Information Regarding the Rehabilitation of LAHC

Updated Information Regarding the Rehabilitation of Louisiana Health Cooperative (LAHC)

General Information

  • Federal Waiver - Payments to any non-Federal claimants (providers, subscribers, members, vendors, etc.) cannot be made until the United States Department of Justice issues a federal waiver to LAHC. A claim has been made by the Centers for Medicare and Medicaid Services against LAHC. In that claim the Federal Government has asserted a superpriority over LAHCís assets above all other claimants, including; providers, subscribers, members, and vendors. The Receiver has applied for a Federal Waiver to pay LAHC providers, subscribers, and members before we pay the Federal Government. We were required by the Federal Government to apply for and receive a waiver to pay any party ahead of the United States Government. There is no certainty that such a waiver will be granted.
  • Timely Filed Claims - Proof of Claim forms were to be received by March 31, 2016. If your claim was received on or before March 31, 2016, it will be considered timely filed and will be adjudicated according to the terms of your policy and paid according to La. RS 22:254. When all LAHC claims have been adjudicated, and approved by the Court, claims will be paid based on available assets. The amount of payment will depend on the availability of assets. This process will take several months.
  • Late Filed Claims - Any proof of claim received after March 31, 2016 is considered untimely and will not be considered eligible for payment until all timely filed claims are paid.

Providers

  • An Order was approved by the 19thJudicial District Court allowing the Receiver to apply Medicare fee schedule rates to all allowed claims.(See order here)
  • Federal Waiver - Payments to any non-Federal claimants, including providers, cannot be made until the United States Department of Justice issues a federal waiver to LAHC. A claim has been made by the Centers for Medicare and Medicaid Services against LAHC. In that claim the Federal Government has asserted a superpriority over LAHCís assets above all other claimants, including providers. The Receiver has applied for a Federal Waiver to pay LAHC providers, subscribers, and members before we pay the Federal Government. We were required by the Federal Government to apply for and receive a waiver to pay any party ahead of the United States Government. There is no certainty that such a waiver will be granted.
  • The Receiverís staff is repricing all unpaid claims at the lower of allowed rates per your contract or applicable Medicare rates. This process should be completed and ready by the time the Federal Government approves or denies our application for Federal Waiver. Once all claims are repriced, the Receiver will provide notice to all affected providers through an explanation of payment (EOP). The Receiver plans to send EOPís after the Federal Waiver is granted.

Subscribers/Members

  • Federal Waiver - Payments to any non-Federal claimants, including subscribers and members, cannot be made until the United States Department of Justice issues a federal waiver to LAHC. A claim has been made by the Centers for Medicare and Medicaid Services against LAHC. In that claim the Federal Government has asserted a superpriority over LAHCís assets above all other claimants, including subscribers and members. The Receiver has applied for a Federal Waiver to pay LAHC providers, subscribers, and members before we pay the Federal Government. We were required by the Federal Government to apply for and receive a waiver to pay any party ahead of the United States Government. There is no certainty that such a waiver will be granted.
  • LAHC continues to reconcile its subscriber / member enrollment records with the Federally Funded Marketplace records. The enrollment reconciliation process will determine if additional premium amounts are owed to LAHC or if return premium amounts are owed to subscribers. Once the reconciliation process is complete, certain subscribers may owe premium to LAHC. If it is determined you owe premium, you will receive written notice.
  • There are subscribers who are owed a premium refund. Due to the insolvency and Receivership of LAHC, those amounts are considered a class 4 claim under La. RS 22:254 G. (4) and will not be paid until all timely filed claims in Class 1 through 3 have been paid. These class 4 claims will be paid, if we are granted a Federal Waiver, when the aforementioned Class 1 through Class 3 claims have been paid if there are sufficient funds available for distribution.


 

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