitorandevaluatemeaningfulusecriteriaforitsimpactonHIEandensureservicesare


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toeligibleprofessionalsandhospitalsthroughoutthestate.

TheEHRIncentiveProgramwillincreaseparticipationintheprogramby200percentbytheendofFY2012.CentraltoachievingthegoalssetforthintheHITECHActistherealizationofmeaningfuluseobjectives.Therefore,theprogramwillworktoensurethatatleast75percentofthoseproviderswhoreceivedadopt/implement/upgrade(AIU)paymentsinyearonewillbereadytoattesttostage1meaningfulusebyJune2012.TheEHRIncentivesTeamwillalsobeheavilyengagedwiththeprovidercommunityinsolicitingfeedbackonhowtoimprovetheprogram.Theteamwillalsocollectdatatobeusedtomeasuretheeffectivenessoftheprograminachievingitsgoalsofreducingmedicalerrors,providingeasyaccesstopatientinformation,engagingpatientsintheirhealthcareandprovidingalertsandremindersthatimprovepatientsafety.

Crescent City Beacon Community (CCBC)

DHHexecutiveleadershipwillcloselymonitorandassisttheLPHIasnecessarytohelpthemmeettheprogramgoals.DHHleadershipwillcoordinateacrosstheDepartment,otherARRAHITECHgranteesandotherstatestakeholderstoensurethatprogramobjectivesarebeingmetandthattheyalignwiththeDepartment’sbusinessstrategies.TheDHHSecretarywillcontinuetoserveinhisroleonthesteeringcommitteeoftheBeaconProject.Thesteeringcommitteeisresponsibleforensuringprojectsuccess,strategicvisioning,oversightanddirectionoftheCCBCOperatingBoard,approvalofprojectcriticalpathmilestonesanddeliverables,stakeholderalignment,politicalengagementandthecommunicationofCCBCgoalstothebroadercommunity.

LPHIwillalsoworkwiththeLouisianaHealthInformationTechnologyResourceCentersinaligningqualitymeasuresandintegratingcommunityaccountability.IntegrationwiththeITinfrastructureprovidedbytheLaHIEisalsoplannedalongwithalignmentofanalytics.LPHIwillshareitslessonslearnedonthevaluepropositionprovidedbyHIEsandpracticetransformationtotheLHCQFaswell.

Goal

Collectively,thegoaloftheseinitiativesisthesuccessfuladoptionanduseofHITtodeliverhigherquality,moreefficienthealthcareandproducebetteroutcomesforLouisianaresidents.DHHwillworktonotonlyquantitativelymeasuretheHITadoptioninthestate,buttodefineandmeasurethequalitativeimpactofadoptionthroughtheimpacttohealthcarecostsandimprovementsinhealthoutcomes.

Program Strategy and Operations

DHHplaysadifferentroleineachofthefollowingHITinitiatives.DHHissolelyresponsiblefortheexecutionoftheMedicaidEHRIncentiveProgramandwillworkthroughFY2012toincreaseefficiencythroughtheintroductionofanautomatedpaymentprocess;animprovedcommunicationstrategyandenrollmentprocess;andthecontinuedtrackingandreportingofprogresstofederal,stateandlocalpartnersthroughdashboards.

FortheLaHIEandLHITprojects,DHHwillsupporttheLHCQFandcontinuetomonitortheprogressoftheseinitiativestoensurethatdeliverablesaremetinatimelymanner.Likewise,DHHwillassistLPHIanditspartnerstoensuresuccessfulimplementationofthegoalsoftheCCBC.WhileDHHisonlyonepartnerinthiseffort,wewillplayaleadershiproleinensuringcollaborationacrossthestakeholdercommunity.

Louisiana Medicaid EHR Incentive Program

TheEHRteamisworkingwiththesystemscontractorandMedicaidstafftoensurerapid,butaccurate,paymenttoentitiesapplyingforincentivepayments.Bytakingadvantageofenhancedfederalfunding,DHHwillbeabletodevotemorestaffandresourcestoprogramoperations,programintegrityandproviderrelations.Additionally,theautomationofthepaymentprocessingsystemwillreducehumanerrorsfrequentinmanualprocessinganddecreasethetimefromapplicationsubmissiontopaymentissuance.SincehighratesofEHRadoptionarecrucialtothesuccessofHIEs,theEHRteamwillworkcloselywiththeLHCQFanditsRECprogramtoprovideoutreachandeducation


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thetechnicalassistanceneededtoitsenrolleessothat20percentofthemwillmeetmeaningfulusestage1byJune2012.Furthermore,atleast40percentofitsenrolledprovidersandhospitalswillbein“golive”statusbytheendofFY2012.

DELIvERABLESLouisiana Medicaid EHR Incentive Program

h Finalize revised eligible hospitals worksheet and receive approval from CMS to resume issuing payments July 2011, Aug 2011

h EHR team will collaborate with Medicaid Program Integrity to develop and implement an audit plan in accordance with federal regulation to be included in next State Medicaid HIT Plan (SMHP) update July 2011- Sept 2011

h EHR staff will draft HIT I-APD update to be sent to CMS for year 2 funding of the program’s administrative costs Sept 2011

h EHR staff will address CMS concerns and questions in its final HIT IAPD to be sent to CMS for approval by 10/5/2011 Sept 2011, Oct 2011

h Implementation of web-based registry and attestation system Nov 2011

h EHR Program staff and Molina will collaboratively develop provider manuals and communication materials for eligible hospitals and providers. Molina will develop an online user manual Oct 2011-Dec 2011

h Submit revised SMHP to CMS for approval Nov 2011

Crescent City Beacon Community (CCBC), ONC HITECH Beacon Community Program

h Update DHH and HIT dashboards monthly to include Beacon metrics July 2011-June 2012

h Review and provide regular feedback to the CCBC’s policy strategy to ensure that all program resources are leveraged toward the program’s success July 2011-June 2012

Louisiana Health Information Exchange (LaHIE), ONE HITECH State HIE Cooperative Endeavor Agreement

h Update DHH and HIT dashboards monthly to include HIE program metrics July 2011- June 2012

h Review and provide regular feedback to LHCQF’s policy strategy to ensure that all program resources are leveraged toward the

Louisiana Health Information Exchange (LaHIE) and Louisiana Health Information Technology Resource Center (HITRC)

DHHexecutiveleadershipwillcloselymonitorandassisttheLHCQFtohelpassuresuccessfulimplementationofLaHIE,HITRCandexpansionofstatewidehealthinformationexchange.DHHwillfosterrelationshipswithpublicandprivatepartners/stakeholderstoensurecoordinationofelectronicinformationsystemsplanning,development,implementationandexchangeofinformation.AsthestateagencyprimarilyresponsibleforHIT/HIEexecution,DHHwillcoordinaterelatedactivitiesacrossallstateandfederalagencies,includingMedicaidandpublichealth,aswellascoordinationwithotherARRA-fundedprogramsinLouisiana.Furthermore,DHHwillworktoidentifyimprovementsinthemanagement,availabilityanduseofpublichealthandhealthcaredatatoassessandimprovethehealthstatusofLouisianaresidents.

LaHIEplansforimplementationtobecompletebyNovember2011.Currentprojectionsareforatleast15ofthestate’s138acutecarehospitalsto“golive”bytheendofFY2012.Asthelargehospitals“golive”ontheHIE,theywillbringalloftheiraffiliatedphysicianswiththem,greatlyincreasingthenumberofexchangeusers.TheLHCQFplanstoincentearlyadoptionoftheHIEbywaivingsubscriptionfeesforthefirstyeariftheprovidergoeslivewithinsixmonthsofsigningup.

TheLHCQFhasalsoidentified11integrationservicesthatLaHIEwillfacilitateinthefuture.Theseservicescompriseakeyvalue-addforthebusinessmodelandallowhospitalsandphysicianstorealizesavingsthroughintegration.TheDHHservicesLaHIEistargetingforintegrationareLouisianaImmunizationforKidsStatewide(LINKS),ElectronicMedicaidEligibilityVerificationSystem(eMEVS),syndromicsurveillance,infectiousdiseases,eLabreporting,birthoutcomes,analytics,LEERS/vitalstatistics,EMSTAT,anemergencymanagementstatusreportingsystem,andotherprogramregistries.LHCQFandtheHITCoordinatorwillworktoensurethatfouroftheseservicesareinplaceandfacilitatedbyLaHIEduringFY2012.

LHITwillshiftitsfocusfromenrollmenttoothermilestonesduringFY2012.Itwillprovide


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percentseriousmentalillness,15percentdiabetesorhighbloodsugar,and11percentheartdisease.Thirty-onepercentoftheresidentsreportedgeneralmentalhealthchallenges.

PriortoHurricaneKatrina,muchofthehealthcareforthelow-incomeanduninsuredpopulationintheGreaterNewOrleansareawasprovidedinemergencydepartmentsandoutpatientclinicsatLSU’sCharityandUniversityhospitals.IntheaftermathofHurricanesKatrinaandRita,DHHwasawardeda$100millionPrimaryCareAccessandStabilizationGrant(PCASG)programtorestoreandexpandaccesstoprimarycareservices,includingmentalhealthcareservicesanddentalcareservices,withoutregardtoapatient’sabilitytopay.

Duringthegrantperiod,PCASGclinicsservedmorethan292,000individualswithapproximately1.3millionvisits,nearly20percentoftheregion’spopulationannually.Ofthoseserved,43percentwereuninsuredandanestimated60,000ofthosehadincomesbelow200percentofthefederalpovertylevel.Underdifficultconditions,thenetworkdevelopedintoasuccessfulnewmodelforrapidlybuildingcapacityforqualityprimarycareandcommunitymentalhealthservices.ThePCASGclinicsbecameanimportantsourceofcareforalargelydisadvantagedpopulationthathistoricallyreliedonthepublichospitalandemergencyroomsforprimarycare.

ThePCASGgrantendedinSeptember2010,andDHHhasworkedwithlocalandfederalofficialstopreservetheaccesstoprimaryandbehavioralcarebuiltbytheoriginal25organizations(87clinics)thatparticipatedinthegrant.Todoso,DHHcommitted$32.5millioninCommunityDevelopmentBlockGrant(CDBG)fundsandsecuredapprovalfromtheCentersforMedicareandMedicaidServices(CMS)foraMedicaiddemonstrationwaiver,effectiveOctober1,2010throughDecember31,2013,thatwilluse$97.5millionofDisproportionateShareHospital(DSH)fundingtosupportapatient-centeredmedicalhomemodelservingtheuninsured,low-incomeadultpopulationtobecoveredthroughtheMedicaidexpansionandStateHealthBenefitsExchangemandatedbytheAffordableCareActeffectivebeginningin2014.

success of the program with regard to the HIE in the following specific areas: patient privacy and security, regulatory, provider participation/incentives, payment reform, governance and sustainability, others as needed Sept 2011, Dec 2011, Mar 2012, June 2012

h Organize Pilot LaHIE Launch Oct 2011

h Review and assist with efforts to mainstream launch of LaHIE Jan 2012

h Adjust DHH IT infrastructure to ensure HIE interface with LaHIE for DHH programs (Immunization, Electronic Lab Reporting, Public Health Surveillance) July 2011- June 2012

LHIT Resource Center, ONE HITECH REC Program

h Review and provide regular feedback to LHCQF’s policy strategy to ensure all program resources are leveraged toward the success of the REC program July 2011-June 2012

h Align the Medicaid EHR Incentive Program with the REC program messaging and ensure that appropriate resources are available to address questions and requests from the REC staff July 2011-June 2012

h Update DHH and HIT dashboards monthly to include REC program metrics July 2011-June 2012

Greater New Orleans Community Health Connection (GNOCHC Clinics)Background

TheGreaterNewOrleansarea,comprisedofOrleans,Jefferson,St.BernardandPlaqueminesparishes,isoneofthelargestpopulationcentersinthestate.Accordingtothe2010Census,itishometo835,290individualsandrepresents18percentofthestate’spopulation.But,accordingtothe2009AmericanCommunitySurvey,39percentofindividualslivingintheNewOrleansareahadincomesbelow200percentofthefederalpovertyleveland19percentwereuninsured,makingtheareaoneofthemostvulnerableinthenation.Thissurveyalsoindicatesthatlow-incomeadultsaremorelikelythanotheradultresidentstohaveahealthproblem.Overall,nearlytwo-thirdsofresidentsreportedachronicillness,37percentreportedhypertensionorhighbloodpressure,17percentasthmaorotherbreathingproblems,15


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accesstoanetworkof18PCASGorganizations,including36deliverysitesofGNOCHC-coveredprimarycare,preventivecare,behavioralhealthcare,immunizationsandvaccinations,carecoordination,laboratory,radiologyandspecialtycareservicesthroughouttheGreaterNewOrleansarea.

Linkingenrolleestoapatient-centeredmedicalhomewillprovidefinancialincentivestoparticipatingprimarycareprovidersforachievingNationalCommitteeforQualityAssurance(NCQA)patient-centeredmedicalhomerecognitionandprovidediscretepaymentsforenrolleecarecoordination,includingadd-oninterpregnancycarecoordinationservicestoimprovebirthoutcomesforeligibleenrollees.

ThesestrategieswillalsotransitionasystemofprospectiveinterimpaymentsbasedonhistoricalPCASGgrantawardamountstoasystemofretrospectiveencounterratepaymentsforabundleofcoveredservicesprovidedtoenrollees.Also,providersthatpreviouslyreportedlimitedencounterdatainspreadsheetformatunderPCASGwilltransitiontoservice-lineleveldetailreporteddirectlytotheState’sfiscalintermediaryinstandardMedicaidCMS-1500format.Finally,participatingproviderscanmakeinvestmentstobuildtheinfrastructurenecessarytosuccessfullymovefromtraditionalfundingsourcesforuninsuredcare(grantsandpatientcostsharing)tobillingandrevenuegenerationfromthirdpartycoveragesources,suchasMedicaidandcommercialinsurance.

DELIvERABLES h Develop and issue provider manual based on CMS approved funding protocol and train providers on manual content August 2011

h Complete provider enrollment tasks required for encounter data reporting and claims payment through the state’s fiscal intermediary August 2011

h Set encounter payment rates , begin encounter data reporting and begin encounter claim payments September 2011

h Promulgate program rules consistent with CMS approved funding protocol, replacing emergency rules November 2011

Goals

�PreservemostoftheprimaryandbehavioralhealthcareaccessthatwasrestoredandexpandedintheGreaterNewOrleansareaafterHurricaneKatrinawiththePCASGfunds;

�AdvanceandsustainthemedicalhomemodelbegununderPCASG;and

�Transitionthegrant-fundedmodeltoafinanciallysustainablemodeloverthelongtermthatincorporatesMedicaid,LaCHIPandotherpayersourcesintoparticipatingproviders’revenuebaseandhelpsparticipatingproviderstobecompetitiveinthechangingmarketplace.


ThroughoutFY2012,DHHwillpursueseveralstrategiestofurtheroperationalizetheGNOCHCdemonstration.First,theDepartmentwillsecureCMSapprovalofoutstandingattachmentstothespecialterms,conditionsanddeliverablesduringPhase1(October1,2010throughDecember31,2011)onwhichkeyelementsofprogramoperationsdependkeyoperationsincludeadministrativecostclaimingprotocolandauditandaccountingprotocol,theevaluationdesignandevolutionplanforPhase2(January1,2012throughDecember31,2013).

Second,theDepartmentwillcompletethestart-upofprogramoperations,consistentwiththefundingandreimbursementprotocolapprovedbyCMSonJune27,2011,andthepreviouslymentionedattachmentsanddeliverablesonceapprovedbyCMS.Finally,DHHwillsecureCMSapprovalofawaiveramendmenttoclarifythestate’soriginalintentforcoveredservices(excludingpharmacy).

Thesecombinedstrategieswillenrolleligibleindividualsintothedemonstration,providingintheprogram’sfirstninemonthsbasichealthinsurancecoverageto22,000lowincome,uninsuredadults—morethanone-thirdofthetotalnumberoflowincomeuninsuredindividualsservedbyPCASGduringitsthree-yeargrantperiod.Further,enrolledproviderseligibletoparticipateinthedemonstrationwillgetcontinued


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theSolicitationforProposals(SFP).Inlate2009,DHHheldmorethan20presentationsfromvendorswhoareleadersinMedicaidtechnology.Usingallinput,DHH,withtheIV&Vcontractor,developedrequirementsfortheproposal.TheproposalwasreleasedinApril2010asaRequestforComments(RFC)whereanyentitycouldprovidecommentstotheproposedMMISsolution.Afterreviewingmorethan800comments,DHHrevisedtherequirementsandinNovember2010issuedanSFP.TheproposalincludedrequirementstosecureaMedicaidfiscalintermediarythatcouldprovideaweb-basedMMISthatcomplieswithCMSMITAframework,whichrequiresstatestoupdateandstreamlinetheirtechnology.DHHconvenedateamofmorethan60subjectmatterexpertstoreviewthefourproposalsreceivedfromleadersintheindustry.Thehighestscoringvendor,CNSI,wasselected.DHHisnowmovingintoaperiodofcontractnegotiationthatwillultimatelyprovideLouisianawithafederallycompliantandinnovativesystem.

ThecurrentIV&VcontractendsSeptember21,2011.DHHhasreleasedanRFPandwillbeprocuringacontractortoassistthroughthecontinuedimplementationofthereplacementMMIS.ThecurrentMMISfiscalintermediarycontractendsDecember31,2011withtheoptiontorenewforoneyearatatimethroughDecember31,2014.Louisianamustcompleteimplementationbythattimeorriskfederalfundingforit’ssystem.

Goal

LouisianaMedicaidwillprogresswithimplementationofanewMMISthatwillincorporatethelatestadvancementsinsecurity,interoperability,datasharing,datamining,easeofuse,expandability,flexibility,reliabilityandautomation,whilealsobeingfullycompatiblewiththeexpectationsoftransparency,accountability,qualityofcareandotherhealthcareinitiatives.ThereplacementsystemwillalsoallowtheDepartmenttomakechangeswithindaysinsteadofmonthsbasedontable-driventechnologies.ThenewsystemwillbeappropriatelyintegratedwiththestateHIEandproviderecipientswitheasyaccesstotheirMedicaidclaimsinformation,ensuringthatrecipientsarereceivingtheservicesforwhichMedicaidhasbeenbilled.

h Secure CMS approval of an evolution plan for Phase 2 of the demonstration, and implement plan beginning 1/1/12 June 2012

h Secure CMS approval of the administrative cost claiming protocol September 2011

h Secure CMS approval of the audit and accounting protocol October 2011

h Secure CMS approval of the evaluation design, and implement approved design June 2012

h Issue Request for Proposals for and award infrastructure investment payments September 2011 and December 2011

h Link enrollees to patient-centered medical homes November 2011 through June 2012

h Implement interpregnancy care coordination pilot January 2011 through June 2011

medicaid management Information System (mmIS)Background

Louisiana’sMedicaidManagementInformationSystem(MMIS)istheelectronicsystemthatprocesses1.2millionclaimsandissuesnearly$106millioninpaymentstohealthcareproviderseachweek.Inplacesince1984,theDepartment’scurrentMMISisantiquatedandunabletomakechangesquickly.ThishinderstheimplementationofanybudgetcutsoradditionofnewprogramsandmakesitdifficulttoobtaindetailedreportswithinareasonableamountoftimeasrequestedbytheLegislatureandotherentities.

InSeptember,theDepartmentbegantheprocessofplanningforanMMISreplacementwiththecontractingofanIndependentVerification&Validation(IV&V)vendorasrecommendedbyCMS.IV&VvendorshaveexperiencewithfederalMedicaidInformationTechnologyArchitecture(MITA)andMMISCertificationToolkitrequirementsfornewMMISreplacement.Thestateperformedit’sMITAstateselfassessmenttoidentifyaroadmaptotheinnovativetechnologyCMSrequiresforthenewsystem,holdingjointapplicationdesignmeetingswithDHHsubjectmatterexpertsaswellasaproviderassociationstakeholderinputmeetinginDecember2008.InSeptember2009,therewasapublichearingbeforetheJointHealthandWelfareCommitteetodiscussthecontentsandreleaseof


25

DepartmentisassuredthereplacementMMIScanprocessclaimsappropriately.

Awebportalwillbedevelopedtokeepprovidersandthepublicapprisedoftheprogress.Providerswillbenotifiedandprovidedtrainingpriortoimplementationoftherequirementtoutilizevisitverificationandtore-enrollinMedicaid.

DELIvERABLES h Negotiate contract with winning vendor September 2011

h Execute MMIS fiscal intermediary contract November 2011

h Release Independent Verification and Validation (IV&V) Contract Request for Proposals August 2011

h Choose IV & V vendor and execute contract October 2011

h DDI - collection of requirements. The requirements will start for all areas, but the main focus will be on provider enrollment and visit verification November 2011, January 2012, March 2012, May 2012

h Development and implementation of a web portal for provider enrollment, training and updates on the project’s status May 2012


ItisestimatedthatthedevelopmentofthereplacementMMISwilltakethreeyears.Duringthefirst12months(inFY2012),therewillbeearlyimplementationoftwodepartmentalinitiativestoaddressfraudandabuse:

1) VisitVerification-acall-basedverificationsystemtovalidatethatadirectserviceworkisactuallyintheparticipant’shomewhoisauthorizedtoreceiveservices;and

2) Electronicproviderenrollment-electronicsystemthatwilldocriminalbackgroundchecks,verifycertificationsandlicensesonanannualbasis.

Duringthethreeyearsofdesign,developmentandimplementation(DDI),theIV&Vandfiscalintermediarycontractor,withdirectionfromDHH,willconvenemeetingswithsubjectmatterexpertstocollectrequirementstobuildtheMMIS.Therewillalsobeanextensivetestingperiodofatleastsixmonthstoensuretheclaimsareprocessedbasedonthedocumentedrequirements.TheexistingMMISshallcontinuetoprocessclaimsuntilthe

Comparison of a few major components of the existing system capabilities vs. proposed system capabilities

Existing System Proposed System

Paper process with manual review Totally electronic online application, with ability to accept scanned documents and electronically verify certifications and licenses

Core processing components more than 20 years old, cannot be easily modified and are duplicated across data silos

Federally compliant system that promotes interoperability, data sharing, data mining, flexibility, reliability and automation

100 percent paper provider enrollment process Paperless electronic enrollment, using electronic signatures

Little verification of provider enrollment requirements

Electronic verification of ownership, exclusion and criminal background checks

Service authorizations are reviewed on paper by staff

Service authorizations will use clinical standards automated in electronic claims editing/processing

Enrollees have no access to their claims history

Web portal will allow enrollees to view their electronic claims data and demographics

No validation of home-based services

Verification system that validates worker is with the participant and the service is authorized using tools such as voice verification


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behavioralhealthof150,000LouisianacitizensbyJune30,2013.


Inanefforttoenhanceservicequality,facilitateaccesstocareandeffectivelymanagecosts,theDepartmentisworkingtorestructurethecurrentservicedeliverymechanismsbydevelopingandimplementingacomprehensivesystemforbehavioralhealthservices.TheLBHPdesignedtoprovideanarrayofservicesto:

�Alleligiblechildrenandyouthinneedofmentalhealthandsubstanceabusecare;

�Adultswithsubstanceusedisorders;

�Adultswithfunctionalbehavioralhealthneeds,including:

•Personswithacutestabilizationneeds;

•Personswithseriousmentalillness(SMI);

•Personswithmajormentaldisorder(MMD);

•Adultwhohavepreviouslymettheabovecriteriaandneedsubsequentmedicallynecessaryservicesforstabilizationandmaintenance;and

�At-riskchildrenandyouthwithsignificantbehavioralhealthchallengesorco-occurringdisordersofmentalillnessandsubstanceuse(COD)in,oratimminentriskof,out-of-homeplacement.

AcorecomponentofthisreformistheStatewideManagementOrganization(SMO).TheSMOwillassistwiththereformeffortsby:

�Fosteringindividual,youthandfamily-drivenbehavioralhealthservicesthatareevidence-based;

�Increasingaccesstoafullerarrayofevidence-basedandpromisinghome-andcommunity-basedservicesthatpromotehope,recovery,andresilience;

�Improvingqualitybyestablishingandmeasuringoutcomes;

�ManagingcoststhrougheffectiveuseofState,federalandlocalresources;and

h Outreach and training related to provider enrollment and visit verification January 2012- June 2012

h Visit verification (proposed within eight months of contract start) June 2012

The Louisiana Behavioral Health Partnership (LBHP)Background

Louisianahaslongexperiencedspiralingcosts,pooroutcomesandlimitedavailabilityofservicesinmanygeographicareasformentalhealthandsubstanceabuseservices.Thoughmanyeffortshavebeenmadetoreformthesystem,Louisianacontinuestorankpoorlyinnationalbehavioralhealthcomparisons.Inadditiontoplacing49thforoverallhealthinAmerica’sHealthRankings,theNationalAllianceonMentalIllnessgaveLouisianaa“D“initsmostrecentNationalReportCard.Evenmoretroubling,thoughfewerthanfivepercentofchildreninLouisianaareuninsured,only7to14percentwithmentalhealthdisordersarereceivingtheservicestheyneed.Muchofthiscanbeattributedtofourchallengesinthecurrentsystem:

�Fragmentation:Thesystemlacksaclearsinglevisionforhowthestateserveschildrenandadultswithsignificantbehavioralhealthchallenges;

�Financing:Thestatedoesnotleverageandmaximizestatetaxdollarseffectively.LouisianadepartmentsarenotensuringthatMedicaideligiblechildrenarereceivingMedicaidserviceswheneligibleandthatthoseeligibleforMedicaidareidentifiedandenrolled;

�InconsistentServices:Thestatemakeslimiteduseofbestpracticesanddoessoingeographicandbureaucraticsilosonly–failingtotakethoseeffortsstatewide;and

�PoorOutcomes:Louisianianswithbehavioralhealthconditionshaveinadequateaccesstoqualitytreatmentandservices,resultinginpoorbehavioralhealthoutcomes.

Goal

Byfocusingonenhancedindividualoutcomes,theLBHPwillimprovethequalityofcareand


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�DeveloptrainingcoursestomeettheneedsofrequiredtrainingintheeventcoursesarenotcommerciallyavailabletomeetthespecificLBHPrequirements;

�DevelopcredentialandcertificationprocessforprovidernetworkwithinLBHP;

�Identifyevidence-basedassessments,programsandinterventionsforpersonsreceivingservicesthroughLBHP;and

�DesignandimplementqualitymanagementplanforLBHP.

DELIvERABLES h Establish a LBHP communication plan with on-going review and updating July 2011

h Create a documented process for accessing Mercer’s consulting services September 2011

h Create a management plan for the SMO August 2011

h Select winning SMO proposer September 2011

h Create a cross systems matrix identifying populations of focus September 2011

h Publish a provider requirements list inclusive of licensed and non-licensed providers by service type September 2011

h Complete review and approval by CMS of waivers and state plan amendments October 2011

h Complete implementation plan with SMO October 2011

h Publish services manual for providers of service under the 1915(i) and 1915(b) waivers for the proposed focus populations October 2011

h Implement SMO provider network development November 2011

h Publish catalogue of required training, approved curriculum, process for approval of equivalent training November 2011

h Complete training courses, curriculum and delivery process to assure provider compliance December 2011

h Complete Medicaid and OBH required rulemaking for LBHP December 2011

h Credential and certify providers January 2012

�Fosteringrelianceonnaturalsupportsthatsustainindividualsandfamiliesinhomesandcommunities.

Clientswillhaveincreasedaccesstoamorecompleteandeffectivearrayofbehavioralhealthservicesandsupports,leadingtoareductioninthenumberofrepeathospitalizations,institutionalizations,out-of-homeplacementsandemergencydepartmentvisits.ByJune30,2012,anestimated75,000Louisianianswillbenefitfromcoordinatedbehavioralhealthcare.

TheDepartment’sOfficeofBehavioralHealthwillimplementthefollowingstrategiesinestablishingLBHP.

�DevelopLBHPcommunicationplanforOBHstaff,providersandpersonsreceivingservices;

�IdentifyactuarialcontractresourcesandestablishwaystoaccesstheresourcesforLBHPimplementation;

�DeveloptheITbusinessplanforLBHPandsubmitforapprovalinclusiveofelectronicbehavioralhealthrecord;

�SubmitamendmentstotheLouisianaMedicaidStatePlan,includinga1915(i)StatePlanamendment,aswellasapplicationsfor1915(b)and1915(c)waiverstotheCentersforMedicareMedicaidServices(CMS)forauthorizationtoimplementtheproposedcoordinatedsystemofcareforbehavioralhealth;

�DevelopandissuetheStatewideManagementOrganization(SMO)RequestforProposal(RFP);

�Identify,defineandsubmitservicedescriptionsinclusiveofeligibility,providertypes,unitsofserviceandreimbursementratestoCMSforapproval;

�DevelopmatrixforpersonsreceivingserviceswithinLBHP,clarifyingeligibilityandidentifyinggaps;

�IdentifyqualifiedproviderswithinLBHP,clarifyingcredentialand/orcertificationrequirements;

�Identifyandassureavailabilityofproviders’trainingneedswithinLBHP;


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residentialorprobationandparoleservicesthroughthejuvenilejusticesystem.

Recentestimates(Pires,1996,2002)indicatethefollowingpercentagesoftheseyouthinLouisiananeedbehavioralhealthservices:

�40percentofthoseplacedinDCFSfosterhomes;

�70percentofthoseinOJJout-of-homeplacements;

�20percentofchildrenandparentsservedintheirhomesbyDCFS;and

�50percentofchildrenandparentsservedintheirhomesbyOJJ.

Itiswidelyacknowledgedthatthesechildrenandfamiliesarecurrentlyservedthroughafragmentedservicedeliverymodelthatisnotwellcoordinated,isofteninadequatetomeettheirneedsandisoftendifficulttonavigate.Stateagenciesarenotcurrentlypoolingresourcesandleveragingthe‘smartest’financingtoprovideacoordinatedsystemofbehavioralhealthservices.ThistoooftenresultsinhavingLouisiana’schildrenwiththehighestlevelofneeddetainedinsecureorresidentialsettings,whicharethehighestcostserviceswiththepoorestoutcomes.

TherealityofLouisiana’scurrentsystemwasdemonstratedinthefinancialanalysisconductedbythestate,whichindicatedthatstateagencyspendingforrestrictivelevelsofcare(includingpsychiatrichospitalcare,residentialtreatmentandchildreninalternativeschoolprograms)wasapproximately$171millionandrepresentedabout38percentoftotalspendingonbehavioralhealthservices.

CSoCeffortshavebeenshowntoaddresscommonproblemsfoundinotherstatesandcommunitiesthroughoutthenation,including:

�Lackofhome-andcommunity-basedservicesandsupports;

�Patternsofserviceutilizationthatareracially/ethnicallydisparateanddisproportionate;

�Highcostadministrativeinefficiencies;

�Pooroutcomes;

h Complete and approve business plan for information technology Electronic Behavioral Health Record (EBHR) March 2012

h Complete LBHP implementation March 2012

h Verify SMO has enrolled a total of 54,680 individuals receiving services from addictive disorder and mental health clinics, and current mental health rehabilitation provider agencies April 2012

h Verify SMO has enrolled an additional 20,446 individuals accessing behavioral health services for a total of 75,126 individuals June 2012

h Conduct quality performance review of LBHP June 2012

The Coordinated System of Care (CSoC) Background

ThecurrentbehavioralhealthsystemforyouthinLouisianaconsistsofseparateeffortsbyfourdifferentstateagencies–theOfficeofJuvenileJustice(OJJ)andtheDepartmentsofChildrenandFamilyServices(DCFS),HealthandHospitals(DHH)andEducation(DOE).Thissystemisfragmented,resultsinduplicationofbehavioralhealthservicesandisnotcosteffective.Moreover,thesystemhasinadequatelyprovidedbehavioralhealthservicesforLouisiana’schildrenandfamiliesingreatestneedandathighestrisk,resultingintoomanyout-of-homeplacementsinarangeofsettingsthatarecostlyandoftennotveryeffective.

Leftuntreated,mentalhealthdisordersinchildrenandadolescentsleadtohigherratesofsuicide,violence,schooldropout,familydysfunction,juvenileincarcerations,alcoholandotherdruguseandunintentionalinjuries.AccordingtoastudyconductedbytheNationalCenterforMentalHealthandJuvenileJustice(2006),70percentofyouthinthejuvenilejusticesystemsufferfrommentalhealthdisorders.Today,approximately54,000childrenandfamilieshavesomeformofcontactwithLouisiana’schildwelfareand/orjuvenilejusticesystems.Annuallymorethan8,100ofthesechildrenreceivefostercareservicesand8,700childrenreceive


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TheDepartment’sOfficeofBehavioralHealth(OBH)hasestablishedaCSoCGovernanceBoardtoimplementtheinitiative,whichiscomprisedofstafffromthepartneringchild-servingagencies(DCFS,DOEandOJJ),afamily/consumerrepresentativeandotherstakeholderstooverseeCSoCimplementation.

TheCSoCteamwillengageinaneducationalandconsensus-buildingprocessforprovidersandchild-servingsystemstocreateacommonvisionandunderstandingoftheCSoCconceptandwhatitmeansforLouisiana.ThisteamwillworkwithrepresentativesfromLouisianaMedicaidtoensureCMSapproval,appropriateimplementationandcompliancefortheMedicaidwaiversandstateplanamendments.AfteritsselectionthroughtheLBPHinitiative,theCSoCwillpartnerwiththeStatewideManagementOrganization(SMO)toensurethesystemofcareisoperationalizedwithintheimplementingregionswithfidelity.

TheCSoCteamwillassistthePhaseIAct1225regions(regions2,7,8,9andJeffersonParish)withimplementationofregionalCSoCsthatincludeestablishmentofregionalcommunityteamstosupportandguidetheirimplementationeffortsaswellaswraparoundagenciesandfamilysupportorganizations.TheywillguidestatepartnersandothercriticalstakeholdersthroughtrainingandtechnicalassistancetoalignwithCSoCvaluesandprincipleswithintheirrespectiveenvironments.ByworkingwiththeGovernanceBoardandstandingcommittees,theteamwillberesponsibleforensuringoutcomesaredefinedandachieved.

DELIvERABLES h Develop a refined organizational structure that ensures adequate staffing for the CSoC team, including creation of the Family Support Partner and other positions as needed September 2011

h Conduct an Implementation Institute for 25 people representing the five Phase I regions to support their CSoC development and implementation efforts October 2011

h Partner with OBH and the SMO to develop policies and procedures for eligibility into the CSoC September 2011

�Rigidfinancingstructures;and

�Deficit-based/medicalmodels,limitedtypesofinterventions.

(Source: Pires, S. (1996). Human Service Collaborative, Washington, D.C.)

OnMarch3,2011,Gov.BobbyJindalissuedanExecutiveOrdermakingLouisianaoneofthefirststatesinthenationtoformallybringtogethertheleadershipofthefourchild-servingstateagenciesthatservethispopulationtoformastatewideCSoCforyouthwithsignificantbehavioralhealthneedsandtheirfamilies.OneinitiativewithintheLouisianaBehavioralHealthPartnership,CSoCwillreducethefragmentationandduplicationinthedeliveryofbehavioralhealthservices;increaseintegrationandcollaborationacrossthesefouragenciesinpartnershipwithfamiliesandyoungpeople;andleveragedollarsmoreeffectivelytoenhancetheavailableservicearray.Thedevelopmentofthiscomprehensive,community-basedCSoCforyoungpeoplewithbehavioralhealthchallengeswillallowLouisianatosupporttheminachievingbetterfunctioningacrossthebasicareasoflife,includingsafety,mentalhealth,physicalhealth,permanency,educationattainmentandself-sufficiency.

Goal

DHH,inconjunctionwithitspartneragencies,willestablishaneffectivestatewidesystemofcarecapableofserving2,500youthandfamilieswithblendedfundingthatisbuiltontheCSoCmodelandvalues.InFY2012,throughthefirstphaseofimplementation,200childrenandfamilieswillbeginreceivingCSoCthroughcomprehensivecareplans.

Thissystemwilldevelopandfinanceservicesandsupportsforat-riskchildrenandyouthtokeepthemintheirhomecommunity,inschoolandoutofdetentionwhileachievingthebestpossiblehealthandfunctioningincommunitysettings.Itwillprovideforthecomprehensivebehavioralhealthneedsofat-riskchildrenandyouthandtheircaretakersbyreinvestingcurrentfundsinthesystemintoamoreorganizedsystemofcare.Withthisinitiative,Louisianaisfollowingadocumentedpathofsuccessfulsystemreform.


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actuallysufferfromboth.Research(Charneyetal.,2001;Drakeetal.,1998,1997;McClellanetal.,1993)hasfurtherproventhatwhenpersonswithco-occurringdisordersarenottreatedforbothdisorders,theiroutcomesandprogressintreatmentarepoor.Giventhehighprevalenceratesofco-occurringdisorders,thestandardforbehavioralhealthcareisanintegratedmodelwhereapersonisabletoreceivecomprehensiveandseamlesscareforbothmentalhealthandsubstanceusedisorders.Theintegratedmodelsofcarehaveproventobemoreefficient,lessredundantandproducebetteroutcomes,suchasreducedrelianceonhospitalizationandlongerperiodsofsymptomremission.

Unfortunately,manystate-supportedmentalhealthandaddictivedisorderproviders,includingthoseinLouisiana,havebeenindirectlyencouragedtoprovideseparatetracksofcare.Historically,personswithco-occurringdisordershavebeentoldbymentalhealthprovidersthattheyneedtoget“clean”beforestartingmentalhealthtreatment,orhavebeentoldbyaddictivedisordersprovidersthattheycannotreceivementalhealthcareortakemedicationswhileundergoingtreatmentforaddictivedisorders.Thishaspresentedasituationwherestateaddictivedisordersandmentalhealthclinicoperationshavemaintainedseparateleadership,separatefundingandseparateservicedeliveryoperationsfromoneanother.Inanefforttoaddressthisissue,Louisianahasworkedtowarddevelopinganintegratedbehavioralhealthdeliverysystemthatisabletoeffectivelymanagepersonswithco-occurringdisorders.

Inthe2009LegislativeSession,Act384authorizedDHHtomergetheOfficesofAddictiveDisordersandMentalHealthtoformasingleOfficeofBehavioralHealth(OBH).Thismergercombinedandfullyintegratedboththeadministrativeandservicedeliveryfunctionsofeachoffice.Theaddictivedisordersandmentalhealthprogramsmergedlocalmanagementandfiscalactivities,andreorganizedclinicalservicedelivery.Intheinitialphases,thementalhealthandaddictivedisordersclinicsbeganthefirststepofmovingmentalhealthandaddictivedisordersstafftogetherintounified“behavioralhealth”clinics.Theultimategoalfortheseclinicsistodevelopintegratedproviderteams

h Have key staff positions in place for wraparound agencies in selected implementing regions January 2012

h Have key staff positions in place for family support organizations in selected implementing regions January 2012

h Finalize a core set of CSoC outcomes and indicators January 2012

h Define roles and responsibilities for provider participation in child and family teams and ensure providers are aware of these expectations February 2012

h Conduct education/discussion sessions reaching 200+ people for the internal CSoC team and other key partners (child-serving agencies, providers, families, youth, etc.) to support operationalization of CSoC values into practice February 2012

h Complete technical assistance and training to Phase I regions to support wraparound agency and family support organization readiness March 2012

h Ensure that 100 percent of the five wraparound agencies and family support organizations are ready for service delivery March 2012

h Ensure that 200 children and families are receiving CSoC services through the five implementing regions June 20121.Pires,S.(1996).HumanServiceCollaborative,

Washington,D.C.

Pires,S.(2002).BuildingSystemsofCare,APrimer.,HumanServiceCollaborative,Washington,D.C.

Integrating Behavioral Health Business Practices and Treatment ApproachesBackground

Nationalstudies(SAMHSA,2006;Kessleretal.,2005)haveshownthatthereisahighrateofprevalenceofpersonswhosufferfrombothmentalhealthandsubstanceusedisorders.Research(Comptonetal.,2000;Sacksetal.,1997)hasrevealedthatapproximatelyhalfofpersonsseekingtreatmentforabehavioralhealthconditionsufferfromco-occurringmentalhealthandsubstanceusedisorders.Thesestatisticsvarydependingonresearchmethods,butthecurrentstandardofcareisto“expect”thatindividualsseekingtreatmentforeitheramentalhealthorsubstanceusedisorder


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DELIvERABLES h Create a document that provides an overview of funding mandates and sources October 2011

h Develop a strategic plan for implementation of electronic health records for OBH Clinics September 2011

h Begin accreditation process for publicly operated clinics November 2011

h Convert publicly operated clinics into Medicaid Access Centers January 2012

h Give behavioral health providers access to workforce development opportunities that are in line with the state’s current behavioral health goals and objectives January 2012

h Implement a financial efficiency and accountability plan for state-operated clinics that projects revenue based on service delivery January 2012

h Public clinics will begin using uniform treatment guidelines March 2012

h Develop written uniform policies and procedures for the delivery of integrated services at all state run clinics March 2012

h Develop a marketing outreach plan and timeline for public clinics March 2012

h Develop a plan and timeline for the integration of primary care with publicly operated clinics March 2012

h Provide behavioral health providers with exposure to evidence-based practices/ evaluation techniques and access to implementation strategies July 2012

h Have all publicly operated clinics using a newly crafted Business Operational Process Manual July 2012

Integrating Public Health and Primary Care Background

In2010,Louisianaranked49thoutof50statesinAmerica’sHealthRankingslargelybecauseofitshighburdenofchronicdiseasesandbarrierstoaccessingcare.Someofthesefactorsincluded:

�33.9percentofpopulationisobese(49thinthenation);

thatarecapableoftreatingthewidespectrumofpersonswithco-occurringdisorders.

TheseservicesystemchangescomeatacriticaltimeasthestatemovestowardacoordinatedcaremodelthroughtheLouisianaBehavioralHealthPartnership(LBHP).ThesystemchangesforanintegratedcaredeliverysystemalignandcomplementthenecessarychangesneededtomeetthestandardsfortheMedicaidandcoordinatedcareenvironment.Thisemergingdeliverysystemhastwosignificantdeparturesfromtheolddeliverymodel:servicesaredeliveredinanintegratedfashion,andservicesarecoordinatedbyastatewidemanagementorganization.

Goal

OBHwilldevelopnewbusinessandtreatmentprocessesthataccountforintegrationofmentalhealthandaddictivedisorderservicesandmanagedcaredelivery.


OBHwillfirstconductastreamlinedoverviewoffundingsourcesandidentifypolicyandprotocolmandatesforeachsource.Workingwithinthatcontext,OBHwilltakespecificstepstocontinuetheintegrationofservicesatpubliclyoperatedclinics.Thiswillincludeimplementationofafullyelectronichealthrecordsystem,standardizationofoperationalproceduresanddevelopmentoffinancialefficiencyandaccountabilitystandards.OBHwillworkcloselywithlocalinstitutesofhighereducationtoexploreandfacilitatetheimplementationofevidence-basedpractices.Thisfall,allOBH-runclinicswillembarkupontheaccreditationprocess.

OBHwillworktoconvertallclinicstoMedicaidAccessCentersbythebeginningof2012.IntheSpring,OBHwilldevelopandcommittoatimelinefortheclinicalintegrationofpubliclyoperatedfacilities,aswellasaneedsassessmentforthenecessaryworkforcetraining.OBHwilltheninitiateatransitionallicensureplanuntilnewlegislationcanbecraftedtoaccountforbehavioralhealthintegration.Simultaneously,OBHwilldevelopmarketingandoutreachstrategiesforeachpubliclyoperatedclinic.Bytheendoftheyear,allOBH-operatedclinicswillbeusinganewlycraftedBusinessOperationalProcessManual.


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publichealthregionsmustuseandleverageexistingresourcestomaximizeefficienciesindeliveringpublichealthservices.TheseresourcesincludeparishgovernmentsthatprovidebuildingspaceandsharedstaffingbetweenOPHandlocalgovernmentsfortheprovisionofpublichealthservices.Tobetterdetermineandprioritizeneedsandopportunities,OPHwillconductcommunityhealthassessmentsthatwillidentifythehealthprofile,healthneedsandresourceswithineachcommunity.ThecommunityhealthassessmentswillallowOPHtoidentifyhealthdisparities;targetpopulationsatriskfornegativehealthoutcomes;andpinpointbarrierstoandopportunitiesforchange.

Thereareatleastthreepublichealth-primarycareintegrationmodelscurrentlyoperatinginLouisiana.

Co-location:PHUandprimarycareprovidersareco-locatedinthesamephysicalfacility,butoperateasseparateentities,i.e.twodistinctpointsofentry.(Example:JeffersonParishPHUandDaughtersofCharityHealthCenterinMetairie,LA)

Parish Health Unit with Primary Care Services:PHUoffersaprimarycareservicethroughOPH-employedorcontractproviders,i.e.singlepointofentry(Example:PrenatalservicesinOuachitaPHU)

Federally Qualified Health Center with PHU Services: FederallyqualifiedhealthcenterofferspreventivepersonalhealthcareservicestraditionallyofferedinthePHUandservesastheparishPHUthroughcontractualagreementswithOPH.(Example:St.CharlesCommunityHealthCenterinLuling,LA)

Asstateandfederalhealthcarereformeffortstakeeffect,itisimportantlocal,stateandnationalstakeholdersareactivelyengagedintheprocessofidentifyingthemodelsthataremostappropriateforeachcommunityandthatwillbestpositionLouisianatoimproveitspublichealthandprimarycaredeliverysystem.

Goal

OPHwillincreaseaccesstocomprehensive,highqualityprimarycareservicesforallLouisianiansby:

�Increasingthenumberofclinicsstatewidethatprovidebothprimarycareandpreventive

�35.6percentofpopulationhashypertension(46thinthenation);and

�18percentofthepopulationlackhealthinsurance(41stinthenation).

Inaddition,TrustforAmerica’sHealthfoundthatLouisianarankedinthetopfiveformanypreventableconditionsin2011,including:

�#2inprevalenceoflowbirthweightbabies

�#4diabetesrate

�#2syphilisrate

�#4chlamydiarate

DHH,throughitsOfficeofPublicHealth(OPH)providespreventivepersonalhealthcareservicesthrough68parishhealthunits(PHUs)locatedinnineregionsthroughoutthestate.Althougheachregioncontainsatleastonefederallyqualifiedhealthcenter(FQHC),aruralhealthclinic(RHC)andnumerousprivatepractitioners,aformalmechanismthatensurescoordinationofserviceswithprimarycareprovidersandlinksresidentstopatient-centeredmedicalhomesdoesnotexist.

InDecember2010,thePHUsunderwentacombinationoffacilityclosures(inOrleansParish)andtargetedoperationalreorganizationinselectparishesacrossthestate.ManyPHUsnowsharestaffandcoordinateservicessothatonePHUisopenforthreedaysperweekandthepartnerPHUisopenfortwodaysperweek.TheassessmentusedtoidentifyPHUsforreorganizationevaluatedwhetherotherhealthcareentitieswerelocatedincloseproximityandinsomecasesprovidingduplicativeservices.EngagingthesehealthcarepartnersinredesigningthesystemwillprovideopportunitiestocoordinateandintegrateservicestoimprovedeliveryofcaretoLouisianaresidents.

AnotherkeyconsiderationinthetransformationofthecurrentpublichealthdeliverysystemistheadventofCoordinatedCareNetworks(CCNs),DHH’ssolutiontoimprovingMedicaid.CCNswillprovidemedicalhomesforMedicaidrecipientsanddeliverhigh-qualitycoordinatedhealthcareservicesthatachievemeasurableimprovementsinpopulationhealth.

Currently,OPHadministers50distinctpublichealthprogramsand72federalgrants.Eachofthe


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DELIvERABLES h Conduct a summit with LPCA/LRHA for the purpose of establishing stakeholder buy-in from their respective memberships in transitioning the delivery of personal health services October 2011

h Complete the health care access resource assessment for 36 parishes in primary care and mental health professional shortage areas October 2011

h Create and implement one standardized agreement or contract with FQHCs and RHCs to provide personal health services January 2012

h Implement a pilot initiative based on delivery of personal health services by FQHCs/RHCs in a priority area of the state March 2012

h Execute provider agreements with CCNs in all areas of the state March 2012

h Execute at least two agreements in prioritized communities based on need for services with FQHCs/RHCs May 2012

Louisiana Birth Outcomes ProjectBackground

Louisianacontinuestofailinmostreports,rankingsandstudiesofhealthstatusandhealthsystemsperformancetalliedbyorganizationssuchastheUnitedHealthcareFoundation,theAnnieE.CaseyFoundation’sKidsCountDataCenterandtheMarchofDimes.Forbirthoutcomes,thestate’srankingsareparticularlyworrisome.Louisianaranks48thnationallyininfantmortalityandpretermbirth,and49thinthepercentageoflowandverylowbirthweightbabies,accordingtotheNationalCenterforHealthStatistics.HealthdisparitiesdefineandshapethesepoorrankingsasindicatedbyelevatedpooroutcomesinLouisiana’sAfrican-Americanpopulation.

WhileMedicaidfinancesnearly70percentofbirthsinourstate,amongthehighestinthenation,Medicaideligibilityends60dayspostpartumfor73percentofwomenwhosematernitycarewascoveredbyLouisianaMedicaid.Duetothislackofinterconceptioncare,manywomenwillhaveasubsequentMedicaid-coveredbirthwithahighcostandadversepregnancyoutcomebeforetheirmedicalandpsychosocialrisksareaddressed.

personalhealthcareservicesfromfiveto10inFY2012;and

�ExecutingCCNprovideragreementsinallregionsinFY2012.


OPHwillcompleteanassessmentthatidentifiestheareasofneedforhealthcareprofessionalstoprovidepreventiveandprimarycareservicescoupledwiththeavailableresources(i.e.,PHUs,FQHCs,school-basedhealthcenters,etc).Thisassessmentwillstrengthenpartnershipswithentitieswithinthisserviceareatocollaborativelydesignaservicedeliverymodelthatencompassesbothpreventiveandprimarycareservicesinunderservedcommunities.Thismodelwillensurethatcommunityhealthneedsintheareasofchronicdiseases;Tuberculosis(TB)treatmentandcommunicablediseasecontrolservices;familyplanningservices;sexuallytransmitteddisease(STD)services;HIV/AIDSservices;women,infantandchildren(WIC)nutritionservices;andimmunizationsareadequatelyaddressedandareprovidedwithinamedicalhome.

OPHisdevelopinganintegratedstrategytotransitionessentialpublichealthservicesintotheprivatesectorofcommunitiesthathaveadequateresourcesandinfrastructuretosustaintheservices.Byfacilitatingcommunication,coordination,andcollaborationofpreventiveandprimaryhealthcareentities,OPHstrivestoavoidduplicationofservices,achieveoptimalqualityinhealthservicesanddemonstratemeasurableimprovementsinpopulationhealthinLouisiana.OPHwillalsoincludestakeholdersintheprocessbyprovidingaplatformforstakeholderinputwithitspartners,includingtheLouisianaPrimaryCareAssociation(LPCA)andLouisianaRuralHealthAssociation(LRHA).

CCNswillexistineachregion.Thesenetworksofproviderswillprovideamedicalhome,whichwilldeliverhighqualitycoordinatedhealthcareservicesforMedicaidrecipients.OPHwillredefineitsroleassafetynetproviderforsomeservicesorinsomegeographicareasofthestatedependingontheadequacyofthenumberofprovidersinthenetwork.


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childbearingagetoreduceriskfactorsthatmightaffectfuturepregnancies.TheInterconceptionCareProjectatGradyMemorialHospitalinAtlantademonstratedhowthesecomponents,deliveredthroughapatient-centeredmedicalhome,andintensivecasemanagementimprovethehealthofwomen,increasepregnancyintervalandimprovepregnancyoutcomes.

CompoundingLouisiana’spoorbirthoutcomesisthefinancialburdenassociatedwithhighlaboranddeliverycosts.TheaveragecostforprematureinfantsinLouisianais$33,000comparedtoanationalaverageof$4,000fortermnewborns(MarchofDimes,2010).Withapproximately7,000prematurebirthscoveredbytheMedicaidprogrameachyear,theexcesscoststothestatepotentiallyexceed$200millionannually.Inmanyhospitals,unnecessaryinductionsandcesareansectionsoccurbefore39weeksgestationandleadtoincreasesinneonatalintensivecare(NICU)admissions.Theseinductionsnotonlyleadtoincreasedcosts,butoverwhelmingevidencealsoindicatestheyharmmothersandbabies.OrganizationsincludingtheAmericanCollegeofObstetriciansandGynecologists(ACOG),theMarchofDimesandtheAmericanAcademyofPediatricshaveallprioritizedthisissue.Significantimprovementsinendingelectivedeliverieswithoutmedicalindicationpriorto39weeksgestationhavebeendemonstratedbyIntermountainHealthcareinUtahandtheSetonFamilyofHospitalsinTexas.Louisiana’sownWoman’sHospitalinBatonRougeandEastJeffersonGeneralHospitalinMetairiehaveseenmarkedperinatalimprovement,inlargepartduetotheireffortstotrackandmonitordata.

Goal

ToimprovebirthoutcomesinLouisiana,theBirthOutcomesInitiative(BOI)will:

�CreateacultureofcontinuousqualityimprovementandsafetyinLouisiana’sbirthinghospitals;

�IncreaseDHHdatacapacityandperformancemeasurementofmaternitycareandincreaseaccountabilityforclinicaloutcomes;

�AssessandimprovethebehavioralhealthofLouisiana’spregnantwomen;and

Diabetes,hypertension,sexuallytransmitteddiseases,obesity,smoking,heavyalcoholuseanddepression,forexample,allaffectawoman’slong-termhealthandcancontributetohigh-riskpregnanciesandbabiesbeingborntoosmall,toosoonorsick.

Nationalsurveysindicatethatopportunitiesforpreventivecareandhealthpromotionamongwomenarelargelymissed.TheKaiserFamilyFoundation2005surveyedwomenbetween18and44yearsofageandfoundthatjustoverhalfofthewomenhadspokenwithahealthcareproviderinthepreviousthreeyearsaboutdiet,exerciseornutrition;andlessthanhalfhaddiscussedcalciumintake,smokingandalcoholuse.Smokingisanimportantdeterminantofhealthstatusandamajorcontributortoprematurityandlowbirthweight.Twenty-twopercentofwomeninLouisianabetween18and44yearsofagereportedsmokingin2009,atwopercentagepointincreaseover2008.Drinkingalcoholduringpregnancy,particularlybingedrinking,cancausebirthdefectsanddevelopmentaldelays.In2009,13percentofLouisianawomenbetween18and44yearsofagereportedbingedrinkinginthepastmonth.Inadditiontosubstanceuseissues,womeninLouisianaalsosufferwithmentalhealthissues,includingdepression.Resultsofscreeningprogramsshowtheratesofclinicallysignificantdepressionsymptomsinpregnantandpostpartumwomenareapproximately15-20percentinLouisiana.

Providingbetteraccesstopreconceptioncare,improvingscreeningfortobaccoandalcoholandbuildingabetternetworkoftreatmentservicesareallvitalstepstoimprovingthehealthofwomeninLouisiana.NationalrecommendationsfromtheCentersforDiseaseControlandPreventionSelectPanelonPreconceptionHealthandHealthCareandevidence-basedrecommendationsonthecontentofpreconceptioncareprovideaframeworkofchangingtheparadigmofprimarycareforwomenofchildbearingage.Preconceptioncareincludescarebeforeafirstpregnancyorbetweenpregnancies(commonlyknownasinterconceptioncare).Thepurposeistoprovidehealthpromotion,screeningandinterventionsforwomenof


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indeterminingwhichwomenmightbenefitfrom17Padministrationandtoensurethatwomenatelevatedriskofhavingapoorbirthoutcomesbasedonbehavioralfactors,suchascigarettesmokingandalcoholconsumption,receiveadequatescreeningandtreatment.

Behavioral Health Screening:FormeasurableimpactsinbehavioralhealthtobeachievedforLouisiana’sMedicaid-eligiblewomen,astatewidesystemofscreening,referralandtreatmentforthehighestriskpregnantwomenisbeingimplemented.PrivateproviderswillbereimbursedforperformingabehavioralhealthscreenandabriefinterventionforeachpregnantwomaninMedicaid.BOIandMedicaidarecurrentlydevelopinganonlinesubmissionmechanismforthescreeningtool.ThiswillallowDHHtocollectadequatedataonbehavioralhealthneedsofpregnantwomeninMedicaidandtrackbehavioralhealthoutcomesthroughdatacollectionandmonitoring.Provideroutreachandtrainingontheuseofthenewscreeningtoolwillbecompleted.OfficeofPublicHealthregionalstaffcanassistwithmedicalandnon-medicalcommunityoutreachineachofDHH’sgeographicregions.PartnershipswithexistingprogramssuchastheTobaccoQuitLineandLouisiana’sTobaccoControlProgramarecurrentlybeingstrengthenedandleveragedtoensurethatprovidersareadequatelytrainedandthatwomenareabletoreceiveappropriatetreatmentservices.

Interconception Care:Finally,theBOIwillseektoimprovepreconceptionandinterconceptionhealthforwomenathighriskofpoorbirthoutcomesinLouisiana.Expertshaveidentifiedevidence-basedinterventionssuchasassistancebyacarecoordinatorandhomevisitationthatcanbedeliveredtowomenathighriskofapoorbirthoutcometoreducethechancesofanadverseoutcomeformotherandbaby.Thepurposeistoprovidecarecoordination,healthpromotion,screeningandinterventionsforwomenofchildbearingagetoreduceriskfactorsthatmightaffectfuturepregnancies.Currently,BOIisworkingtoinstituteaninterconceptioncareprogramintheGreaterNewOrleansCommunityHealthConnection(GNOCHC)program.IfapprovedbyCMS,theprogramwillprovideaccesstointerpregnancy

�ImprovepreconceptionandinterconceptioncarecoordinationtoimprovethehealthofLouisianawomen.


SinceAugust2010,theDepartmenthasengagedcommunitymembersandkeystakeholderstodetermineevidence-basedpracticesthatcanbeimplementedinLouisianatoimprovewomen’sandinfanthealth.InApril2011,withheavystakeholderinput,BOIfinalizeditsstrategicplanandwillcontinuetoexecutestepsnecessarytoimprovepatientsafety,datacapacityandtransparency,behavioralhealthscreening,referralandtreatmentandcarecoordinationforhigh-riskwomen.

39-Week Initiative:Toachievegreaterpatientsafety,hospitalsmustimplementevidence-basedbestpractices,suchasendingmedicallyunnecessarydeliveriespriorto39weeks.InJuly2011,theSecretaryaskedallbirthinghospitalsinLouisianatoendthesedeliveries.Hospital-levelreportingandthecreationofhospitalandproviderconsensusaroundprovenprotocolsandstatewidequalitymeasureswillhelpensureimprovedoutcomes.BOIhascreatedaperinatalqualitycollaborativethroughoutthestate’sleadingmaternitycarehospitalsthatwillfocusonlaboranddeliveryandNICUqualityimprovement.Thisyear-longprojectbeganinJuly2011with20majormaternityhospitalsandisledbyDHHandtheInstituteforHealthcareImprovement(IHI).BestpracticeslearnedfromthisexperiencewillbesharedwithandusedbyallbirthinghospitalsinLouisiana.

Birth Report Cards:Performancemeasurementsystemsarebeingputinplacetodeterminewhetherinterventionsaresuccessfulandtoensuretransparencyinpractice.Aperinataldataandmeasurementportalisbeingcreatedwiththeideathatreportingcouldreachbeyondbirthoutcomesintoothermetrics.Datawillbesharedwithappropriateentitiestaskedwithgeneratingthestatewideannualperinatalreportcard.Collectionofdataaswellasvoluntaryreportingofdatafromhospitalsmustbeachieved.BOIwillalsoworktoestablishahighriskdatabasethatcouldbeusedbyphysicianstoaidinpatientcareand


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undertheAmericanswithDisabilitiesAct(ADA).ManyoftheactionscalledforinthePlanforChoicearewell-establishedbestpracticesthatnationalresearchersandtheCentersforMedicareandMedicaidServices(CMS)haveidentifiedashallmarksofaright-balancedlong-termcaresystem.

Louisianacurrentlyspendsabout27percentofitsMedicaidlong-termcarefundingonolderadultsandpeoplewithadultonsetdisabilityonhome-andcommunity-basedservices($314millionforcommunity-basedservicesinFY2011versus$849millionfornursingfacilitycare).EventhoughLouisianaisservingamuchlargernumberofpeopleinthecommunitythanitdid10yearsago,DHH’scurrentwaitinglistforcommunity-basedservicesincludes20,000people–andtheagingofLouisiana’spopulationmeansdemandwillcontinuetogrow.

Asthetransitionfrominstitutional(nursinghome)caretohome-andcommunity-basedservices(HCBS)continuestoexpandinthecomingyears,DHH’sOfficeofAgingandAdultServices(OAAS)mustfacethechallengesofensuringquality,maintainingfinancialsustainabilityandimplementingHCBSprogramimprovements.Overthepastseveralyears,OAASreceivedseveralfederalsystemschangeandsystemstransformationgrantsthathaveallowedittoplananddevelopTransformationalPrioritiestoaddresskeyissues,including:

Heavy Reliance on 1:1 In-Home Care:Threeyearsago,OAASinheritedanHCBSprogramthatincludedfewalternativestoin-home,one-to-onecare.Heavyrelianceonin-homeworkersencouragesservicedependencyanddisplacementofnaturalsupports,leadingtounnecessarilyexpensiveplansofcareandviolationsoffederalcost-neutralityrequirements.

Provider Capacity:Louisianahasoneofthelowestnursingfacilityreimbursementratesinthecountry(AARP,AcrosstheStates:ProfilesofLong-TermCareandIndependentLiving,2009).Thenursingfacilityratesdeterminethecostneutralityofaggregatedannualbudgetsforcommunity-basedcarerecipients.Whencombinedwithoveruseof1:1assistance,

primarycarehealthservicesforeligiblewomenwhohavepreviouslydeliveredapremature,stillbirth,loworverylowbirthweightinfantintheGreaterNewOrleansarea.Toincreaseopportunitiesforpreconceptionandinterconceptioncarestatewide,theBOIandMedicaidwillworkwithCoordinatedCareNetworkprovidersastheydevelopandimplementinterconceptioncareprogramsfortheirenrollees.

DELIvERABLES h Publish an online statewide behavioral health screening tool through Medicaid January 2012

h Launch a care coordination program in GNOCHC program January 2012

h Provide technical assistance to and collaborate with Coordinated Care Networks as they plan and implement interconception care programs statewide January 2012, March 2012, May 2012

h Create and share Louisiana’s Birth Report Card with demonstration group public reporting planned for late 2012 November 2011

h Significantly reduce non-medically indicated deliveries prior to 39 weeks gestation by having policies in all Louisiana birthing hospitals January 2012

h Create a hospital IHI perinatal quality improvement collaborative that will culminate in Louisiana birthing centers of excellence July 2011, October 2011, June 2012

h Create a hospital Neonatal Intensive Care Unit quality improvement collaborative that will culminate in Louisiana birthing centers of excellence October 2011, January 2012, October 2012

Promoting Independence through Community-Based CareRedesigning the Community-Based Long Term Care Infrastructure

Background

Louisiana’scomprehensiveplanforlong-termcarereform,Louisiana’sPlanforChoiceinLong-TermCare,isastrategicblueprintforsystemrebalancingandhasservedasLouisiana’s“OlmsteadPlan.”The1999U.S.SupremeCourtOlmsteaddecisionruledthatunnecessaryinstitutionalizationcouldbeaformofdiscrimination


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in-homemonitoringsystemsandassistivetechnologies,home-deliveredmeals,caregiverrespite,andnursing.Therewillalsobeanew,data-drivenapproachtoqualityassuranceundertheCommunityChoiceswaiverandadditionalcontrolsoverexpensiveserviceslikehomeaccessibilitymodifications.

Support Coordination Improvements:InconjunctionwiththeCommunityChoiceswaiver,OAASisimplementinganextensivecompetency-based,mandatorytrainingprogramforallsupportcoordinators.Trainingincludestestingandcertificationofcompetencyinassessmentandcareplanning.ThiscertificationtrainingwillbecoupledwithanautomatedsupportcoordinationmonitoringprocessandtoolthatwillallowOAAStoassessandimproveprogramqualityandreadilyreportprogramcomplianceandoutcomes.Performanceagreementshavebeenexecutedwithallsupportcoordinationagenciestoeffectivelyremedypoorresultsandcreateperformanceincentives.OAASwillprovideanextensiveprogramoftechnicalassistancetoprovideragencyadministrators,executives,supervisorsandstaff.

Adult Residential Care (i.e., assisted living) Waiver:OAASplannedtoimplementanAdultResidentialCarewaiverthatwillprovidearesidentialalternativeforindividualswhoseneedscannotbemetcost-effectivelyinthecommunityandwhorequireadegreeofassistanceandsupervisionthatmightotherwiseleadtomoreexpensivenursingfacilityplacement.ThiswaiverwasdeniedbyCMSonAugust24,2011andDHHiscurrentlyevaluatingalternativestomoveforwardwithprovidingthislong-termcareoptionforlow-incomeLouisianaresidents.

Consumer Direction within OAAS Community-Based Programs:TheCommunityChoiceswaiverwillincludeaconsumer-directedoption,allowingparticipantsgreaterbudgetflexibilityandtheabilitytorecruit,hireandfiretheirowncareworkers.Participantsinconsumerdirectionwillbeabletonegotiateworkersalarieswithoutgoingthroughaprovideragency.Consumerdirectionisrecognizedasonetoolforaddressingthelimitedpoolofavailablelong-termcareworkers.Thisoptionwillbeexpandedtootherservicesasresourcespermit.

ratespaidtohome-andcommunity-basedserviceprovidersmustalsobelow,negativelyimpactingprovidercapacity.Thereisalsoaninsufficientpooloflong-termcareworkersinallareasandratesofworkerpayaregenerallylow.

Support Coordination Competency/Capacity: Theprivatesystemofsupportcoordination(i.e.,casemanagement)doesapoorjobofprovidingtimelyaccesstoservicesandperformingitscorefunctionsofassessmentandcareplanning.Thisproblemhasbeenexacerbatedrecentlybythelargenumberofnursinghometransitionsthatsupportcoordinatorsarenowplanningandfacilitating.Capacitychallengesalsoexistasseveralregionslackasufficientnumberofeffectivecasemanagementagencies.

IT Capacity: ManykeyOAASbusinessprocessesarestillperformedonpaper,includingparticipantassessmentandplanofcaredevelopment.Thislong-standingissueinhibitsDHH’sabilitytoprovidehigh-qualityservices.

Goal

DHHwillorganizeandmaintainadeliverysystemforhome-andcommunity-basedservicestoachievequalityandpreventionoutcomesthatmeetorexceedoutcomesforresidentsinnursingfacilitiesasmeasuredbynationalHealthEffectivesDataandInformationSet(HEDIS)andAgencyforHealthcareResearchandQuality(AHRQ)standards.Atthesametime,theseserviceswillbeprovidedatanaverageannualper-personcostatorbelow50percentoftheaverageannualper-personnursingfacilitycost,areductionfromthecurrent54percent.Inrealdollars,thatwouldreduceper-personcostsforhomeandcommunity-basedservicesfromapproximately$21,500to$20,000peryear.


Implementation of Community Choices Waiver:TheCommunityChoiceswaiverwillreplacethecurrentElderlyandDisabledAdult(EDA)waiverprogramwithabroaderarrayofcosteffectiveservicesdesignedtoincreaseormaintainindependence.Thenewservicestobemadeavailablewillincludeskilledtherapies,


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h Complete system design document for electronic plan of care October 2011

h Reduce average annual per person HCBS cost to below 50 percent ($20,000) of average annual per-person nursing facility costs June 2012

Right Balancing Institutional and Community-Based Long Term CareBackground

Louisiana’sMedicaidlong-termcareserviceshavehistoricallybeenamongthemostinstitutionallybiasedinthenation.Louisianahasmadeconsiderableprogresssince2000whenitranked49thinpercentageofspendingforcommunity-basedvs.institutionallong-termcarefortheelderlyanddisabled.By2009,Louisiana’srankinghadrisento14th–asignificantaccomplishment(ThomsonReuters,MedicaidLongTermCareExpenditures,1996-2009).However,Louisianastillrankssecondinthenumberofnursingfacilitybedsandsixthinthenumberofnursingfacilityresidentspercapitaovertheageof75(AARP,AcrosstheStates:ProfilesofLong-TermCareandIndependentLiving,2009).Louisianaalsohasoneofthelowestnursinghomeoccupancyratesinthecountryat72percent.Thesefactscoupledwiththegrowingwaitinglist(nowat20,000people)forcommunity-basedservicespointtotheneedforcontinuedright-balancing.Thisshiftisalsosupportedbyseveralotherimportantfactors.

Cost Effectiveness and Outcomes:Louisiana’shome-andcommunity-based(HCBS)long-termcareprogramsforolderadultsandpeoplewithadultonsetdisabilityprovidehighqualitycareatlowcosts.In2011,HCBSprogramsforolderadultsandpeoplewithadultonsetdisabilitycost$12,919lessperpersonthanMedicaidnursinghomecare.DHH’sHCBSprogramsalsoperformaswellorbetterthaninstitutionalservicesonAgencyforHealthcareResearchandQuality(AHRQ)andHealthcareEffectivenessandDataInformationSet(HEDIS)measures.Additionally,surveysconductedwitharandom,statisticallyvalidsampleofrecipientsshowhighlevelsofsatisfactionwithDHH’scommunity-basedprograms.

Automation and IT Improvement:OAAShasrecentlycontractedfordevelopmentofanelectronicplanofcareandparticipanttrackingsystem.Web-basedautomationoftheplanofcarewillallowthestatetomorereadilyreview,approveandprocessplansofcare.Thiswillspeedaccesstoservicesandwillallowformoreeffectivemonitoringofaccessandsupportcoordinatorperformance.

Resource Allocation and Benefit Right Sizing: OAAShassuccessfullyimplementedanacuity-basedresourceallocationsystemthatsetsindividualbudgetandservicemaximumsbasedonaperson’srelativelevelofdisabilityandacuity.OAAShasalsoreducedthemaximumallowablecostforanindividual’splanofcareandisintheprocessofreducingthepersonalcareprogrammaximumfrom42to32hoursperweek.Thesechangessaved$19millioninfiscalyear2010;andinFY2011,OAASwasabletoserve5,000morepeoplefor$2millionlessthaninfiscalyear2009.Theaveragewaiverexpenditure($26,629thousandperyear)isstillhigherthanaveragecostsinstateslikeArkansasandTexasthataresuccessfullyusingcommunity-basedwaiverstoavoidinstitutionalization.Louisiana’spersonalcareprogrammaximumremainshigherthanthenationalaverageof28hoursperweek.Theseadjustmentswillputthepersonalcareprogrammoreinlinewithnationalnormsandallowthestatetoservemorepeoplewithavailablefunds.Closemonitoringoftheseprogramsshownoincreaseinnursinghomeadmissionssincetheimplementationofthesechanges.

DELIvERABLES h Implement Community Choices waiver October 2011

h Implement Consumer Direction in conjunction with Community Choices waiver October 2011

h Have approximately 300 support coordinators and support coordinator supervisors complete assessment and care-planning training, competency-based online and field testing and be certified to perform assessments and care planning September 2011

h Implement annual performance and quality assurance monitoring of the 28 support coordination agencies currently under performance agreement with OAAS April 2012


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Goals

Louisianaisworkingtowardthenationalaverage(34percentin2009)inpercentageoflong-termcarespendingforcommunityservicesversusnursinghomeservices.Italsoseekstoserveatleasthalfofelderly/adultlong-termcarerecipientsinthecommunity.ForFY2012,OAASaimstoincreasethepercentageoflong-termcarespendingoncommunity-basedlongtermcareto30percentandserveatleast45percent(projectedtobeabout20,000people)ofOAASlong-termcareclientsincommunity-basedsettings.


DHH’ssolutiontomeetingLouisiana’srebalancingobjectivesinvolvesthefollowingstrategies:

Expand Implementation of Money Follows the Person (MFP):OAAShastransitionedmorethan99individualsoutofnursinghomesunderMFP(56oftheminthecurrentcalendaryear)withanother73intheprocessofbeingtransitionedand40awaitingavailablehousing.Allwhohavetransitionedarebeingservedatalowercosttothestate.DHHrecentlyreceivedanadditional$14millionforMFPandisintheprocessofexpandingthoseefforts,includinginclusionofbehavioralhealthservices.

Pursue 1915(k) Authority for Personal Care Services:ProvisionsintheAffordableCareAct(ACA)provideanadditional6percentmatchforpersonalcareservicesprovidedthroughaMedicaidmechanismor“authority”referredtoas1915(k).OAASwillevaluatetheprovisionofpersonalcareservicesthroughthisnewauthorityasanalternativetothecurrentpersonalcareprogram.

Explore Options for Managed and Coordinated Care:Accordingtorecentlegislativemandate,OAASwillworktodevelopamanagedcarepilotforlong-termcare.OAAS’scurrentexperiencewithmanagedcareapproachesislimitedtoitstwoProgramforAll-inclusiveCareoftheElderly(PACE)programsinNewOrleansandBatonRouge.PACEisawell-establishednationallystandardizedmodelforcombiningacuteandlong-termcaredeliveryviaacapitatedpaymentcombiningMedicareandMedicaidfunding.SuchanapproachthatincludesbothHCBSand

Consumer Preference, Demand and Utilization:Whilenursinghomesareanimportantpartofthelong-termcareprovidercommunity,thereisevidenceofastrongconsumerpreferenceforhome-andcommunity-basedservicesovernursinghomecare.PublicopinionsurveysconductedbytheKaiserFamilyFoundation,mostrecentlyin2007,havefoundthatifconsumersrequiredlong-termcare,53percentwouldoptforcareintheirhome,17percentwouldchooseassistedlivingand21percentwouldprefertomoveinwithfamily.

Publicperceptionandexperiencearereflectedindecliningnursinghomeutilization,whichhasdecreasednationallyby26percentsince1974.InLouisiana,nursinghomeutilizationdeclined9percentinthelastfiveyearswhilethewaitinglistforcommunity-basedprogramshasincreasedto20,000people.

Legal: TheU.S.SupremeCourt’s1999decisioninOlmsteadv.L.C.notedthat“confinementinaninstitutionseverelydiminishestheeverydaylifeactivitiesofindividuals–includingfamilyrelations,socialcontacts,workoptions,economicindependence,educationaladvancement,andculturalenrichment.”TherulingfoundthatunnecessaryinstitutionalizationcouldbeaformofdiscriminationundertheAmericanswithDisabilitiesAct(ADA).LouisianawasoneofthefirststatestobesuedunderOlmstead.ThesettlementagreementinBarthelemyvs.LouisianaDepartmentofHealth,whichexpiredinDecember2010,mandatedtheimplementationoftheLong-TermPersonalCareServicesprogramasaMedicaidstateplan“entitlement,”andwhileineffect,determinedmanyfeaturesofthesystemofMedicaid-fundedhome-andcommunity-basedservicesinLouisiana.LouisianacurrentlyfacesanewlegalchallengeregardingreductiontothemaximumnumberofpersonalcarehoursallowedintheLong-TermPersonalCareprogramandremainsat-riskforfutureOlmstead-relatedsuitsandDepartmentofJusticeactions.


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atUniversityofMassachusetts.SELNisacross-statecooperativeventureofstatedevelopmentaldisabilityagenciesthatarecommittedtoimprovingemploymentoutcomesforadolescentsandadultswithdevelopmentaldisabilities.

Inordertoadvancethegrowingnationalmomentumtofocusonintegratedemploymentasadesiredoutcomeforpeoplewithdevelopmentaldisabilities,theDepartment’sOfficeforCitizenswithDevelopmentalDisabilities(OCDD)partneredwithMedicaidontheMedicaidInfrastructureGrant(MIG)tocreatetheFive-YearWorkPaysStrategicPlanin2010.Outofthisinitiative,theWorkPaysCoalitionformedtobecomethegrouptaskedwiththeimplementationofthestrategicplan.ThegoalsforLouisianaaretoseeanincreaseinpeoplewithdisabilitiesemployedincareersoftheirchoiceandaworkforcethatisaccessibleforallpeoplewithdisabilities.OversightoftheplandevelopmentwasprovidedbytheLouisianaWorkforceCommission.

Louisianaisintheprocessofrefocusingresourcestosupportindividualsincompetitiveemploymentinthecommunity,andmakeintegratedemploymenttheprimaryoptionforallindividualswithdisabilities.OCDDisthefirstagencyinLouisianatomakethetransformationtoanEmploymentFirstagency.OCDDhasformedanEmploymentFirstWorkgroup.Theworkgroupconsistsofpartneragencies,individualswithdevelopmentaldisabilitiesandadvocates,anditassistsinreviewingOCDDpoliciesandprocedurestoensurethattheyaresupportingthephilosophyofEmploymentFirst.Additionally,theworkgroupoffersrecommendationstosupportOCDDduringthistimeoftransformation.

Ofthe2,746adultsservedbyOCDDinemploymentanddaysupportsinFY2009,1,288receivedintegratedemploymentservices.Currently,thevastmajorityofindividualsreceivingintegratedemploymentservicesfromOCDDareingroup-supportedemploymentplacements(Butterworthetal,2011).Additionally,datafromOCDD’sparticipationinthe2009-2010NationalCoreIndicatorsProjectemploymentsurveyfoundthatofthe267adultslivinginthecommunitywhoweresurveyed,only10.9percentwereactuallyemployedinintegratedjobs.Further,only20ofthe

institutionallybasedcare,butonalargerscalethanPACE,coulddomuchtoalignutilizationandpaymentwiththegoalsofright-balancing.OpportunitiesunderACAforimprovedcoordinationofacute,long-termandbehavioralcarefordualeligiblesandthosewithchronicconditionswillalsobeconsidered,aswillanyresourcesthatbecomeavailabletofundthenecessaryresearchanddevelopmentworkthatwouldhavetobeperformedpriortoimplementinganysuchprogram.

DELIvERABLES h Complete hiring of nine MFP regional coordinators to implement MFP statewide September 2011

h Exceed the 2011 MFP benchmark by transitioning at least 90 individuals from nursing homes into the community December 2011

h Add behavioral health services to Louisiana’s MFP operational protocol and submit for CMS approval December 2011

h Seek CMS approval to include Long-Term Personal Care Services as a qualified community service for Louisiana’s MFP demonstration January 2012

h Increase number of people served in HCB programs from 16,000 to 20,000 June 2012

Employment first Initiative for Citizens with Developmental DisabilitiesBackground

“EmploymentFirst”isusedtodescribehowstateandlocalsystemsacrossthecountryarticulatethevaluesandphilosophywhichsecureemploymentservicesandsupportsavailableforindividualswithdisabilities.An“employmentfirst”approachmeansthatintegratedindividualemploymentisofferedbeforeotherserviceoptionsandthatcommunityemploymentissupportedasthepriorityoutcomeinpolicy,practiceandqualitymanagement.Thismeanspromotingafocusonrealjobsandrealwagesinrealbusinesssettings.Louisianaisoneof25statesparticipatingintheStateEmploymentLeadershipNetwork(SELN),ajointinitiativeoftheNationalAssociationofStateDirectorsofDevelopmentalDisabilitiesServicesandtheInstituteforCommunityInclusion


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thedevelopmentofpilotprojectsforyeartwo.Additionally,OCDDwillworkwithSELNtocollectbaselinedatabydefiningterminologyandmetricsthataccuratelyevaluatecurrentemploymenttrendsforpeoplewithdevelopmentaldisabilitiesinLouisiana.Informationregardingwagesearned,hoursworked,placesofemployment,hoursinthecommunityandotherpertinentinformationwillbecollectedontheindividualssupportedbyOCDD.Policies,procedures,servicedefinitionsandrateswillbereviewedtoensuretheysupportEmploymentFirst.EducationandtrainingonEmploymentFirstwillbeprovidedtoindividuals,families,providersandsupportcoordinators.

Strategies for FY 2012 include:

1. Creatingandcontinuingpartnershipswithstakeholdersandlocalandnationalorganizations;

2. Assessingopportunitiesandbarriersrelativetoindividualintegratedemployment;

3. Trainingproviders,familiesandselfadvocatesonEmploymentFirstInitiative;

4. Planningpilotprojectsforyearoneimplementationofbestpractices;

5. Proposingchangesinruleandpoliciestosupportindividualintegratedemployment;and

6. Expandingemploymentinitiativeinyeartwo.

DELIvERABLES h Establish a diverse Employment First Workgroup comprised of self advocates, families, providers and key state agencies July 2011

h Establish a definition for integrated employment and identify metrics to collect baseline and ongoing data September 2011

h Collect baseline employment data from the 93 enrolled supported employment providers September 2011

h Identify and conduct orientation and training with 30 provider agencies to launch the Employment First Initiative September 2011

h Identify 30 individuals for supported employment September 2011

267adultswereinindividualjobsinthecommunity(unpublisheddata,HumanServicesResearchInstitute(HSRI)andInstituteforCommunityInclusion,2011).

Goals

InJune2011,OCDDreleaseditspositionstatementonEmploymentFirst,stating“EmploymentwillbetheprimaryoutcomeforallpersonsreceivingOCDDserviceswhoareofworkingage.”Overthenextfiveyears,OCDDwillincreasethenumberofpersonsinindividualintegratedemploymentby850,with75inthefirstyear.ByJune30,2012,OCDDwilldevelopacomprehensiveplanforimplementingandexpandingindividualintegratedemploymentinthesecondandsuccessiveyears.ByJune30,2012,OCDDwilldevelopproposedpolicychangestosupportindividualintegratedemployment.


Employment,characterizedastypicaljobswithcompetitivewagesthatarefullyintegratedintheworkforce,willbetheprimaryoutcomeforallpersonsreceivingOCDDserviceswhoareofworkingage.Thiswillbeaccomplishedthroughafive-yearprojectbeginningwithbuildingfoundationforimprovementinstrategicpartnershipsandcollaborationwithstakeholdersandcontinuingthroughsuccessiveyearstoruleandpolicyrevisionsand,finally,tofullstatewidedeploymentofbestpracticesinindividualintegratedemployment.StrategicpartnershipsincludetheEmploymentFirstWorkgroup,LouisianaWorkforceCommission,theMIG,theAllianceforFullParticipationandtheWorkPaysCoalitionaswellasLouisianaprovidersandadvocates.OCDDwillworktodevelopadditionalnewpartnershipsastheprojectprogresses.TechnicalassistanceandguidancefromtheSELNwillcontinuetoensureOCDDisawareofnationalbestpracticesandtrendssurroundingEmploymentFirst.Datawillbecollectedeachyeartomonitorprogress.

ThefirstyearwillbeusedtolayEmploymentFirst’sfoundationandwillincludethedevelopmentofacomprehensiveplanthatwillbeusedtoguideEmploymentFirstimplementation.OCDDwillbuildpartnershipswithapproximatelyfiveprovideragencieswithafocusonsecuringindividualintegratedemploymentfor75peopletofacilitate


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toassistintheallocationofresources.Additionally,twoorthreepeoplecouldnotsharesupportservices,withtheexceptionofcongregatevocationalservices,resultinginhigherperpersoncosts.DHH’sOfficeforCitizenswithDevelopmentalDisabilities(OCDD)obtainedCentersforMedicaidandMedicareServices(CMS)approvaltoamendtheNOWprograminJuly2009toincludeselfdirectiontoprovideparticipantswiththeopportunityforgreatercontrolovertheirservicesandagreateremphasisonsharedsupportstobuildrelationshipswhilereducingone-on-onesupportservices.

ImplementationofaresourceallocationsystemwasmandatedbytheLouisianaLegislaturein2008throughHouseResolution190andSenateResolution180,throughHouseConcurrentResolution142ofthe2009RegularSession,andagainin2010whenAct305wassignedintolaw.Evenbeforethesemandates,DHHrecognizedthatasystemthatmatchesneedandresourcesisnecessaryforthesustainabilityofthehome-andcommunity-basedserviceprograms.In2005,anumberofperformanceindicatorsdemonstratedthatLouisiana’sdevelopmentaldisabilitiesservicessystemwasinneedofmodification,including:

�Over-relianceonone-on-onesupportsincommunity-basedsettings;

�Inequitywithintheservicessystem:Noconnectiontoneeds-basedresourceallocationapproach;

�Highcostofservicesperperson:ApproximatelyoneoutoffourNOWserviceplansincludedannualprior-authorizedcostsinexcessof$100,000;

�Overallfiscaleffortranking4thinthenation:Totalspendingof$763.4million;and

�Morethan10,000peoplewaitingforcommunity-basedserviceswithapproximately4,500individualsreceivinghome-andcommunity-basedwaiverservices.

Beginningin2005,OCDDworkedcloselywithstakeholderstodeveloparesourceallocationsystemthatmergedwithitsoverarchingperson-centeredplanningprinciplesandpractices.Thestateworkedtodevelopadata-drivenmethodologyconsistentwithnationalbestpracticesasaguidetofairand

h Conduct nine regional job fairs in collaboration with advocacy and provider organizations and Louisiana Rehabilitation Services October 2011

h Host forums in each of the five regions and five Human Services Districts November 2011

h Meet goal of having 20 individuals with secured employment December 2011

h Identify an additional 75 individuals for supported employment December 2011

h Meet goal that 27 additional individuals have secured employment March 2012

h Meet goal that 28 additional individuals have secured employment June 2012

h Preliminary draft changes to OCDD policies and procedures to support Employment First June 2012

h Plan for implementation and expansion, including second year pilots, completed and submitted June 2012

Sustainable Home- and Community-Based Supports and ServicesBackground

TheDepartmentisfocusedoncontinuedimplementationandongoingrefinementofastructuredresourceallocationmodeltowardadeliverysystemthatisperson-driven,costeffectiveandsustainable.Theresourceallocationmodelestablishesabalancethatrecognizesfiscalsavings,supportingthesustainabilityofcommunity-basedprograms;acknowledgestheuniquenessofeachrecipientandthechallengesofdevelopingamodelthatcanworkforeveryone;andallowsforflexibilitywhenappropriatewithasystemicreviewprocessandqualitymonitoringsystem.

Louisianaimplementeditsfirstcomprehensivehome-andcommunity-basedservices(HCBS)waiverprogramforindividualswithdevelopmentaldisabilitiesin1992andamendedtheprogramsignificantlytocreatetheNewOpportunitiesWavier(NOW)programin2003.Thewaiverprogramhad,andcontinuestohave,oneofthemostcomprehensiveservicemenusinthenationandcallsforone-on-onesupportservicestofosterindividualizedsupports.Thereimbursementpracticeswerenotbasedontheindividualssupportneeds,andplanswerewrittenwithoutusinganassessmenttool


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providerstoidentifyanddevelopnaturalsupports,communityinclusionandgenericservicesinsteadofjustpaidsupports;

3. Usein-stateadvocacyorganizationstoprovidemoretrainingandassistancetofamilies;

4. Supportindividualswithdevelopmentaldisabilitiesandtheirfamiliesthroughpolicydevelopmentandtrainingthatmeetstheirneedsthroughabetterbalanceofpaidandnaturalsupports;and

5. Developandimplementmoreobjectivecriteriaforexceptionstoresourceallocation.Theinitialcriteriahavebeendevelopedandimplemented;effectivenesswillbeassessedthroughFY2012andcriteriawillberefinedasneeded.

DELIvERABLES h Implement Workgroup focused on family members as paid caregivers to conduct policy analysis and review September 2011

h Complete 10 statewide NOW HCBS waivers self-direction training and informational meetings to all regions, districts and authorities; support coordination agencies, families-helping-families agencies and HCBS waivers recipients/families September 2011

h Complete plan development for capacity-building project, including selecting two initial community provider organizations and one supports and services center September 2011

h Develop and conduct surveys for current NOW and Children’s Choice waiver participants to identify and target individuals and families interested in transferring to self direction September 2011

h Begin implementation of self direction expansion for initial 20-person target group September 2011

h Implement kick off plan with three participating organizations October 2011

h Meet goal of 20 NOW participants using the self-direction option October 2011

h Develop a registry list for HCBS waiver participants requesting the self-direction option November 2011

equitableallocationofresourcesbasedonindividualneeds.ByembeddingtheresourceallocationsystemwithinDHH’sperson-drivenguidelinesforsupportplanningprocess,OCDDismaintainingaresponsive,flexiblesystemthatallowsforuniqueindividualplanningandsupportdifferences.

OCDDbeganimplementationofresourceallocationintheNOWinOctober2009.Sincethen,OCDDhasmanagedtoreducetheaveragecostperwaiverparticipantby$12,000.Thisresultedinaplansavingsof$6millioninFY2010andaprojectedcumulativesavingsofmorethan$44millionbytheendofFY2012.ThesuccessofthisinitiativeisevidencedbyOCDD’sabilitytoexpandparticipationintheNOWprogramby8.3percentwithonlya.48percentexpendituregrowthinFY2011.Theprogram’sexpansionthroughefficiencieshasreducedthewaittimeforservicesbyfouryears.Today,theNOWservesapproximately7,500individualswithdevelopmentaldisabilities.

Goals

OCDDwillincreaseselfdirectionandconsistencyinplanningsupportsandservicesintheNOWprogramwiththreepreciseobjectives:

1. BytheendofFY2012,238additionalpeopleparticipatinginHCBSwaiverswilluseselfdirection;

2. OCDDwillestablishabaselineofsharedandnaturalsupportsintheNOWtoidentifypercentageincreaseforFY2013;and

3. OCDDwillresolveallpendingcasesrequestingexceptionstoresourceallocationbyJune30,2012.


Thekeytosustainabilityisnotsimplycostcontrol,butalsoprovidingmoreeffectiveandefficientsupportsandopportunities.OCDD’sapproachistosupportcontrolofservicesbythepersonandincreasetheabilityofthesystemtomovebeyondsimplyidentifyingandprovidingpaidsupportsthroughthefollowingstrategies.

1. Expandandrefineselfdirectioninwaiverservices;

2. Useexpertassistancetoincreasethecapacityofservicecoordinationandwaiver


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thebaronquality.Today,LouisianahasclosedallbutthreeofitspublicICFs/DDandhasdevelopedstrategiestoassistpeopleintransitioningintothecommunity.In2004,therewere1,615individualsresidinginthestate’snineinstitutions;today,approximately840individualsliveintheremainingthreestate-operatedinstitutions.However,challengesstillremain.

AccordingtoState of the States in Developmental Disabilities: 2011(Braddocketal.,UniversityofColorado,2009data),Louisianaranksasthesixthhigheststateinthenationintermsofoverallspendingforindividualswithdevelopmentaldisabilities.Louisianaspends$7.13per$1,000ofpersonalincomecomparedwiththenationalaverageof$4.34.Louisianaexpendituresforinstitutionsarethethirdhighestinthenation–spending$1.61per$1,000ofpersonalincomeoninstitutionalizationservicescomparedtothenationalaverageof$0.68.

TheUnitedCerebralPalsyrecentlyissuedits2011report,CaseforInclusion,AnAnalysisofMedicaid for Americans with Intellectual and Developmental Disability(Lakin,etal.,UniversityofMinnesota2009data),whichindicatesaneedforincreasedcommunity-basedservicesforpeoplewithdevelopmentaldisabilitiesinLouisiana.AlthoughLouisianahasmadeimprovement,thestatestilllagsbehindthenation.Currently,only60percentofLouisiana’sresidentswithdevelopmentaldisabilitiesreceivehome-andcommunity-basedwaiverservices(HCBS)comparedtothenationalaverageof86percent.Louisiana’shome-andcommunity-basedservicesspendingismorethan20percentagepointslowerthanthenationalaverageof66percent.Thecaseformovementtowardssustainablecommunitylivingoptionsisalsosupportedbythenational“Olmstead”mandateandLouisianaclassactionsuits,suchasChisholmandtheDepartmentofJustice’ssettlementwithDHHoveritslargepublicinstitutions.LouisianaiscloselymonitoringDepartmentofJusticesuitsandsettlementsandotherstates,includingarecentrulinginGeorgiathatmandatesclosureofallstate-runICFs/DDby2015.Courtmandatedsettlementagreementsoftenunderminetheabilityofstatestorebalance

h Meet goal of 40 additional NOW and/or ROW participants using the self-direction option December 2011

h Complete 10 statewide ROW HCBS waiver self-direction training and informational meetings to all regions, districts and authorities, support coordination agencies, families-helping-families agencies & HCBS waivers recipients and families December 2011

h Meet goal of 88 additional NOW and/or ROW participants using the self-direction option March 2012

h Meet goal of 90 additional NOW and/or ROW participants using the self-direction option June 2012

h Develop and complete 18 training opportunities and educational materials for 400 individuals, including individuals with developmental disabilities, their families and direct support staff June 2012

h Complete determination on all requests for exceptions to resource allocation under consideration June 2012

h Assess year one, plan for continued assistance to original pilot organizations in year two and expansion of infrastructure and the number of participating organizations June 2012

Systems Rebalancing for People with Developmental DisabilitiesBackground

Nationally,thepredominantresidentialservicesettingforpeoplewithdevelopmentaldisabilitieshasshiftedfromlargefacilitiestocommunity-basedlivingoptions.Additionally,Louisianahasadisproportionatelyhighnumberoflargeandsmallinstitutionalfacilities(IntermediateCareFacilitiesforPeoplewithDevelopmentalDisabilities–ICFs/DD)thatarepubliclyorprivatelyownedand/oroperated.Louisianaalsolagsfarbehindtherestofthenationintermsofpromotingcommunity-basedsupportsandservicesasanalternative.Asaresult,Louisiana’scostsfordevelopmentaldisabilitiesservicestendtobehigherthanmoststates.

In2004,Louisianawasoneofonly12statesthathadnotclosedapublicICF/DDandbegantheprocessofredesigningitslong-termcaresystemtoonethatofferedchoice,managedcostsandraised


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developmentaldisabilitiessystemthroughspecifictargetgroupsbyconvertingprivateICFs/DDintosharedlivingwaiverhomes.Thiswillprovidecommunityalternativestoindividualsincrisiswhoseonlychoiceisinstitutionalization.

OCDD’srebalancingsolutionsadvancethegoalofsystemsrebalancingby:

1. Developingaplanofactiontoincreaseinternalcapacityandexternalcommunitypartnersupporttomovetheperson-centeredsystemapproachtoalargerscale;

2. Usingexpertconsultationtosupportclosure/downsizingeffortstobridgeremainingknowledgegaps;improvepractice;andenhanceapplicationofperson-centeredprinciplesthatproducepositiveoutcomesforpeopletransitioningfrominstitutions;

3. Providingmoreflexibleandspecializedcommunity-basedservicealternatestoinstitutionalization;and

4. ConvertingprivateICF/DDcommunityhomesintocommunity-basedwaiveropportunities,assuringthatcommunityfundinglevelscannotexceedinstitutionalonesandmatchingservicestoindividualneedsthroughnationallyrecognizedassessmenttools.

DELIvERABLES h Complete plan development for capacity-building project, including selection of initial organizations September 2011

h Begin plan implementation with participating organizations and identified internal and external staff October 2011

h Train and support trainees and organizations during implementation October 2011

h Assess phase one and plan for second year implementation and expansion December 2011

h Identify referral sources and geographic area of requests for institutionalization due to behavioral issues September 2011

h Form stakeholder workgroup to assess causes and options October 2011

h Complete scope of problem assessment December 2011

thesysteminamannerthatisflexibleandmakessensefortheindividualssupportedthroughthedeliverysystem.

Goal

OCDD’slong-termgoalistorebalancetheintellectualanddevelopmentaldisabilitiesservicesystemoverfiveyearsby:

1. IncreasingthenumberofindividualswithdevelopmentaldisabilitiesreceivingsupportsthroughHCBSwaiverstothenationalaverageof86percent.InFY2012,OCDDwillincreasethenumberofindividualsservedinHCBSwaiversfrom10,352to11,659;and

2. IncreasingthepercentageofresourcesdirectedtoHCBSfrom45percenttothenationalaverageof66percent.InFY2012,HCBSspendingsharewillincreaseto51percent.


ThroughoutFY2012,LouisianawillcontinueitseffortstodownsizeitspublicICFs/DD.OCDDhasassessedallresidentsofthesefacilitiesusingtheSupportsIntensityScale/LouisianaPlus(SIS/LAPlus)needs-basedassessmentinstruments.Asaresultoftheseassessments,OCDDissystemicallyofferingcommunitywaiveropportunitiestogroupsofresidentsprogressingfromthoseassessedwiththelowestoverallneedsandsupportstoassistwithactivitiesofdailyliving;thoserequiringhigherlevels;andsomewithminormedicalneedsand/orchallengingbehaviors.OCDDwillofferachoiceoftransitioningintocommunitylivingusingtheNewOpportunitiesWaiver(NOW)toallofitspublicICFs/DDresidents.

Inaddition,inFY2012OCDDwillcontinueimplementationofitsnewResidentialOptionsWaiver(ROW).TheROWallowsthefundingtofollowthepersoninsteadofbeingtiedtotheproviderandoffersnew,innovativeresidentialmodelsandadditionalwaiverservices,longrequestedbystakeholders(i.e.,occupationaltherapy,physicaltherapy,speechtherapyanddentalservices).Thiswaiverwasdesignedtobeaflexible,costeffectivealternativetotheNOW,andwillaideffortstorebalanceLouisiana’s


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Additionally,regardlessofwhereservicesweredelivered,thefiscalimpactandtheanticipatedgrowthinlong-termcareneededtobeaddressedtoreduceserviceduplication,managecosts,simplifyaccessandreducetheadministrativeburdenforproviders.

Overthelastseveralyears,DHHhasworkedtoaddressthegoalsandobjectivesoutlinedinLouisiana’s Plan for Immediate Action,including12areasoffocus,suchasqualitymanagementandlicensing.In2007,DHHpublishedLouisiana’s Plan for Choice in Long-Term Care:Comprehensive Long-Term Care Reform Planthatoutlinedprogresstowardthegoalsofthe2005plan.Theplancalledforthedevelopmentandimplementationofaqualitymanagementsystemconsistentwiththestate’stransformationofitslong-termservicesystemforadultswithdisabilities,eldersandindividualswithdevelopmentaldisabilities.DHHlauncheditsqualitymanagementsystemin2008withongoinganalysistorefinestrategiesandprocedures.Theplan’sactionstepsalsoincludedtheconsolidationoflicensingforallMedicaid-reimbursedlong-termcareservicesintoonelicensingrule.Thevariousprogramshadconflictingregulationsthatmadeoperatingandmonitoringhome-andcommunity-basedservices(HCBS)cumbersomeanddifficultforproviderstocomply.Aworkgroupwasconvenedandhasworkedforthepastfewyearstocreateamulti-servicelicensingrulethatwouldstreamlineregulations,assurecompliancewithfederalandstatestatutoryrequirementsandsupportthevision,valuesandguidingprinciplesforLouisiana’slong-termcareservicessystem.AnemergencyrulewaspublishedintheJune2011Louisiana RegistryandthepublichearingwasheldonJuly27,2011.DHHisreviewingpubliccommentsandreconvenetheworkgrouptofinalizethelicensingrule.

Ashome-andcommunity-basedservicesandprogramshavegrown,thesystemhasbecomemorecomplexwithadministrativeburdensthatareoftenfocusedonprocesscomplianceratherthanoutcomes.Additionally,programgrowthhasoutpacedupdatestotheinfrastructure,suchasprogrammaticpolicesthatareconflictingoroutdatedaswellasantiquatedtechnology.This

h Complete and submit proposed action plan to address community support and diversion for people with behavioral issues currently referred for institutionalization February 2012

h Recruit and certify at least one host home per region as a residential alternative to institutionalization for children January 2012

h Establish stakeholder workgroup to address ICF/DD conversion including reasons for underuse of the ROW, incentives to convert and changes needed to promote conversion September 2011

h Release proposed workgroup recommendations and plans for increasing conversion of ICF/DD services to community supports January 2012

Strengthening the Home- and Community-Based Infrastructure Background

Overthepastdecade,Louisianahasexperiencedasignificantincreaseinthenumberofresidentsinneedoflong-termcarereceivingservicesinhome-andcommunity-basedprogramsratherthaninstitutionalsettings.Theshifttothedeliveryofhome-andcommunity-basedservicesbeganinthe1960s,wellbeforethepassageoftheAmericanswithDisabilitiesAct(ADA)in1990.TitleIIregulationoftheADArequirespublicentitiestoprovideservicesinthemostintegratedsettingappropriatetotheneedsoftheindividualwithadisability.Nineyearslater,theU.S.SupremeCourtfoundthatunnecessaryinstitutionalizationcouldbeaformofdiscriminationundertheADA.

In2005,DHHpublishedLouisiana’s Plan for Immediate Action:Long-Term Care Choices for the Elderly and People with Disabilities,whichincludedintegralinputandfeedbackfromadiversegroupofstatewidestakeholders.Louisianathenembarkedonfundamentalchangestothedeliverysystemthatwouldbeeffectiveincontrollingcostsoflong-termcarewhileensuringqualityservicesresponsivetoindividuals’needsandpreferences.Thestatehaslongrecognizedthesystemneededtoberebalancedbasedonthedemandsforhome-andcommunity-basedservicefromtheelderly,adultswithdisabilitiesandindividualswithintellectualanddevelopmentaldisabilitiesandtheirfamilies.


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plantostrengthenthehome-andcommunity-basedinfrastructureisexpectedtoproposechangesinrules,policiesandstandardsforperformancetomakesystemicchangestoimprovethedeliverysystem’squalityandaccountability.

DELIvERABLES h Develop and convene a steering committee comprised of internal and external stakeholders to develop a comprehensive plan August 2011

h Develop and convene sub-committees comprised of stakeholders to address plan components outlined in Act 299 September 2011

h Identify issues and solutions based on sub-committee input, projects plans and steering committee feedback October 2011

h Collaborate across DHH program offices and bureaus that administer, fund, operate and/or regulate HCBS through monthly meetings August 2011-June 2012

h Develop a comprehensive plan as outlined in Act 299 including any additional issues and solutions identified by the steering committee and/or sub-committees January 2012

h Submit report to the House and Senate Committees on Health and Welfare January 2012

h Finalize HCBS licensing rule January 2012

h Repeal conflicting rules and regulations January 2012

h Finalize implementation of all phases of comprehensive plan June 2012

managing Smarter for Better PerformanceLouisiana Electronic Event Registration System (LEERS)

Background

LEERSisamulti-yearendeavortore-engineertheissuanceandregistrationprocessesofLouisianaVitalRecords.Thisnewelectronicweb-basedsystemreplacestheinefficientandoutdatedDOS-basedsystemthatreliesonpapervitaleventrecords.LEERSwillstreamlinetheregistrationofvitaleventrecordswhileimprovingdataqualityandthetimelinessthatvitaleventdataiscollectedandaccessible.

hashamperedtheabilitytoassistgoodprovidersinmeetinglicensingregulationsandperformancestandards.Conversely,thesystemhasexperiencedincreasingchallengesassociatedwithmitigatingfraud,wasteandabuse.

Recentimprovementshavefocusedonprogrammaticissuesassociatedwithcosteffectiveness.Thoseeffortshavebeensuccessfulinmanyareasandhavesignificantlyloweredperpersonspendingresultingintheexpansionofpeopleservedwithminimalincreasesinoverallspendingonhomeandcommunitybasedservices.Forexample,theNewOpportunitiesWavier(NOW)programgrewby8.3percentlastyearwithaspendingincreaseoflessthanahalfpercent.

Finally,therecentdownturnintheeconomyhasheightenedDHH’sawarenessanditsstakeholderstothefactthateveryonemustworksmartertomaximizelimitedresourcesandenforceaccountability.Discussionswithprovidershaveidentifiedareasthatmustbeaddressedtomakenecessaryimprovements;thiswarrantsacomprehensivereviewofinfrastructureissues,identificationofsolutionsleadingtoplandevelopmentandimplementation.Act299ofthe2011LouisianaLegislativeSessionbuildsondiscussionsthattheDepartmentandstakeholdershavehadtostrengthenthehome-andcommunity-basedinfrastructure.

Goal

Overthenextthreeyears,theOfficeofAgingandAdultServicesandtheOfficeforCitizenswithDevelopmentalDisabilitieswillimprovecapacity,qualityandaccountabilityofhome-andcommunity-basedserviceinfrastructuretopreservetheservicedeliverysystem.ByJanuary1,2012,DHHwilldevelopacomprehensiveplantodosoasoutlinedinAct299ofthe2011RegularSessionoftheLouisianaLegislativeSession.


OverthecourseofFY2012,DHHwillengageadiversegroupofinternalandexternalstakeholderstoprovideinputandfeedbackonsystemicissuesandsolutions.Thiswillinvolveworkingacrossdepartmentalofficesthatadminister,fund,operateand/orregulateHCBS.Thefinalcomprehensive


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thenewLEERSmodules,VitalRecordsstaffwillconducttrainingswithphysiciansandvitalrecordprofessionals(e.g.funeralhomedirectors,clerksofcourt,hospitals,etc.)throughoutthestatebefore,duringandafterinitialimplementation.

Thefollowingstrategieswillsupportthegoalofprovidingaccesstovitalrecordsinformationinatimely,efficientandaccuratemanner.

LEERS Annual Software Upgrade:TheupgradeforthebirthmoduleandSAMmoduleswillprovideinternalandexternaluserswithseveralenhancementstoimproveefficiencyandallowforincreasedproductivity.Theupdatewillalsoaddressissuesthathavebeenreportedfromend-users.

Induced Termination of Pregnancy (ITOP), Divorce, Fetal Death and Marriage Modules:TheadditionofthesevitaleventmoduleswillfacilitatethereportingandregistrationoftheseeventsinLouisiana.Currently,eachofthesemodulesismanualandlaborintensive.Theimplementationofthesemoduleswillallowforelectronicregistrationofthesevitaleventrecords,whichwilldecreasetheamountoftimeittakesforVitalRecordstoreceivethedata.Inaddition,thestandardvalidationsrequiredwithinthemoduleswillgreatlyimprovethequalityofdatareceivedanddisseminatedthroughdatarequestsforresearch,publichealthandhealthpolicypurposes.

Death Module:TheimplementationoftheLEERSdeathmodulewilldramaticallychangethewaydeathrecordsareregisteredinLouisiana.Thecurrentdeathregistrationprocessismanualandinvolvestherecordbeingphysicallymovedthroughvariousfacilities.Thisprocessrequirescoordinationbetweenthefamilyofthedeceased,funeralhomedirectors,thephysician/coronerandtheparishhealthunits.Thisprocesscurrentlytakes4to5monthsfromoriginationtoregistration.Ifthereisaproblemormistakewiththerecord,itmustbereturnedtotheparishhealthunitforthefuneralhomeorphysician/coronertocompletetherecordcorrectly,lengtheningtheprocess.

Byusinganelectronicregistrationsystem,deathrecordscanbeelectronicallysignedandregisteredwithVitalRecords.Weanticipatethatimplementationofthedeathmodulewill

TheLEERSBirthModulewentliveinDecember2010andtheSalesandManagement(SAM)ModulewentliveinJanuary2011.Sinceimplementingthesemodules,thefollowingimprovementshavebeenrealized:

�Reductionintheamountoftimebetweenbirthandregistrationfromanaverageof72daysto17days;

�Reductionintheamountoftimebetweenbirthregistrationandmailingofthecomplimentarybirthcertificatefrom60daystolessthan3days;and

�Improveddataqualitythroughuseofbuilt-invalidationsthatensuremandatoryfieldsarecompleteandthatdatabeyondnormalrangesisverifiedbytheuser.

Louisianae-Certs(LEC)isaweb-basedcustomerserviceinterfaceforLEERS.ThissystemwillfurtherstreamlineaccesstovitaleventrecordsandimprovecustomerservicebyallowingthepublictorequestcertifiedcopiesofvitaleventrecordsonlinedirectlyfromVitalRecords.

Goals

LEERSwillprovidevitalrecordsinformationtothecitizensandotherstakeholderstimely,efficientlyandaccurately.GoalsforFY2012include:

�CompletetheannualsoftwareupgradeinJuly2011;

�ImplementthefiveremainingLEERSVitalEventmodulesbytheendofFY2012toprovidealldatamoretimelyandimprovedataquality;and

�CompletethebusinessplantoinitiateLouisianae-Certs(LEC)bytheendofFY2012.


FiveadditionalLEERSvitaleventmoduleswillbeimplementedinFY2012.Thesemodulesincludeinducedterminationofpregnancy(ITOP),divorce,marriage,deathandfetaldeath.ImplementationofthesemodulesrequiresthoroughtestingbyVitalRecordsstaffandexternalusers,aswellascontinuoussupportfromfieldrepresentatives.Tocreateawarenessandpromotethebenefitsof


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DELIvERABLES h Conduct LEERS annual software update July 2011

h Implement ITOP Module August 2011

h Implement Divorce Module September 2011

h Implement Marriage Module November 2011

h Implement Fetal Death Module June 2012

h Collect baseline data on the current death registration process October 2011

h Implement Death Module - 402 funeral homes will use the LEERS and all physicians will have the ability to use LEERS for registering deaths March 2012

h Collect data on the death registration process after the LEERS Death Module implementation to evaluate process improvements June 2012

h Complete birth certificate additions for Birth Outcomes Initiatives March 2012

h Complete the Louisiana e-Certs (LEC) Business Plan preparations for development June 2012

Louisiana’s Disaster Data Collection System for Health Care facilities- EmSTATBackground

In2008,HurricanesGustavandIkehighlightedtheDepartment’sneedforadditionalvisibilityintothereal-timestatusandoperationalcapabilitiesofcriticalhealthcarefacilitiesduringandafteremergencyevents.Inresponse,emergencyruleswerepromulgatedthatrequiredhospitalsandnursinghomestoreporttheirstatus,buttheexistingsystemsdidnothavethecapabilitytocapturethedataDHHrequired,andwereultimatelyunsuccessful.However,afterthehurricanesof2008,DHH’sEmergencyPreparednessSectionledamajorinitiativetodevelopanddeploycoresystemsdesignedtocapturecriticalstatusinformationandtosupportcriticaloperations,includingafacilitystatusreportingsystem.Thisworkinggroupdevelopedthebusinessrequirementsforsuchasystemandevaluatedthealternativesthatcouldbeimplementedforthe2009hurricaneseason.

Afteradetailedreviewofexistingandpotentialresources,DHHmovedforwardwiththeadaptationandexpansionofacurrentfacilityreporting

significantlyshortenprocessingtime;reduceerrors;provideresearchersandpolicymakerswithricherdata;andallowreal-timedatasharingsothatpublicassistancecanbestoppedandvoterregistrationrollsupdatedinatimelymanner.

Inaddition,theLEERSdeathmodulewillallowburialtransitpermitstoberequestedandissuedthroughLEERStoafuneralhome24/7.Aburialtransitpermitisneededbeforetheremainsofadeceasedpersoncanbeburied,crematedorremovedfromthestate.Currently,deputylocalregistrarsinparishhealthunitsissueburialtransitpermitsduringofficehoursandsomeparishhealthunitshavecontractswithspecialagentsforissuanceofburialtransitpermitsafterhoursandonweekends.

PriortoimplementingtheLEERSdeathmodule,currentbaselinedatawillbecollectedonthelengthoftimeittakestoregisteradeathrecord;thenumberofdeathrecordsreturnedtofuneralhomesduetoerrors;andthelengthoftimeittakestoreportthedeathtootheragencies.ThesamedatawillbecollectedafterthedeathmoduleisimplementedtoevaluatetheimprovementsgainedbyimplementingLEERS.

Data Collection for Birth Outcomes Initiative:ChangesarebeingplannedtocollectadditionalstatisticaldataonLouisiananewbornswithagestationunder39weeks.ThegoalofcollectingthisadditionaldataistobetterinformpolicydecisionsaimedatimprovingLouisiana’spoorbirthoutcomes.

Louisiana e-Certs (LEC):Currently,customerscanordercertificatesonlinethroughathird-partyintermediarythatchargesfeestocustomers.Louisianae-Certs(LEC)isaweb-basedcustomerserviceinterfaceforLEERSthatwillallowthepublictorequestcertifiedcopiesofvitaleventsdirectlyfromVitalRecordsatanominalcost(births,deaths,fetaldeathsandOrleansParishmarriagerecords).ThisservicewillbeintegratedwiththeLEERSSAMmoduletostreamlinerequestprocessingandtheissuanceofcertifiedcopies.BusinessrequirementswillbedraftedtosolidifytheexpectationsandresourcesnecessaryforthisprojectbytheendofFY2012,andabusinessplanwillbecompletedtomoveforwardwiththisservice.


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troubleshooting.Thismovewilloccurbetweenthe2011and2012hurricaneseasons.

DHHwillexpandtheuseofthecoreEMSTATdatabasetoservedatatootherapplications,avoiding“siloed”databasesandduplicatedataentry.Thisincludesdeploymentofothermodulesthatwillprovideenhancedapplicationsecurityanduseraccountmanagement,messagingandincidentmanagementfunctionssurveymanagementfunctions,andresourcemonitoringfunctions.AllwillusetheEMSTATdatabaseasthecoresystemforfacilityandcontactinformation.

Finally,EMSTATwillbeusedasthefeedersystemtothefederalHAvBEDsystemthroughanXML-basedintegration.Thiswillallowstafftodiscontinuetheuseofanexpensivethird-partysystemgoingforward,providingsavingsthatcanbeusedtosupporttheemergencymanagementinformationmanagementfunction.

DELIvERABLES h Migrate EMSTAT to DHH IT Infrastructure December 2011

h Establish a regular database review process December 2011

h Connect all emergency management modules to EMSTAT November 2011

h Deploy a GIS tool connected to EMSTAT data November 2011

h Deploy an XML transformation tool to link to federal systems November 2011

h Conduct at least two successful data transfer tests with federal systems May 2012

Combatting fraud and Abuse Background

TheDepartmentiscommittedtoadministeringtheMedicaidprogramwithintegrityand,asstewardsofpublicdollars,willnottoleratefraudulentorabusivebehavior.Incalendaryear2010,LouisianaMedicaidhad11,362providerswhowerepaid$600ormore,andwerethereforeissuedfederal1099forms.PerdatasuppliedbyDHH’sfiscalintermediary,therewasatotalof98,963,399claimssubmitted,resultingintotalMedicaidpaymentsofmorethan$5.5billionoverthesametimeframe.Themajority

systemhousedwithinDHH’sHealthStandardsSectionapplication.ThisapplicationwasrenamedEMSTATandtheinitialversionwasdeployedbyJune1,2009.ThecontinueddevelopmentandenhancementofEMSTATisrequiredtoachievearobustdatabasethatcanserveastheinformationhubforavarietyofotheremergencymanagementmodulesandsystemsthroughoutDHH.

AsthefirstversionofEMSTATwasaMedicaid(BHSF)application,theentireemergencymanagementtechnologyinfrastructurehascontinuedtobesupportedontheMedicaiddomain.ThosefunctionswillbetransferredtothemainDHHITtechnologyinfrastructurebetweenthecloseofthe2011hurricaneseasonandtheonsetofthe2012hurricaneseason.

Goal

EMSTAT’sgoalistoprovidecontinuousaccesstotheapplicationbyalllicensedhospitalsandnursinghomesinthestate.StrategicuseofEMSTATwillhelpDHHavoid“siloed”databasesbyusingthecoreEMSTATdatabaseastheinformationhubforotherkeyemergencymanagementapplicationsandreportingtoolsthroughoutDHH.Moreover,DHHwilluseEMSTATastheprimaryautomatedreportingtoolforthefederalHAvBEDsystem.


LouisianawillcontinuetoenhanceEMSTAT,aweb-basedfacilitystatusreportingapplicationthatincorporatescensusreportingandbedavailabilityfeatures.EMSTATcurrentlyincorporatestrackingoffacilitygeneratorsandpowerstatus;overalloperating,evacuationandfuelstatus;anddetailedcensusdataandfacilitycontactinformation.Thisconstellationofdatagatheredreal-timeduringaneventhasallowedforthedevelopmentofpowerfulsimulationtoolsthatcanforecastcriticalfacilityneedsduringanevent.

TheoperationalconceptforthisyearistobothcontinuetoprovideaccesstoEMSTATwhileplanningforfutureinfrastructureimprovements.ThemajorinfrastructurechangewillbeamovefromtheMedicaidtechnologyinfrastructuretothemainDHHinfrastructure.Thiswillinvolvedetailedplanningforissuessuchasdisasterrecoveryanddatabackup,serveravailabilityand


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Goal

Throughanaggressiverealignmentofit’sfraudandabusesystem,DHHhopestosignificantlyincreasecostavoidanceandrecoveries.DHHseekstoachieveprogramsavingsthroughdenialofimproperclaimspriortopaymentratherthanidentifyingsuchclaimsafterpaymenthasbeenmade.

Thisenhancedpre-paymentreviewprocesswillcomplementthecurrentfront-endclaimsprocessesDHHcurrentlyusestoreduceimproperandwillfurtherassistinidentifyingareasthatrequirestrengtheningofpolicyandadditionalsystemediting.ProgramIntegrityhasestablishedarecoverygoalof$12milliontobeattainedthroughthepre-payment(costavoidance)andpost-paymentreviewstructuresforFY2012.


ProgramIntegritywillimplementapre-paymentreviewprocessthroughDHH’scurrentcontractors,whereclaimswillbeadjudicatedandsubsequentlypendedforfurtherreviewpriortopayment.Aspartofthisprocess,ProgramIntegritywillbeusingClaimChecktohelpdeterminewhichclaimsgointopendstatus.ClaimCheckisaversatiletoolthatcanbemodifiedtolookfortrendsorpatternsindicativeoffraudand/orabuse.

AsDHH’smoveforwardwiththeimplementationofthisprocess,agradualtransitiontoanewpaymentschedule,willminimizethefinancialimpactontheprovidercommunity.ThiswillalsoalignwiththeCCNpromptpaymentprovisions.

DHH,pursuanttoAffordableCareActrequirements,willreleaseaRequestforProposalsforoneormorerecoveryauditcontractors.Chosenrecoveryauditcontractorswillconductdataminingandpost-paymentreviewonacontingencyfeebasis.ThisshouldleadtoincreasedrecoveriesbasedonfraudandabusewithoutanincreaseincosttoDHH.Inadditiontotheserecoveryauditcontractor’sefforts,ProgramIntegritywillcontinuetoconductitsownpost-paymentreviewofsuspiciousclaimsactivity.

DHHwillaggressivelyauditandpursuecollectionsfromprovidersguiltyoffraudand/orabuse.Asaresultofpriorauditsinthearea

oftheseprovidersdeliverhighqualityservicesanddonotperpetratefraudorabusethesystemviaoverutilizationandotherwastefulpractices.However,DHHhastakenstepstoenhanceourabilitytodetectandrootoutthefraudulentandwastefulbehaviorthatdoesoccurandwillcontinuetodosointoFY2012.

LouisianaMedicaid’sprogramintegrityfunctioncurrentlyconductsreviewofMedicaidclaimsbothonthefront-end,beforetheclaimispaid,aswellasinpost-paymentreview.Pre-payfunctionsincludesystemeditsthatautomaticallydetectvariationsinclaimsthatsignalfraudulentactivity,hospitaladmissionandlengthofstayreview;andapprovalbasedonnationallyrecognizedInterqualcriteria,radiologyutilizationmanagement(RUM);andotherpre-certificationandpriorauthorizationfunctions.Unfortunately,toooftenstaffisforcedtoplaythe“payandchase”gamebyfrauddetectionandrecoupmentafterthepaymentismade.Thesefunctionsincludesomelimiteddata-mining,investigatingcomplaintsthroughthefraudhotlineandotherinvestigationsbasedonstaffanalysisofclaimhistories.Also,morethan10percentofactiveprovidersareauditedannually,resultinginavarietyofactionsrangingfromeducationtoexclusionfromtheMedicaidprogram.ThecurrentreviewstructurealsoallowsforacloseworkingrelationshipwiththeAttorneyGeneral’sMedicaidFraudControlUnit,withwhomcaseissuesarediscussedonamonthlybasis.InFY2011alone,20percentofcaseclosuresresultedinareferraltotheMedicaidFraudControlUnit.

Thebelowchartshowstheamountofdollarsidentifiedandrecoveredthroughthecurrentreviewstructureforthepastfivestatefiscalyears.SinceFY2007,therehasbeenanearly500percentimprovementintheamountofdollarsrecovered.

State Fiscal Year Dollar Amounts

Time From Time To Dollars Identified Dollars Recovered

07/01/06 06/30/07 $1,429,648 $1,423,51707/01/07 06/30/08 $2,082,062 $2,074,80407/01/08 06/30/09 $6,240,578 $5,856,65907/01/09 06/30/10 $5,632,691 $4,466,30307/01/10 06/30/11 $8,793,220 $8,456,744


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practices;crosscontamination;foodcontactequipment,utensilconstructionandsanitization;toxicchemicals;waterandsewage;andinsects,rodentsandanimals.Theninenon-criticalviolationsincludelabeling;foodprotection;utensils,equipmentandsingleservice;personnel,clothesandhairrestraints;toiletsandhandwashingfacilities;garbageandrefusedisposal;structural,design,maintenanceandplumbing;permits,plansandfoodsafetycertificates;andmiscellaneous(linen,wipingcloths,maintenanceequipment,laundryfacilitiesandwaterpressure).

Sanitariansuseanelectronicinspectionprogramtoconductinspections.Theprogramprovidesadropdownselectionbuttonineachcategorythatallowsthesanitariantoimmediatelyidentifythespecificapplicablecodereferenceandstatementforeachviolation.Theinformationcanthenbeprintedandprovidedtotheretailfoodestablishmentatthetimeoftheinspection.

Goals

Louisianawillseeareductioninthenumberofrestaurant-attributablefoodbornediseaseoutbreaksthroughthreemeasurablegoals:

�Onlineavailabilityofretailfoodestablishmentinspectionsthatarecompletedeachmonthwithinoneweekoftheinspection;

�Reductioninthenumberofretailfoodestablishmentcomplaintsfrom1,653(FY2011)to1,488inFY2012(a10percentreduction);and

�Decreaseinthenumberofretailfoodestablishmentre-inspectionsfrom5,688(FY2011)to5,119inFY2012(a10percentreduction).


ThepublichasaccesstoLouisianaretailfoodestablishmentinspectionsatwww.eatsafe.la.gov.LinksareprovidedonthecurrentDHHwebsiteaswellastheRetailFoodProgramsite,andDHHisworkingwithnewandtraditionallocalmediatomaximizepublicawareness.

EatSafeLouisianawentliveinAugustof2011.Whenavailable,uptothreeofthemostrecentinspectionreportsforeachestablishment

ofhome-andcommunity-basedservices,DHHhassentnoticesofoverpaymentstonumerousproviderstotalingapproximately$4.2million.ProgramIntegritywillinterfacecloselywithDHH’slegalstafftoensuremaximumrecoveriesviacollectionsuitsandliens,ifnecessary.

DHHwillalsobeimplementingaprojectwithLexisNexis,aspartoftheDepartment’seffortstoimprovetheintegrityofhome-andcommunity-basedservices.Theproject’spurposeistomakesystemicchangesrelatedtothefindingsoftheauditsconductedbytheauditcontractor.LexisNexiswillscreenallproviderswhorenderlong-termcare,personalcareattendanceandsupervisedindependentlivingservicesandwillprovideaproviderrankedbatchanalysischeckedagainstnumerousstateandnationaldatabasesthatindicatepotentialriskoffraud.

DELIvERABLES h Implementation of Prepayment Review Initiative December 2011

h Lexis Nexis batch analysis completion December 2011

h Recovery audit contractor implementation February 2012

h Payment calendar transition completion July 2011-June 2012

Eat Safe LouisianaBackground

Thereareapproximately34,000retailfoodestablishmentsinthestateofLouisiana.DHH’sOfficeofPublicHealth(OPH)sanitariansconducta300-pointinspectionforeachoftheseestablishments.Inthepast,inspectionresultshavenotbeenreadilyaccessibletothepublic.

TheinspectionprocessisanevaluationoftherequirementsaddressedinTitle51,PublicHealthSanitaryCode,PartXXIIIandRetailFoodEstablishments.Thereare17categoriesonwhicharetailfoodestablishmentisevaluated.Violationsineightofthesecategoriesareconsideredcriticalandtheremainingninecategoriesareconsiderednon-criticalviolations.Theeightcriticalviolationsincludefoodcondition,sourceandlabeling;foodtimeandtemperature;employeehealthand


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constructedandoperatedindependentlyforthedepartmentofficesandbureaus.Forexample,thecasemanagemententerpriseportfoliohas109distinctapplicationsprovidingfunctionalitythatisduplicatedmultipletimesover.Bytoday’sITstandardsandbestpractices,DHH’soperationsareinefficientandarchitecturallyflawedwhenviewedfromanenterprise-wideperspective.

Evenmorechallengingaretheinherentbarriersfacedbydecisionmakersandproviderswhichareinstitutionalizedintothecurrentarchitectures.IfamoreintegratedITarchitecturereplacedwhatisinplacetodaytherewouldbeamorecohesivedatalinkagethatwouldfacilitateamorethoroughandcomprehensiveanalysisofavailabledataandamorestructuredandinformedviewoftheactualimpactonhealthoutcomes.

Avarietyoffactorshavecontributedovertimetothecreationofthisduplicative,inefficient,andless-effectiveportfolioofsystems.Variability,timingandregulationsofavailablefundingfosteredasiloedapproachthathasledtotheimplementationofsystemsthatmeetnarrowprogramobjectives.

Historically,ITprojectshavefollowedfederalandstatefundingstreamswithverylittlecoordinationacrosstheDepartmentwhichwouldleveragecommontechnologyassetsandresources.Also,asnewsystemswereproposed,nomechanismexistedthatwouldrecommendcosteffectivealternativesthatleveragedexistingfunctionalitytobettershareandintegratedatawhilecontainingcost.

�Goodbusinesspracticesatalllevelsdemandthatfundsbedeployedtoexpandinnovativetechnologysolutionsinthemostcosteffectivemannerbyapplying“bestpractices”inarchitecturalandimplementationdesign.

�Itisalsoimportanttobepro-activeatmeasuringthepositiveROIreturnforeachITinvestmentwhichwouldinfluencethedecisionmakingprocesstoeitherbuildornot-build.

Fortunately,thistransformationalfocusofferstheDepartmentawidearrayofopportunitiestodevelopnewdecisionmakingcriteriaandstreamlinedeliveryprocesses,allofwhichareintendedtoachievebetteroutcomes.

areprovidedforpublicaccess.Allretailfoodestablishmentinspectionswillbeuploadedwithinsevendaysoftheinspectionbeingcompleted.Inadditiontoinspectiondata,thesitealsocontainsinformationtoeducatethepubliconfoodsafety(commercialandresidential),emergency/disasterfoodandwatersafetyandotherusefulinformation.ThewebsitealsoallowsconsumerstocontactDHHtoissueacomplaintorcommentaboutrestaurantsanitaryconditions.

Animprovementinfoodsafetyandsanitaryconditionsinretailfoodestablishmentswillbemeasuredbyareductioninthenumberoffood-relatedcomplaintsDHHreceivesandthenumberofre-inspectionsrequiredduetouncorrectedviolations.Thiswillbemeasuredandmonitoredonaquarterlybasis.Increasedtransparencyofretailfoodinspectionsisexpectedtodecreasebothofthesemeasuresprogressivelyoveraone-yearperiod.

DELIvERABLES h Website “Go Live” August 2011

h Explore the utility and viability of mapping restaurant inspections results and making available for the public October 2011

h Collect data on the number of complaints generated. A decrease from 1,653 to 1,488 (10 percent) is expected by the end of 4th quarter. June 2012

h Collect data on the number of re-inspections required. A decrease from 5,688 to 5,119 (10 percent) is expected by the end of 4th quarter. June 2012

DHH Information TechnologyBackground

TheDepartment’smyriadtechnologyproductsandprocessesruneverythingfromcasemanagementandcompliancetosecurityandtrainingfunctions.Indeed,thecurrentITportfolioiscomprisedof236applicationsoperatinginavirtualserverenvironmentconfiguredwith300virtualserverssupportedby225physicalunits.Aparallelenvironmentof185virtualserverssupportedby120physicalserversisalsoconfiguredtosupportMedicaid.Almostallofthecurrentinventoryofapplicationsandserversaredesignedtoprovidecomparablefunctionality,yet


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DepartmentofChildandFamilyServices(DCFS),andUniversityofNewOrleans(UNO).

DELIvERABLES h Provide an analysis document of

�as-isITinventoryandplannedprocurement,

�as-ishumanresourceorganizationandalignment,and

�as-isandplannedITbudgetingandexpendituresAugust 2011

h Identify and create a department-wide Information Technology Core Team (Steering Committee) to establish core IT Governance. October 2011

h Collaborate with DHH CIO and Medicaid IT Director (via UNO) to build IT personnel resourcing strategy October 2011

h Develop and complete future state architectural vision and associated document frameworks document with DHH CIO or other IT architect resource October 2011

h Collaborate on DHH IT Strategic Plan and Year 1–3 tactical plans (People, Process, Financial, Information and Technology August 2011

h Refine Draft DHH IT Strategy with Department leaders, including assistant secretaries, bureau and division directors September 2011

h Finalize and submit DHH IT Strategic Plan. Complete working delivery/project plans for Year 1 tactical plan, including the funding, resource re-allocation and financial business case October 2011

h Refine and obtain agreement, consensus and commitment on the DHH IT Strategic Plan and details of the Year 1 Transition/Tactical plan November 2011

h Initiate Phase 1 of transition/tactical plans December 2011

h Launch Technical and Financial Implementation Phase of DHH IT Strategy to focus on:

�Technical Infrastructure Design

�Foundational Architectural Platforms

�Applications and Tools January 2012

Goals

TransitionDHHtechnologyarchitectureandservicedeliverytoaconsolidatedenterprise-widemodelinordertoaccomplishthefollowing;

�eliminationofduplicativesystems,processesandorganizationswhicharenotcurrentlyoperatinginthemostcohesivemanner;

�improvethevaluepropositionforallITinvestmentsbyensuringthereisalwaysapositiveROIwhichexceedsanacceptablehurdlerate;

�positionthefoundationalpartsofservicedeliverysuchthatthedepartmentcanadoptchangeswhichwillresultinnewandbetterserviceofferings;and

�institutionalizeasetofoperationalprincipleswhichwillsupportsustainabilityofsoundITbestpractices.

Strategy

InJuly2011,throughthere-allocationofcurrentpositions,SecretaryGreensteinappointedtheDepartment’sfirst-everChiefTechnologyOfficer(CTO)toworkside-by-sidewiththeChiefInformationOfficer(CIO)andotherDepartmentleadershiptodevelop,planandimplementtheDepartment’sITintegrationstrategyandresourcere-alignment.

TheCIOandCTOwilljointlydevelopacohesive,department-wideITstrategythatwill:

�Capitalizeoncurrentinvestments,

�Alignfutureexpendituresandresourcesforcurrenttransformations;and,

�ReadytheDepartmentforfuturechangesinthestateandnationalhealthcareprograms.

Theseinitialactivitieswillfocusondiscoveryandgatheringinformationtodevelopthestrategyandtheaccompanyingtacticalplans.Theareasoffocuswillbeonfiveprimarycategories:People,Process,Financial,InformationandTechnology.

ThisinitialeffortisheavilydependentoncollaborationacrossDHHofficesandextra-departmentalorganizationsincludingbutnotlimitedtotheDepartmentofAdministration(DOA),

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Louisiana Department of Health and Hospitals628 North 4th Street, Baton Rouge, Louisiana 70802

(225) 342-9500www.dhh.la.gov

www.facebook.com/LaHealthDept. www.twitter.com/La_Health_Dept www.myhealthla.org

leading transformation · 2011. 10. 18. · a catalyst for better health. through smarter...

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