PA Commonwealth Court overturns HealthChoices Contracts

HealthChoices—Pennsylvania’s managed care program for physical health, which includes our pediatrics practice—announced its newly rebid contracts in early 2017. For the past several years, this rebid process has been fraught with issues due to Managed Care Organizations’ (MCOs) protests. The newly announced contracts proved to be no different, as United submitted a contract bid protest shortly after this announcement.

United submitted this protest due to their belief that the state made an improper contract decision. Recently, Pennsylvania’s Commonwealth Court took up this protest and ruled in favor of United. The Court found that DHS met with MCOs during the black out period, thus ruling in favor of United’s protest.

DHS has not yet announced its next steps, but it is possible that the department will have to rebid all of HealthChoices’s contracts again. Because HealthChoices represents over $12 billion in contracts for potential MCOs, this ruling has created unprecedented waves in the state’s healthcare community. GAO will continue to monitor the outcomes of this ruling and will update the pediatric practice as more information becomes available.

Delaware Rate Floor Bill Passes

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

The General Assembly, in the wee hours of the morning on the last day of session, passed the rate floor bill! This measure will ensure that Managed Care Organizations (MCOs) hourly home health care rates for registered nursing (RN) and licensed practical nursing (LPN) care will never fall below Delaware Health and Social Services (DHSS) hourly rates. This will help to ensure access to home health care for Delawareans with disabilities, and giving providers the ability to make informed business decisions. Dedicated effort by our BAYADA team of clients and employees, in partnership with the Delaware Association for Home and Community-Based Care and other home health care providers, made this possible. Thank you for your emails, phone calls, and attendance at Advocacy Day in Dover. This bill will go into effect when Governor John Carney signs it.

Delaware Rate Floor Bill Passes House Committee

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following compelling testimony by clients Nancy and Christopher Lemus, Delaware Association for Home and Community-based Care (DAHCC) President Bob Bird, Delaware Pediatrics (DP) Associate Director Mandy Brady, and myself, the House Health & Human Development Committee passed a bill that would set a minimum reimbursement rate paid by Medicaid managed care organizations (MCOs) to home health care providers for skilled nursing services.
Representatives asked probing questions, sparking true debate over the measure. The vote was 10-0 with 4 additional members absent. The bill must still pass the full House, the Senate Health, Children & Social Services Committee, and the full Senate. The legislature closes on June 30. If this bill passes, MCOs would not be able to pay any less than the Department of Health and Social Services (DHSS) pays for the same care, giving DHSS the ability to ensure access to needed services.

Nancy Lemus giving testimony at the hearing

Rate Floor Bill Introduced in Delaware

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following a concerted education effort and participation by many members of the home health care industry, HB200, which sets a “rate floor” for skilled nursing paid by Medicaid managed care, has been introduced. Nine members of the legislature have said that home health care matters to them, and are sponsoring the bill. Every home health care provider who answered an industry-wide survey said their number of unfilled hours has increased over last year. HB200 would go a long way toward ensuring access to skilled nursing for home health care clients across the state. If the bill becomes law, managed care organizations would not be able to pay less than the Department of Health and Social Services pays directly for similar services.

Delaware PAC makes amazing gains at Awards Weekend 2017

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

The Delaware PAC is BAYADA’s newest PAC, with Awards Weekend being the first major push for members.

The DE PAC recruited 16 new members during Awards Weekend, pulling in an annual total of over $3,800! GAO is doing a lot of work educating legislators about the impact home health care has in DE by keeping families together and helping clients remain at home instead of using more costly nursing facilities and hospitals. In Delaware this year, we are asking the legislature to set a rate floor for skilled nursing services paid for by MCOs. PAC members make a personal statement that BAYADA in Delaware matters to them.

PA Office of Long-Term Living Announces Temporary Rate Floors

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

Last week, during the Pennsylvania Homecare Association Annual Conference, Deputy Secretary for the Office of Long-Term Living (OLTL) Jen Burnett announced Managed Care Organizations (MCOs) will be required to reimburse providers at least the state posted fee-for-service reimbursement rate for personal assistant services. This “rate floor” will be in effect for the first 36 months post transition of each region. After the announcement, I had the opportunity to speak with Deputy Secretary Burnett, and she stated the reason OLTL made that decision was to provide stability for providers. During our conversation, I asked that her office consider extending the temporary rate floor to registered nurse (RN) and licensed practical nurse (LPN) services as well for the same reason. She invited us to meet with her formally to discuss. BAYADA’s Government Affairs Office (GAO) will work to set up a meeting with OLTL to lobby for the inclusion of RN and LPN services in the 36-month rate floor.