Office of State Procurement PROACT Contract Certification of Approval This certificate serves as ...

147 Pages·2016·25.06 MB·English

Office of State Procurement
PROACT Contract Certification of Approval

This certificate serves as confirmation that the Office of State Procurement has
reviewed and approved the contract referenced below.

Reference Number:2000107363 ( 4)
Vendor: Amerihealth Caritas Louisiana Inc
Description: Provide healthcare services to Medicaid enrollees
Approved By: Pamela Rice
Approval Date: 1/05/2016
Your amendment that was submitted to OSP has been approved.

Attachment A-4
MCO Contract Amendment #4

Effective 12/01/2015

Attachment/ Contract
Exhibit Letter Document
or Number Name Change From: Change To1: Justification
Attachment D Rate Replace with Mercer rate A rate revision was necessary
Certification certification dated October 15, to address technical changes
2015. related to out-of-state
hospital payments and kick
payments, as well as
programmatic changes related
to the termination of LaHIPP
and the addition of new
mandatory populations.
Attachment I Behavioral New attachment Add Mercer rate certification Specialized behavioral health
Health Rate dated November 20, 2015. services are being integrated
Certification into Bayou Health and rates
for these services were
developed by Mercer
Attachment J Non- New attachment Add Mercer Rate certification All non-emergency
Emergency dated November 4, 2015. transportation services will be
Medical provided by the MCOs and
Transportation rates for these services were
Rate developed Mercer.
Certification
Exhibit 3 305PUR- Changes are contained in the Specialized behavioral health
DHHRFP-BH- redlined version of the RFP. services are being integrated
MCO-2014- into Bayou Health.
MVA

1 Additions underlined; deletions struck through
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Attachment A-4
MCO Contract Amendment #4

Effective 12/01/2015

Exhibit 3 305PUR- Replaced with updated version.- Changes were made to add
DHHRFP-BH- requirements related to the
MCO-2014- assignment of anti-trust rights
MVA to the State of Louisiana.

Appendix O
Exhibit 3 305PUR- Replaced with updated version. Changes were made due to
DHHRFP-BH- the integration of specialized
MCO-2014- behavioral health services into
MVA Bayou Health.

Appendix T –
Request for
Member
Disenrollment

Exhibit 3 305PUR- Replaced with updated version. Changes were made due to
DHHRFP-BH- the integration of specialized
MCO-2014- behavioral health services into
MVA Bayou Health.

Appendix UU
– Behavioral
Health
Provider
Network –
Geographic
and Capacity
Standards

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