Why is HealthChoices Delayed?

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

As many may know by now, the Department of Human Services recently announced they would delay and stagger the implementation of the new HealthChoices contracts. This was due to several bid protests and court battles currently working its way through the system.

This pushes the implementation to January of 2018.  The current plan is to rollout the new HealthChoices contracts:

January 2018                Southwest & Northwest

March 2018                   Northeast

July 2018                       Southeast

January 2019                Lehigh/Capitol

This will make the staggered roll-out similar to the Community HealthChoices implementation plan.

But why the delay?

Simply put, there are billions of dollars at stake.  The total funds available for HealthChoices are  estimated to be over $12 billion. So those organizations that do not win bids miss out on one of the largest state contracts in the US.

Number of Regions in Old ContractNumber of Regions in New Contract
Centene33
Health Partners12
United50
UPMC for You54
Keystone11
Gateway25
Aetna10
AmeriHealth32

This could also be one of the reasons why DHS is staggering the roll out. With the staggered roll out the Lehigh Capitol region transitions in January of 2019. This means that United and Amerihealth will get to keep their consumers for almost two years longer than originally anticipated.

We are still expecting court challenges which could delay the implementation further.

For your reference, I have included charts which details what MCOs were awarded what regions and the number of regions they were awarded.

GAO continues to monitor this situation and will update the pediatric leadership as more information becomes available.

 

 

 

 

 

Bills in Motion at the NC General Assembly

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

  1. Certificate of Need (CON) under Attack  In the course of 48 hours 4 bills related to CON were filed to either eliminate or modify CON law. As any changes to CON will negatively impact our existing Medicare offices, our GAO Advisory Council identified protection of CON as a 2017 legislative goal. GAO continues to meet with the various bill sponsors to educate them the negative impact such changes would have on the home health industry. We continue to work behind-the-scenes to prevent their enactment.
  2. Medicaid Reform under Review  While the Medicaid Reform 1115 c Waiver application is being reviewed by the Centers for Medicare & Medicaid Services (CMS), there is discussion of a new model emerging from Governor Roy Cooper’s office in conjunction with the General Assembly. GAO continues to work with legislative leaders and the department to ensure quality access to care exists in whatever model emerges.
  3. Trillium LME/MCO Proposed CAP-C/DA Pilot  Senator Michael Lee sponsored a bill to allow Trillium Local Management Entity/Managed Care Organization (LME/MCO), a managed mental health, substance use and intellectual/developmental disability payor, to administer a CAP-C/DA pilot in the coastal area. Analysis of the bill indicates this pilot would have a negative impact on recipients. GAO is working with the bill sponsor to explain the pitfalls of moving coastal recipients into a pilot when these individuals are currently transitioning into a new waiver.
  4. Opioid Bill’s Unintended Consequence  Representative Gregory Murphy sponsored a bill to tighten opioid prescriptions. While we support increased oversight for misuse of prescriptions drugs, the bills language, in its current state, will create a safe-haven for pillpushers. AHHC is taking the lead to work with the bill sponsor to modify the language to eliminate the loop-hole and craft a meaningful bill, as intended.

Breakfast With A Purpose in North Carolina

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

To commemorate the start of the 2017-2018 regular session, our staff attended an annual breakfast in Raleigh on January 11.  As hosts of the event, staff had a 30 minute private mingle with members.  We were able to thank lawmakers for the nursing increase last year, and to discuss the less-than-adequate aide rate and the overly burdensome and varying administrative requirements of Local Management Entity/Managed Care Organizations.  Further, Senator Shirley Randleman, a home care supporter, thanked us for keeping her in the loop on a constituent issue where a medically fragile child is in jeopardy of losing his private duty nursing.  To which Randleman said, “For the insurance company to say this baby is stable and doesn’t need home health care is unbelievable.”  She is willing to help in any way possible.  Events like this allow us to continue to build relationship with lawmakers.  Click here for photos.   Special thanks to the following staff members who represented BAYADA:

  • Chad Shore
  • Dena Hinkle
  • Donna Heatherly
  • Elizabeth Goad
  • Trip Smithdeal
Photo: BAYADA advocates at the Women in Politics breakfast on January 11.