Louisiana Medicaid will be implementing an immunization pay-for-performance initiative which includes supplemental payments to providers. This initiative is being implemented to promote up-to-date immunizations of Louisiana Medicaid eligible children and to increase the number of providers utilizing the Louisiana Immunization Network for Kids Statewide (LINKS) immunization registry.

Requirements to participate in this pay-for-performance initiative and receive supplemental payments include:

• The provider must be enrolled in Louisiana Medicaid as a CommunityCARE PCP;
• The provider must be enrolled in and utilizing the Vaccines for Children (VFC) Program (If KIDMED services including immunizations for members aged 19-35 months are contracted out, then the subcontractor must to be enrolled in and utilizing VFC);
• The provider must be enrolled in and utilizing LINKS. 'Utilizing' LINKS is defined as input of member immunization data into LINKS in the past 30 days. (If KIDMED services including immunizations for members aged 19-35 months are contracted out, then the subcontractor must to be enrolled in and utilizing LINKS);
• Providers must enter the social security number of Medicaid eligible children linked to them for CommunityCARE into the LINKS record to ensure the child is correctly identified and included in the data for payment calculations.

CommunityCARE PCPs interested in participating in the immunization pay-for-performance initiative and receiving the supplemental payments are required to register on the secure website www.lamedicaid.com.

Information required to complete this registration includes:

• CommunityCARE PCP Medicaid Billing Provider ID Number
• National Provider Identifier (NPI) if the provider has one
• VFC PIN Number
• LINKS Provider ID (IRMS Number)

All of the above information will also be required for any subcontractor of KIDMED services that provide immunizations (including the subcontractor's Medicaid Billing Provider ID number). The PCP will be responsible for obtaining this information from the subcontractor and completing the information required on the secure web page mentioned earlier. This information is to be completed at the time the PCP registers to participate in the pay-for-performance supplemental payments.

Note: The enrollment and utilization status of VFC and LINKS will be validated monthly with the Office of Public Health Immunization Program for all CommunityCARE PCPs registered to participate in the immunization pay-for-performance initiative.

Supplemental payments will be dependent on:

• The CommunityCARE PCP (or subcontractor of KIDMED services) being enrolled in and utilizing VFC and LINKS;
• The percentage of 24 month old Medicaid enrolled children linked to the PCP practice that are up-to-date with all childhood immunizations in the 4:3:1:3:3:1 vaccine series and these immunizations must be entered into LINKS; and
• The number of CommunityCARE linkages to the PCP for members under 21 years of age.

Payment calculations will be done on a monthly basis and payments of these monthly calculations will be made on a quarterly basis to the registered CommunityCARE PCPs. Only data that is in the LINKS immunization registry at the time of the monthly calculation for payments will be used.

The supplemental payment tiers or levels for payment are as follows:

• $0.25 per Medicaid member under the age of 21 linked to the CommunityCARE PCP if the PCP or subcontractor of KIDMED services is enrolled in and utilizing VFC and LINKS AND < 75%† of the members aged 24 months old with CommunityCARE linkages to the PCP are up-to-date with the vaccine series 4:3:1:3:3:1*, or;
• $0.50 per Medicaid member under the age of 21 linked to the CommunityCARE PCP if the PCP or subcontractor of KIDMED services is enrolled in and utilizing VFC and LINKS AND 75% to 89%† of the members aged 24 months old with CommunityCARE linkages to the PCP are-up to-date with vaccine series 4:3:1:3:3:1*, or;
• $1.00 per Medicaid member under the age of 21 linked to the CommunityCARE PCP if the PCP or subcontractor of KIDMED services is enrolled in and utilizing VFC and LINKS AND 90%† or more of the members aged 24 months old with CommunityCARE linkages to the PCP are up-to-date with vaccine series 4:3:1:3:3:1*

NOTE: Providers participating in this initiative will only qualify for a single level of payment (e.g. Providers with an immunization rate of 82% will only qualify for the second level or tier payment - not both the first and second tier).

Additional information regarding this immunization pay-for-performance initiative will be provided through RA messages, Louisiana Medicaid Provider Update articles and provider notices posted on the www.lamedicaid.com website. Please watch these information sources for the most up-to-date information on immunization pay-for-performance.

For more information regarding the VFC Program or LINKS, contact the Office of Public Health Immunization Program at 504.838.5300.

For more information on the Immunization Pay-for-Performance Initiative, contact Unisys Provider Relations at 800.473.2783.