305PUR-DHHRFP-CCN-S-MVA-4 by xiuliliaofz

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									                                                         CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                        RFP # 305PUR-DHHRFP-CCN-S-MVA
                 SUBMITTER           SECTION     SECTION
QUESTON #                                                       PAGE #                                         QUESTION                                                                             ANSWER
                   NAME                 #        HEADING


                                                                         This section states that the Department may selectively contract with a limited number
             Louisiana Hospital
     1                                 1.3     Purpose of RFP     5      of qualified entities. This is not as specific as the CCN-P RFP. Does the Department have See §20.14.
                Association
                                                                         a target number in mind for the number of CCN-S entities?



                                                                                                                                                                  DHH is projecting a 50/50 split in CCN membership for budget
                                                                         Shared Savings model success requires a critical mass of members in order to be fiscally
                                                                                                                                                                  projection and planning purposes. However, as Medicaid recipients
             Community Health                   Populations              accountable. Initial Notice of Intent versions as well as Secretary Greenstein's
     2                                  2                        14                                                                                               have choice in the model of CCN they enroll, in final membership
            Solutions of Louisiana               Covered                 statements reflected an even 50/50 split of Medicaid population between CCN-P and
                                                                                                                                                                  percentages will not be known until after Phase 3 of the CCN
                                                                         CCN-S models. A differing scenario is reflected in the RFP. What has changed?
                                                                                                                                                                  Program enrollment.


                                                                                                                                                                  The majority of LaCHIP Phase IV enrollees are Latino. Information
                                                                                                                                                                  that is available as to ethnicity is located on the
             Community Health                   Mandatory                With respect to the LaCHIP Phase IV Program, what ethnicities are likely to be most
     3                                2.3.1                      16                                                                                               MakingMedicaidBetter.com website at:
            Solutions of Louisiana              populations              represented so we can develop OB network and educational materials appropriately?
                                                                                                                                                                  http://new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/Resources/Me
                                                                                                                                                                  dEls_Parish.pdf .




                                                                                                                                                                  The four federally recognized tribes in Louisiana are Chitimacha (St.
                                                                                                                                                                  Mary Parish) who have a health clinic that receives Medicaid PPS
                                                                                                                                                                  reimbursement, Coushatta (Allen Parish) Jena Band of Choctaw
                                                                                                                                                                  (LaSalle Parish) and Tunica-Biloxi (Avoyelles Parish) The number of
                                                                                                                                                                  Medicaid CCN potential enrollees who have self-declared as Native
                                                                                                                                                                  Americans was 409 as of 2/11 and the count by parish can be found
             Community Health                    Voluntary               With regard to Native American members, please provide information regarding tribes,     in the Potential CCN Enrollment file located in the Procurement
     4                                2.3.2                      19
            Solutions of Louisiana              Populations              number of enrollees, and current health care provision.                                  Library . The exact number of Medicaid enrollees who have self-
                                                                                                                                                                  declared as Native Americans and who are also members of these
                                                                                                                                                                  or other federally recognized tribes is not known, but the number is
                                                                                                                                                                  nominal.

                                                                                                                                                                  http://new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/RequestsforPr
                                                                                                                                                                  oposals/LouisianaTribalContact.pdf




5/23/2011                                                                                                                                                                                                                                         Page 1 of 18
                                                             CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                               RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION       SECTION
QUESTON #                                                              PAGE #                                          QUESTION                                                                        ANSWER
                    NAME                  #          HEADING

                                                                                Is there a minimal threshold of members enrolled with a PCP contracted with the CCN
                                                                                                                                                                          DHH has not established a minimum. CCNs could establish such
     5      Meridian Health Services     3.1       Scope of work         22     required before the CCN provides support to transform the primary care practice to
                                                                                                                                                                          policies and submit to DHH for review and approval.
                                                                                PCMH?



              Community Health                     Participation                Wouldn't the one million dollar performance bond cover our payments to our providers
     6                                   3.2                            23                                                                                           No.
             Solutions of Louisiana                Requirements                 which would eliminate the need for a surety bond?



                                                                                                                                                                          Yes.
                                                                                For the DHH evaluation of the Provider Network, to score any points will it be
                                                   Participation                dependent on the ability of the CCN to meet the minimum capacity requirements of
     7      Meridian Health Services    3.2.8                            23                                                                                               No. The CCN must specify the number of linkages for each LOI or
                                                   Requirements                 75,000 Medicaid and LaCHIP eligibles per GSA? Will this be evaluated with the
                                                                                                                                                                          executed contract listed. PCPs can participate in multiple CCN
                                                                                understanding that each open Physician (MD or DO) has a capacity of 2,500 members?
                                                                                                                                                                          networks.

              Community Health                        Bond
     8                                   3.4                            27      Please specify the amount of 'blanket fidelity bond' required.                            $100,000.00
             Solutions of Louisiana                Requirements

                                                                                As the net worth grows, is the CCN-S required to keep seventy-five percent (75%) of the
              Community Health                     Minimum Net                                                                                                          The CCN must maintain a minimum of 75% of the net worth in cash
     9                                   3.7                            28      increased net worth in cash or cash equivalents or does that requirement only apply to
             Solutions of Louisiana                   Worth                                                                                                             or cash equivalents in all cases.
                                                                                the initial one million of net worth?


                                                                                Section 3.8 states "Provide the following pro forma financial statements for the CCN
                                                                                Louisiana operation. The pro forma financial statements must be prepared on an accrual
                                                                                basis by month for the first three years beginning with the first month of the proposed
                                                                                execution date of the Contract:
              Community Health
    10                                   3.8     Financial Reporting    30      o A statement of monthly revenue and expenses;                                            No.
             Solutions of Louisiana
                                                                                o A monthly cash flow analysis; and
                                                                                o A balance sheet for each month;"
                                                                                Would the State consider revising this requirement to be annual or, at most, quarterly
                                                                                financial statement projections?




5/23/2011                                                                                                                                                                                                                                   Page 2 of 18
                                                                CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                               RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER             SECTION         SECTION
QUESTON #                                                              PAGE #                                           QUESTION                                                                         ANSWER
                    NAME                   #            HEADING


                                                                                In reviewing Appendix BB, we were unable to reconcile the total points available for
              Community Health                                                  Sections G and Q to the points assigned to each element in these sections. Could the       An addendum will be issued to correct the total possible points in the
    11                                 Appendix BB     Sections G, Q    30
             Solutions of Louisiana                                             State please provide clarification regarding the required elements in these sections and   items in Sections G and Q in Appendix BB.
                                                                                points associated with each element and/or total points available for these sections?



                                                                                                                                                                           The Emergency Management Plan has been posted in the
              Community Health                         Emergency                Would the State please provide us with DHH or the State of Louisiana's existing            Procurement Library. The plan is relative to DHH continuation of
    12                                    3.11                          31
             Solutions of Louisiana                  Management Plan            Emergency Management Plan?                                                                 operations and is not intended, nor does it provide guidance, to
                                                                                                                                                                           providers.


              Community Health                         Emergency                What are identification triggers for identifying enrollees with special healthcare needs
    13                                    3.11                          32                                                                                                 See definition of special needs population in the Glossary.
             Solutions of Louisiana                  Management Plan            who require evacuation assistance?

                                                                                                                                                                           Medicaid transportation providers are not responsible for providing
              Community Health                         Emergency                What are responsibilities of Medicaid transportation providers to provide evacuation       evacuation assistance. Medicaid reimbursement for transportation is
    14                                    3.11                          32
             Solutions of Louisiana                  Management Plan            assistance?                                                                                limited to medical transportation to/from a medical appointment.
                                                                                                                                                                           Medicaid does not reimburse for evacuation.

                                                                                                                                                                           No. however, the CCN may establish a minimum threshold. Any
                                                           CCN                  Is there a minimum threshold of members enrolled with a PCP required to be met for
    15      Meridian Health Services        4                            35                                                                                                portion of the $1.50 PCCM fee that is not paid to the PCP must be
                                                      reimbursement             the CCN to pay the PCP a monthly pmpm care management fee?
                                                                                                                                                                           reimbursed to DHH.

                                                        PCP Care
    16      Meridian Health Services       4.3                           37     What are the performance measurement goals specifically?                                   See Appendix H.
                                                     management fee


                                                                                Section 4.7.1 states "DHH will conduct periodic reconciliations to determine savings
              Community Health                           Savings
    17                                     4.7                          38      achieved or refunds due to DHH (from the enhanced primary care management fees).           Yes. A schedule is available in the Procurement Library.
             Solutions of Louisiana                   Determination
                                                                                After savings are identified, has the State established a schedule for disbursement?




5/23/2011                                                                                                                                                                                                                                           Page 3 of 18
                                                            CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                             RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION      SECTION
QUESTON #                                                            PAGE #                                          QUESTION                                                                          ANSWER
                    NAME                  #         HEADING

              Community Health                       Savings                  Would the State consider a consistent quarterly schedule for completion of savings        The schedule for distribution of any shared savings is posted in the
    18                                   4.7                          38
             Solutions of Louisiana               Determination               determinations and disbursement?                                                          Procurement Library.



              Community Health                       Savings                  Will the State please clarify whether the savings determination will factor in revenues
    19                                   4.7                          38                                                                                                Drug rebates will be factored in to the savings determination.
             Solutions of Louisiana               Determination               such as drug rebates when calculating actual cost of CCN-S members.



                                                     Savings                  Shared savings will be limited to 5% of actual aggregate costs. Please describe how       An example of the savings calculation is available in the Procurement
    20      Meridian Health Services     4.7                           40
                                                  Determination               aggregate actual costs will be determined.                                                Library.



                                                                                                                                                                        April 1st and October 1st, subject to change at the discretion of the
                                                                                                                                                                        Department.
                                                 Health-Based Risk
                                                                              The health risk of the members will be updated semi-annually. What are the dates of the
    21      Meridian Health Services    4.7.2      adjustment         41                                                                                              Yes, but please note members must have at least six (6) months of
                                                                              update, and will be the same date for all enrollees regardless of date of enrollment?
                                                   methodology                                                                                                        eligibility during the twelve (12) month measurement period to
                                                                                                                                                                      receive a risk score. Unscored members will be assigned the average
                                                                                                                                                                      health risk of the population.



                                                                                                                                                                        In the absence of the Medical Director/CMO the CCN shall have other
                                                                              What is meant by "CCN shall have physician staff to provide competent medical
                                                  Minimum staff                                                                                                         physician staff that can fulfill the roles of Medical Director/CMO as
    22      Meridian Health Services     5.1                           45     direction"? To whom is the medical direction- a provider, hospital or member? Is this
                                                  requirements                                                                                                          detailed in 5.1.b.
                                                                              considered practicing medicine and making medical decisions of care?




5/23/2011                                                                                                                                                                                                                                       Page 4 of 18
                                                            CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                            RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION      SECTION
QUESTON #                                                           PAGE #                                          QUESTION                                                                         ANSWER
                    NAME                  #         HEADING

                                                                                                                                                                      The Medical Director must devote a minimum of 32 hours per week
                                                                             If the Medical Director is also CHCQM through ABQAURP and holds a Masters in Medical
                                                                                                                                                                      to CCN operations. If the Medical Director meets the requirements
                                                                             management, can the Medical Director also serve as the Quality Management
                                                                                                                                                                      of the other positions listed, they may also hold the Coordinator
                                                 Minimum staffing            coordinator, Performance/Quality Improvement Coordinator and Material Child
    23      Meridian Health Services     5.1                          45                                                                                              positions in the respective areas during the transition period.
                                                  requirements               Health/EPSDT Coordinator, and Medical Management Coordinator in the initial
                                                                                                                                                                      However, there should be adequate staff within the areas to assure
                                                                             transition period of the contract (exceeding the maximum 2 position as specified) if
                                                                                                                                                                      that the listed functions are met.
                                                                             requested in the response to the rap?



              Community Health                                                                                                                                        Service accessibility standards for the CCN-S are specified in §8 o the
    24                                    6      Provider Network    54      How are community norms for access to care established?
             Solutions of Louisiana                                                                                                                                   RFP.


                                                                             Why is the provision 7.1.10 from the CCN-P RFP not included in the one for CCN-S? We
                                                                             appreciate the assurance of an offer being provided to the state's safety net provider,
                                                                             LSU Health, in the CCN-P model and feel that it's equally as important in the CCN-S
            Kyle Viator - LSU Health                                         model due to the shared savings model incentivizing lower cost providers. Without such The CCN-S network requirements do not require hospitals as part of
    25                                    6      Provider Network    54
                    System                                                   an assurance, there would be concern that access to our clinics would be arbitrarily     their provider network.
                                                                             denied due to the facility fee that is a part of standard reimbursement for our hospital
                                                                             outpatient clinics.



                                                                                                                                                                     DHH will only specify the outcome required. It is the CCN's
                                                                             Can you please provide the specifics of what functions/tasks DHH will be expecting of a
                                                                                                                                                                     responsibility to determine the functions/tasks necessary to be in
                                                                             CCN-S in order for it to be in compliance with this requirement?
              Community Health                   Patient-Centered                                                                                                    compliance with this requirement.
    26                                   6.9                         63
             Solutions of Louisiana               Medical Home
                                                                             Once identified, where are the costs of these functions reflected in the CCN-S fee
                                                                                                                                                                      It is the CCN's responsibility to determine the cost associated with
                                                                             structure?
                                                                                                                                                                      meeting this requirement.



                                                 Patient-Centered            In addition to NCQA and JCAHO, would DHH be willing to amend and accept URAC and
    27      Meridian Health Services     6.9                          63                                                                                              No.
                                                  Medical Home               Accreditation for Ambulatory Health Care (AAAHC) for PCMH Designation?




5/23/2011                                                                                                                                                                                                                                       Page 5 of 18
                                                            CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                            RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION      SECTION
QUESTON #                                                           PAGE #                                          QUESTION                                                                            ANSWER
                    NAME                  #         HEADING

                                                                             Must each metric of PCMH designation be met in 6.9.2.2 and 6.9.2.3-are the metrics
                                                                                                                                                                        Yes each metric must be met.
                                                 Patient-Centered            "and" or "or" in the subsection description of PCMH designation thresholds? Is the
    28      Meridian Health Services    6.92                          64
                                                  Medical Home               timeframe the end of 365 days of operations, or the end of the first full calendar year of
                                                                                                                                                                        The timeframe is 365 days of operation.
                                                                             operations?


              Community Health                                               What is data standard that FI will accept as an approved PCP referral to reimburse
    29                                   7.1     Care Management     80                                                                                                 Refer to Systems Companion Guide.
             Solutions of Louisiana                                          specialty care?



              Community Health                      Utilization              What is DHH's current reimbursement methodology and rate for both                          Currently, DHH reimburses on a Fee-for-Service (FFS) basis. Rates are
    30                                  7.1.2                        82                                                                                                 posted on the www.lamedicaid.com website at:
             Solutions of Louisiana                Management                inpatient/outpatient and diagnostic services?
                                                                                                                                                                        http://www.lamedicaid.com/provweb1/fee_schedules/feeschedulesindex.htm



                                                                             Can the RFP more specifically outline limitations relative to when applying utilization
                                                                             management criteria would be inappropriate? For instance, there have been provisions
                                                                             put in place through the Medicaid FFS program for individuals who gain Medicaid
                                                                             coverage retroactively. Our patients who fall into this category, do not have to obtain
                                                                             authorization through the Radiology Utilization Management program or extension days A Medicaid recipient will not be retroactively enrolled in the CCN
            Kyle Viator - LSU Health                Utilization
    31                                  7.1.2                        82      based on Interqual criteria for inpatient hospital care. As the state's safety net hospital Program. Once enrolled the enrollee is subject to the utilization
                    System                         Management
                                                                             network, LSU Health accepts patients regardless of payor status. As such, patients who management criteria of the CCN in which they are a member.
                                                                             are in still of need of medical care that could be provided by a lower acuity level
                                                                             provider are unable to access it due to the fact that do not have active Medicaid
                                                                             coverage at that time.




5/23/2011                                                                                                                                                                                                                                        Page 6 of 18
                                                                 CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                                  RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION           SECTION
QUESTON #                                                                PAGE #                                           QUESTION                                                                           ANSWER
                    NAME                  #              HEADING




                                                                                  Could additional detail be provided in this section relative to the CCN's responsibility for
                                                                                  identifying alternative placements for patients who may no longer be in need of
            Kyle Viator - LSU Health                 Utilization                  placement in an acute care setting? We would recommend specifically including
    32                                   7.1.2                            82                                                                                                   Yes, an addendum will be issued for this request.
                    System                           Management                   language that would prohibit CCNs from denying hospital inpatient days due to inability
                                                                                  to locate a lower level of care for a patient. Again, as the state's safety net hospital
                                                                                  network we have a much higher Medicaid patient mix than other hospitals across the
                                                                                  state. Historically, at discharge we have experienced a significant challenge in access to
                                                                                  alternative providers at more appropriate levels of care for Medicaid patients.



                                                                                                                                                                             Question does not relate to 7.1.2.
              Community Health                          Utilization               Can the State please provide twelve months (FY10) claims data related to Fee for Service
    33                                   7.1.2                            84                                                                                               DHH does not have a specific file with pre-authorized claims only. The
             Solutions of Louisiana                    Management                 pre-authorized services?
                                                                                                                                                                           CCN may obtain copies of historical claims (SY 09 and SY10) which
                                                                                                                                                                           includes data that denotes if a claim required service authorization.


                                                                                                                                                                             A summary list of all services is available at:
                                                                                                                                                                             http://new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/
              Community Health                          Utilization                                                                                                          Resources/Medicaid_Services_Chart.pdf
    34                                   7.1.2                            84      Can the state provide specific service limits for services that require authorization?
             Solutions of Louisiana                    Management                                                                                                            DHH is developing a list of only those services that currently require
                                                                                                                                                                             service authorization. Once complete it will be available on
                                                                                                                                                                             MakingMedicaidBetter.com website.


                                                      Medical Record              If the CCN has access to a provider's electronic medical record, can a virtual online
    35      Meridian Health Services    7.1.2.4                            89                                                                                                A virtual online review is acceptable.
                                                      Review Strategy             review be performed, or must the CCN physically go to the provider's office?



                                                      Standard Service            Concurrent reviews must be done within 1 business day. Does this exclude weekends
    36      Meridian Health Services   7.1.2.6.1.1                         93                                                                                                Refer to Glossary for definition of Business Day.
                                                        Authorization             and holidays?




5/23/2011                                                                                                                                                                                                                                             Page 7 of 18
                                                                  CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                                    RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER             SECTION           SECTION
QUESTON #                                                                   PAGE #                                          QUESTION                                                                                ANSWER
                    NAME                   #              HEADING

                                                           Adverse                   What is meant by "in writing using language that is easily understood"? Is there a
    37      Meridian Health Services   7.1.2.6.2.2.                           96                                                                                                   Refer to § 11.10.1 of the RFP.
                                                        Determination                specific grade level required?



              Community Health                        PCP Utilization and                                                                                                          Drug Utilization Review (DUR) is in the purview of the FFS Pharmacy
    38                                    7.1.4                              99      Please define DUR and Reporting requirements for CCN-S.
             Solutions of Louisiana                    Quality Profiling                                                                                                           Program. CCN-S entities do not have DUR reporting requirements.




                                                                                     Section 7.1.4.2 states "CCN PCP profiling activities shall include, but not be limited to,
                                                                                     the following: Individual PCP clinical quality performance measures as indicated in
                                                                                                                                                                                   No. Early Warning System Performance Measures are administrative
                                                                                     Appendix H". Section 7.1.10 states that distribution of savings for the first two (2) years
                                                                                                                                                                                   measures that are not applicable to the individual PCP Office, with
                                                                                     of operation would be based upon meeting established Early Warning System
              Community Health                        PCP Utilization and                                                                                                          the exception of the PCP 24/7 access measure and therefore not
    39                                    7.1.4                              99      Performance Measures, which are included in Appendix H. Specific to Appendix H, would
             Solutions of Louisiana                    Quality Profiling                                                                                                           appropriate for inclusion in the Quarterly PCP Profile Reports. The
                                                                                     the PCP indicators required in quarterly PCP profile reports be limited to Early Warning
                                                                                                                                                                                   indicators required in the first two years of operations are those
                                                                                     System Performance Measures for the first two (2) years of operations? If not, please
                                                                                                                                                                                   listed in § 7.1.4.2 to the extent that the information is available.
                                                                                     specify which indicators would be included in the first two (2) years of quarterly PCP
                                                                                     profile reports.


                                                      Care Coordination,
              Community Health                        Continuity of Care,            Please define PCP responsibilities with respect to PCP-based Behavioral Health Services
    40                                    7.1.5                              105                                                                                                   Defined in §7.1.5.1.4.
             Solutions of Louisiana                        and Care                  versus the Behavioral Health Carve-out?
                                                          Transition




5/23/2011                                                                                                                                                                                                                                                 Page 8 of 18
                                                             CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                              RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION       SECTION
QUESTON #                                                             PAGE #                                          QUESTION                                                                          ANSWER
                    NAME                  #          HEADING


                                                                               Section 7.1.6 states “The CCN shall develop and implement a case management program
                                                                               through a process which provides that appropriate and cost-effective medical services,
                                                                               medically-related services, other services, and behavioral health services are identified,
                                                                               planned, obtained and monitored for identified members who are high risk or have
                                                                               unique, chronic, or complex needs. The process shall integrate the member‘s and case
                                                                               manager‘s review of the member's strengths and needs resulting in a mutually agreed
                                                                               upon appropriate and cost-effective service plan that meets the medical, functional, and
             Community Health                                                  behavioral health needs of the member.” Our model supports care plan development           Refer to § 7.1.6.1.1. which describes a collaborative approach for
    41                                  7.1.6    Case Management       109
            Solutions of Louisiana                                             through collaborative interaction between the RN Case Manager, PCP, enrollee               care plan development.
                                                                               (enrollee's responsible party), enrollees' support system and additional health care team
                                                                               representatives as indicated when permission is granted by the enrollee for
                                                                               communication with service providers outside of the PCP, including specialist. Would
                                                                               the State consider a change in wording to reflect care plan development as a
                                                                               collaborative approach which incorporates the PCP, enrollee and other members of the
                                                                               healthcare team as indicated?




                                                                               Can adjustments be made to the requirement that special permission would have to be
                                                                               granted by DHH in order for family members to be assigned to different CCNs? There is
                                                                               concern that families might find it a considerable hardship to go through this process
                                                                               which will not be well known. As the state's public safety net provider we have
                                                                               historically provided access to services, including primary care which will be the main The section referenced is incorrect, however, an addendum will be
            Kyle Viator - LSU Health                 Voluntary
    42                                  11.2.3                         119     basis of network linkage, to an underserved population who has had considerable         issued to give all members of a family unit an opportunity to select
                    System                       Selection of a CCN
                                                                               difficulty getting access to private providers through Medicaid. As such, we are        the same CCN.
                                                                               concerned that children who have greater access to the private provider networks due
                                                                               to the enhanced reimbursement rate for their services may end up getting linked to a
                                                                               network that would not include the safety net providers and thus create difficulty in
                                                                               accessing timely and quality primary care for their parents.




5/23/2011                                                                                                                                                                                                                                      Page 9 of 18
                                                       CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                     RFP # 305PUR-DHHRFP-CCN-S-MVA
                 SUBMITTER           SECTION    SECTION
QUESTON #                                                    PAGE #                                         QUESTION                                                                        ANSWER
                   NAME                 #       HEADING

                                                                      Section 7.1.9.2 states "The CCN is required to report on PMs listed in Appendix H which
                                                                      include, but are not limited to, Healthcare Effectiveness Data and Information Set
                                                                      (HEDIS) measures, Agency for Healthcare Research and Quality Review (AHRQ)
             Community Health                  Performance            measures, Consumer Assessment of Healthcare Providers and Systems (CAHPS)               No. The Systems Companion Guide has been amended to remove
    43                                7.1.9                   121
            Solutions of Louisiana              Measures              measures, and/or other measures as determined by DHH". Page 9 of the systems            this requirement.
                                                                      companion guide refers to PQRI (Physician Quality Reporting Initiative). Is the CCN-S
                                                                      also required to report PQRI data?



                                                                      When the RFP states HEDIS measures will be captured, is the expectation that CCN-S will
             Community Health                  Performance
    44                                7.1.9                   121     capture this data solely on claims data or is expectation that this will be a hybrid of CCN-S shall capture data solely utilizing claims data.
            Solutions of Louisiana              Measures
                                                                      claims data and record review?


             Community Health                  Performance            Which version of the CAHPS is required- the MHN Clinician and Group CAHPS or the
    45                                7.1.9                   121                                                                                             Medicaid Adult and Child CAHPS.
            Solutions of Louisiana              Measures              Medicaid Adult and Child CAHPS?


             Community Health                  Performance            When establishing rates, did Mercer calculate the costs associated with capturing HEDIS
    46                                7.1.9                   121                                                                                             Yes.
            Solutions of Louisiana              Measures              and CAHPS data?

             Community Health                  Performance
    47                                7.1.9                   121     Is the CAHPS survey required annually or every other year?                              Annually. See §16.12.1.1.
            Solutions of Louisiana              Measures




5/23/2011                                                                                                                                                                                                                  Page 10 of 18
                                                            CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                              RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION      SECTION
QUESTON #                                                            PAGE #                                            QUESTION                                                                        ANSWER
                    NAME                  #         HEADING



                                                                                                                                                                         Level I and Level II measure reporting is required
                                                                                                                                                                         annually, and upon DHH request, beginning in 2013
                                                                                                                                                                         utilizing CY 2012 data for Contracts that begin
                                                                                                                                                                         January 1, 2012. Reports shall be submitted to DHH in July of 2013.
              Community Health                     Performance                Since HEDIS requires a minimum of eleven (11) months of continuous enrollment, what
    48                                  7.1.9                         121
             Solutions of Louisiana                 Measures                  is initial date that DHH expect the CCN-S to report HEDIS measures?
                                                                                                                                                                         Level I and Level II measure reporting is required
                                                                                                                                                                         annually, and upon DHH request, beginning in 2014
                                                                                                                                                                         utilizing CY 2013 data for Contracts that begin after
                                                                                                                                                                         January 1, 2012. Reports shall be submitted to DHH in July of 2014.


                                                                                                                                                                         DHH is currently working with our contractor ULM to establish
              Community Health                    Incentive Based                                                                                                        benchmarks for the Incentive Based and Level I Performance
    49                                  7.1.11                        122     What are competitive benchmarks for incentive based measures?
             Solutions of Louisiana                  Measures                                                                                                            measures.


              Community Health                     Performance
    50                                  7.1.13                        123     Are there established "percentages of improvement" for performance measures?               See response to # 49.
             Solutions of Louisiana               Measure Goals


                                                 Member Advisory              Is there a minimum number of members that are required for the advisory Council? To        No, there is not a minimum number of members. The Council
    51      Meridian Health Services   7.1.19                         129
                                                    Council                   whom does the Council report?                                                              reports to the CCN.


                                                 Behavioral Health                                                                                                       Louisiana Medicaid currently does not reimburse for mental health
    52      Meridian Health Services    7.2.1                         132     Are any mid-level providers excluded from contracting?
                                                     Services                                                                                                            mid-level practitioners.



                                                                              How are behavioral health services currently provided and billed? Specifically, do
              Community Health                   Behavioral Health                                                                                                       Behavioral health professionals who are reimbursed by Medicaid
    53                                   7.2                          133     behavioral health professionals enroll as providers and bill directly or do they bill as
             Solutions of Louisiana                  Services                                                                                                            enroll as providers and bill directly.
                                                                              allied health professionals, billing under a physicians number?




5/23/2011                                                                                                                                                                                                                                      Page 11 of 18
                                                             CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                               RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION       SECTION
QUESTON #                                                             PAGE #                                           QUESTION                                                                                ANSWER
                    NAME                  #          HEADING

              Community Health                   Behavioral Health                                                                                                          These providers are included in the provider listing available on the
    54                                   7.2                           133     Please provide a list of Medicaid enrolled behavioral health providers.
             Solutions of Louisiana                  Services                                                                                                               MakingMedicaidBetter.com website.


                                                 Early and Periodic                                                                                                         The 2010 Report is posted at:
                                                                                                                                                                            http://new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/RequestsforPr
                                                     Screening,
                                                                               What percent of Louisiana Medicaid members under the age of 21 currently receive well- oposals/AnnualEPSDTParticipationReport.pdf
              Community Health                     Diagnosis and
    55                                   7.5                           136     child visits according to periodicity table? Would the State provide the last two 416  All previous 416 reports are located on the CMS website:
             Solutions of Louisiana                  Treatment
                                                                               Reports submitted to the Centers for Medicare and Medicaid Services?                   http://www.cms.gov/MedicaidEarlyPeriodicScrn/03_StateAgencyResponsibilities.as
                                                   (EPSDT)/ Well                                                                                                            p#TopOfPage
                                                        Child                                                                                                               Download the 1995-2008 National Data zip file




                                                                                                                                                                            Louisiana Medicaid reimburses for the following OB GYN services:
                                                 Women’s Health                What is the definition of an OB/GYN Medicaid provider? Is it restricted to MD/DO, or
    56      Meridian Health Services     7.6                           136                                                                                                  MD, DO, Physician Assistant, Nurse Practitioner, and
                                                   Services                    does it include a PA/CNP or Midwife specializing in Ob/Gyn services?
                                                                                                                                                                            Certified Nurse Midwife



                                                 Women's Health                Are female enrollees entitled to see out of network providers for Women’s Health Care
    57      Meridian Health Services     7.6                           136                                                                                                  Yes.
                                                   Services                    Services?


                                                                                                                                                                            DHH only monitors the total number of CCN members to each CCN.
                                                                                                                                                                            It is the CCN's responsibility to maintain and monitor the PCP/patient
                                                  Assurance and
                                                                               How is the 2,500 member enrollment threshold monitored and relayed to the CCN?               ratio.
    58      Meridian Health Services    8.1.1    Adequate Access       138
                                                                               Does the Provider have to be enrolled with the LA DHH Medicaid Program?
                                                   and Capacity
                                                                                                                                                                            Yes, all providers in the CCN-S model must be enrolled in the
                                                                                                                                                                            Louisiana Medicaid Program.



                                                  Travel time and              Is there a list of parishes designated as urban for clarification of this section? The map in
    59      Meridian Health Services     8.4                           139                                                                                                   See Appendix Q for map of rural and urban parishes.
                                                     distance                  Appendix Q on page 450 lists rural parishes. Are all others urban designated?




5/23/2011                                                                                                                                                                                                                                                   Page 12 of 18
                                                           CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                            RFP # 305PUR-DHHRFP-CCN-S-MVA
                 SUBMITTER           SECTION       SECTION
QUESTON #                                                           PAGE #                                         QUESTION                                                                         ANSWER
                   NAME                 #          HEADING


                                                                                                                                                                    Emergent or emergency services could be provided in settings other
                                                                             Can DHH clarify the "emergent or emergency visits immediately upon presentation at
             Louisiana Hospital                                                                                                                                     than hospitals.
    60                                8.6.1      Timely Access       140     the delivery site" requirement from a CCN-S perspective since they do not appear to be
                Association
                                                                             required to maintain hospital network providers?
                                                                                                                                                                    Your are correct hospitals are not a required CCN-S network provider.



                                                                             This section states that the CCN shall disseminate bulletins as needed to incorporate any
                                                                                                                                                                       See §9.3 for CCN requirements for website for providers.
                                                                             changes to the provider handbook, but does not cover means or timing. Can DHH
             Louisiana Hospital                    Provider
    61                                9.4.2                          146     clarify? Also, will the CCN be required to maintain the provider manual on its website?
                Association                       Handbooks                                                                                                            No, DHH will not include an aggregate of all approved CCN provider
                                                                             Does DHH plan to include an aggregation of all approved CCN provider manuals on its
                                                                                                                                                                       manuals on our website.
                                                                             website?


                                                                                                                                                                      Section 10.1.1.3 is being addended to allow the family member the
                                                                                                                                                                      opportunity to choose a CCN.
                                                                             Given that Section 10.1.1.3 states "All members of a family unit will be required to select
             Community Health                      Voluntary                 the same CCN unless extenuating circumstances warrant a different CCN. Such instances
    62                                10.1.1                         153                                                                                                 DHH believes potential members or their representative should have
            Solutions of Louisiana             Selection of a CCN            must be approved by DHH or its agent or designee.", why are all newborns born to
                                                                                                                                                                         choice of the CCN in which they wish to be a member. If a Mother
                                                                             mothers enrolled in a specific CCN-S not required to be enrolled in the same CCN-S?
                                                                                                                                                                         does not choose a CCN, the newborn will be automatically assigned
                                                                                                                                                                         to the Mother's CCN.



                                                                             There are times when it may be appropriate to move a patient from one PCP to another
             Community Health                                                during the 9-month lock in period. Ex: Pregnant woman delivers and the OB does not
    63                                10.1.4   CCN Lock-In Period    155                                                                                             Yes.
            Solutions of Louisiana                                           wish to remain in role of PCP; would the state allow the CCN-S to work with the patient
                                                                             and move to another PCP in order to accommodate wishes of providers/ patients?




5/23/2011                                                                                                                                                                                                                                     Page 13 of 18
                                                             CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                              RFP # 305PUR-DHHRFP-CCN-S-MVA
                 SUBMITTER           SECTION        SECTION
QUESTON #                                                             PAGE #                                          QUESTION                                                                             ANSWER
                   NAME                 #           HEADING


                                                                                                                                                                       The hospital is required to complete and submit to DHH the Third
                                                                               Section 10.1.9.2 states" CCN should work with hospitals to report the birth of newborns
                                                                                                                                                                       Party Liability (TPL) Notification of Newborn Children form to report
             Community Health                       Newborn                    within 24 hours of birth for enrolled members using DHH's web-based Report for
    64                                10.1.9                           159                                                                                             the birth and health insurance status of a qualifying newborn child
            Solutions of Louisiana                 Enrollment                  Newborn ID System." Is there any DHH requirement for hospitals to notify the CCN-S of
                                                                                                                                                                       either directly in the facility, delivered under their care, or transferred
                                                                               a baby's birth?
                                                                                                                                                                       to their facility after birth.


                                                                                                                                                                            DHH is currently developing the ability to electronically transmit this
                                                                                                                                                                            information and plans to have it functional by January 2012.
                                                                               Can this information be transmitted electronically? If so, what transaction standards will
    65         Arpegio Health        10.1.8.3    Change in Status      159
                                                                               be required?
                                                                                                                                                                            Once available, DHH will update the CCN-S Systems Companion
                                                                                                                                                                            Guide with all relative information.

                                                                                                                                                                            Cost projections include the allocation of certain costs across more
                                                                                                                                                                            than one of the seven components. It is the potential CCN's
             Community Health                     Marketing and                With regard to Enrollee Education, where are the costs of this function reflected in the
    66                                 11                              174                                                                                                  responsibility to determine if the ePCCM fee specified in the RFP is
            Solutions of Louisiana              Enrollee Education             CCN-S fee structure?
                                                                                                                                                                            sufficient to meet all requirements specified in the RFP. The ePCCM
                                                                                                                                                                            PMPM specified in Appendix E is non- negotiable.



                                                                               With regard to Section 11.13.2, Welcome Calls, since welcome calls will be made by non-
                                                 Communication
             Community Health                                                  clinical staff we have some concerns regarding the appropriateness of discussions
    67                                11.13        with New            194                                                                                             No.
            Solutions of Louisiana                                             between these staff and members regarding medical conditions. Would the State
                                                   Enrollees
                                                                               consider an alternative such as member completion of a medical questionnaire which
                                                                               would then be forwarded to the member's PCP?



             Community Health                     CCN Member                   Will DHH create "boilerplate" manual with required materials and then allow CCN-S to
    68                                11.14                            194                                                                                                  Yes.
            Solutions of Louisiana                 Handbook                    add program specific material?


                                                    Member
             Community Health                                                  Would the State consider revising the requirement for issuance of cards to allow cards       No. The ID card must be issued within the timeframe with or
    69                                11.15     Identification (ID)    200
            Solutions of Louisiana                                             to be issued once, upon selection of PCP?                                                    without the PCP name.
                                                      Cards




5/23/2011                                                                                                                                                                                                                                             Page 14 of 18
                                                              CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                               RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION        SECTION
QUESTON #                                                              PAGE #                                           QUESTION                                                                             ANSWER
                    NAME                  #           HEADING

                                                  Provider Directory            Please clarify "The CCN shall develop and maintain a Provider Directory in three four (4)
    70      Meridian Health Services   11.16.1.                         200                                                                                               A addendum will be issued to correct the language.
                                                    for Members                 formats"

                                                                                Section 11.21.2 states "The CCN shall ensure that where at least five percent (5%) or
                                                                                more of the resident population of a parish and/or service area is non-English speaking
                                                                                and speaks a specific foreign language, that materials are made available, at no charge,    This information is available on the MakingMedicaidBetter.com
                                                  Oral and Material
              Community Health                                                  in that specific language to assure a reasonable chance for all members to understand       website at:
    71                                  11.21      Interpretation       208
             Solutions of Louisiana                                             how to access the CCN and use services appropriately as specified in 42 CFR §438.10(c)      http://new.dhh.louisiana.gov/assets/docs/Making_Medicaid_Better/Resources/Me
                                                       Services                                                                                                             dEls_Parish.pdf
                                                                                (4) and (5)." Will the State provide CCN-S with a file that identifies the impacted
                                                                                parishes/service areas and the languages that are spoken in those areas?


                                                                                While there are provisions for data reporting around time/accuracy, as well as possible
                                                                                sanctions for CCNs not meeting those targets, what happens if a CCN provides
                                                                                inaccurate or incomplete information that is ultimately used by a provider for
                                                    Pre-Processed                                                                                                            Comment is not relevant to the CCN-S model. The CCN-S is
               Louisiana Hospital                                               participation in such programs such as Medicare DSH or 340B and the incorrect data
    72                                  13.30        Claims Data        227                                                                                                  responsible for only the service authorization of services not
                  Association                                                   adversely affects that provider's ability to participate in those programs, thus costing the
                                                     Submissions                                                                                                             payment.
                                                                                provider money? Does DHH plan to implement requirements for the CCN to make the
                                                                                provider whole?


                                                                                                                                                                          Cost projections include the allocation of certain costs across more
                                                                                                                                                                          than one of the seven components. It is the potential CCN's
              Community Health                       Claims                     With regard to Claims Pre-Processing, where are the costs of these functions reflected in
    73                                   14                             245                                                                                               responsibility to determine if the ePCCM fee specified in the RFP is
             Solutions of Louisiana                Management                   the CCN-S fee structure?
                                                                                                                                                                          sufficient to meet all requirements specified in the RFP. The ePCCM
                                                                                                                                                                          PMPM specified in Appendix E is non- negotiable.


              Community Health
    74                                  14.1      General Provisions    245     Please specify which claims, if any, are carved out of pre-processing by CCN-S.             See Section § 7.1.5.1.1
             Solutions of Louisiana



              Community Health                                                  Based upon the last twenty-four (24) months of claims, what percent of manual claims        Based on FFS claims submission, we currently receive less than 10%
    75                                  14.1      General Provisions    245
             Solutions of Louisiana                                             versus claims submitted electronically should a CCN-S expect?                               of total claims volume (all provider types) in paper form.




5/23/2011                                                                                                                                                                                                                                              Page 15 of 18
                                                              CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                            RFP # 305PUR-DHHRFP-CCN-S-MVA
                 SUBMITTER            SECTION         SECTION
QUESTON #                                                            PAGE #                                         QUESTION                                                                             ANSWER
                   NAME                  #            HEADING
                                                        CCN
                                                                                                                                                                        No - this is the responsibility of the FI - as indicated in Section 14.3.
             Community Health                      Responsibilities-        Is the CCN-S expected to provide "post claims" services to Medicaid providers such as
    76                                  14.2                          245                                                                                               Molina will provide claims status via the e-CSI application and via
            Solutions of Louisiana                     Service              providing claims status, via telephone, after the claim has been pre-processed?
                                                                                                                                                                        provider remits.
                                                    Authorization
                                                       Claims
                                                                             Please identify any category of claims that would not be required to be submitted to the
    77         Arpegio Health           14.1        Management         245                                                                                            See Response to # 74.
                                                                             CCN for pre-processing.
                                                  General Provisions

                                                       Claims
                                                                             Are any category of providers or service types excluded from the pre-processing
    78         Arpegio Health           14.1        Management         245                                                                                              See Response to # 74.
                                                                             requirements (other than pharmacy)?
                                                  General Provisions

                                                       Claims
                                                                             Are all behavioral health services subject to the pre-processing requirement including
    79         Arpegio Health           14.1        Management         245                                                                                              No, only basic behavioral health services.
                                                                             those provided by Community Mental Health Centers or other community providers?
                                                  General Provisions
                                                        CCN
                                                   Responsibilities-         Can you provide historical data on the percentages of electronic versus paper claims
    80         Arpegio Health         14.2.1.                          245                                                                                              Refer to # 75. This information is not available by region.
                                                       Service               submittals? If possible, please provide these data by Region.
                                                    Authorization

                                                                             We are aware that many states have chosen to exempt specific services or providers
             Community Health                      National Correct                                                                                                     There have been no exemptions requested for NCCI editing by
    81                                  14.9                           249   from NCCI edits. Has DHH established any NCCI exemptions for Provider Claim
            Solutions of Louisiana                 Coding Initiative                                                                                                    Louisiana Medicaid.
                                                                             submission?


                                                  Fee For Service to                                                                                                    See §20.8.2 of the RFP. The format will be added to the CCN-S
    82         Arpegio Health          17.9.5                          277   In what format will the 24 month claims history be provided?
                                                        CNNs                                                                                                            Systems Companion Guide .


                                                                                                                                                                        Cost projections include the allocation of certain costs across more
                                                                             Where are Claims Pre-Processing and outreach to new members (phone calls, enrollee         than one of the seven components. It is the potential CCN's
             Community Health
    83                               Appendix E     Mercer Letter      387   materials, etc.) reflected in the rate schedule? Please identify specific allocation for   responsibility to determine if the ePCCM fee specified in the RFP is
            Solutions of Louisiana
                                                                             these requirements.                                                                        sufficient to meet all requirements specified in the RFP. The ePCCM
                                                                                                                                                                        PMPM specified in Appendix E is non- negotiable.




5/23/2011                                                                                                                                                                                                                                           Page 16 of 18
                                                              CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                             RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION        SECTION
QUESTON #                                                            PAGE #                                         QUESTION                                                                           ANSWER
                    NAME                  #           HEADING

                                                                                                                                                                         Cost projections include the allocation of certain costs across more
                                                                                                                                                                         than one of the seven components. It is the potential CCN's
              Community Health                                                Please provide a breakdown of rates contained in "Account Management and
    84                                Appendix E    Mercer Letter     393                                                                                                responsibility to determine if the ePCCM fee specified in the RFP is
             Solutions of Louisiana                                           Overhead” category.
                                                                                                                                                                         sufficient to meet all requirements specified in the RFP. The ePCCM
                                                                                                                                                                         PMPM specified in Appendix E is non- negotiable.

                                                                                                                                                                   Cost projections include the allocation of certain costs across more
                                                                                                                                                                   than one of the seven components. It is the potential CCN's
              Community Health                                                What is the administrative fee percent for the CCN-S model? How does this compare to
    85                                Appendix E    Mercer Letter     393                                                                                          responsibility to determine if the ePCCM fee specified in the RFP is
             Solutions of Louisiana                                           the administrative fee percent for the CCN-P model?
                                                                                                                                                                   sufficient to meet all requirements specified in the RFP. The ePCCM
                                                                                                                                                                   PMPM specified in Appendix E is non- negotiable.


                                                                              For the evaluation of the Provider Network under G.1, will the CCN-S need to
    86      Meridian Health Services Appendix BB      Item G.1        491                                                                                                No.
                                                                              demonstrate a network of non-PCP types of providers under contract or LOI?




                                                                              The Schedule of Events states that CCN Network Adequacy Documentation for Region C
                                                    G.1. Technical            is due January 9, 2012. However, Section G.1. in the Technical Approach requires Letters
    87          Arpegio Health        Appendix BB                     515                                                                                              See §8 of the RFP.
                                                      Approach                of Intent and Geo-Mapping for a network. What standard will DHH use to determine
                                                                              network adequacy for evaluating potential CNN proposals?




                                                                              The Schedule of Events states that CCN Network Adequacy Documentation for Region C
                                                                                                                                                                         Yes, DHH is soliciting proposals from CCNs that include Louisiana
                                                                              is due January 9, 2012. However, Section G.1. in the Technical Approach requires Letters
                                                                                                                                                                         Medicaid enrolled providers.
                                                    G.1. Technical            of Intent and Geo-Mapping for a network. The CNN RFP appears to be soliciting
    88          Arpegio Health        Appendix BB                     515
                                                      Approach                proposals that represent Louisiana and local providers. Is that an accurate depiction of
                                                                                                                                                                         No, Letters of Intent from Medical Societies do not meet the
                                                                              the intent of the CNN program? Would commitment from groups of local providers
                                                                                                                                                                         standard of submission.
                                                                              such as Medical Societies meet the standard for submission of the proposal?




5/23/2011                                                                                                                                                                                                                                       Page 17 of 18
                                                          CCN SHARED SAVINGS RFP - QUESTIONS AND ANSWERS

                                                                                    RFP # 305PUR-DHHRFP-CCN-S-MVA
                  SUBMITTER            SECTION    SECTION
QUESTON #                                                   PAGE #                                          QUESTION                                                                      ANSWER
                    NAME                  #       HEADING

                                                                                                                                                           The “cumulative amount” is the combined value of the bonus
                                       Appendix                      Could DHH please define "cumulative amount" as it is going to be used in evaluating
    89      Meridian Health Services                n/a      570                                                                                           payments, pay for performance incentive payments and other
                                         HH                          provider benefit in the proposals?
                                                                                                                                                           payment arrangements.


                                                                                                                                                           Yes, only financial payments that may be specifically identified for an
                                                                                                                                                           incentive program will be considered. Although other arrangements,
                                       Appendix
    90      Meridian Health Services                n/a      570     Is it the expectation of DHH to quantify the provider benefit monetarily only?        activities and incentives may provide indirect or ancillary benefits to
                                         HH
                                                                                                                                                           providers or influence their financial performance, those are not to
                                                                                                                                                           be included in this section.


                                                                     Can a CCN-S offer benefits above those covered under Louisiana Medicaid?
    91         Adams and Reese         General      n/a      n/a                                                                                           No.



                                                                     Can a bidder submit a proposal to be a primary contractor under the CCN-P program and
    92         Adams and Reese         General      n/a      n/a     also act as a subcontractor under the CCN-S program in either the same region or a    Yes.
                                                                     different region?


                                                                     Will there be an option to convert from a CCN-S to a CCN-P at a later date? What would
    93      Meridian Health Services     n/a        n/a      n/a                                                                                            No.
                                                                     the process & timeline for conversion be?


                                                                                                                                                           The CCN can work with physicians to implement best practices to
                                                                     How can you hold us accountable for pharmacy costs without giving us the ability to
    94      Meridian Health Services     n/a        n/a      n/a                                                                                           further reduce pharmacy cost s and receive a financial incentive for
                                                                     manage pharmacy?
                                                                                                                                                           doing so.


    95      Meridian Health Services     n/a        n/a      n/a     Will pharmacy be fully included in the program at a later date?                       No such decision has been made.




5/23/2011                                                                                                                                                                                                                         Page 18 of 18

								
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