Tag: Medicaid Managed Care

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[ MM Curator Summary]: Paramount throws in the towel now that Anthem will give its workers jobs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

After claiming procurement bias, Paramount makes deal with Anthem

 
 

An Ohio-based Medicaid managed-care company is poised to end its legal action against the state.

Last year it accused the Ohio Department of Medicaid of bias and conflicts in a $22 billion bidding process. Toledo-based Paramount Advantage now says that if the department approves a deal for Anthem to take over Paramount’s patients, it will drop plans to appeal a lower-court ruling that dismissed its attempt to stop the huge procurement.

“Ensuring quality care for members and minimizing local job losses have been top priorities for Paramount since we learned that we had not been awarded a contract for the Ohio Department of Medicaid’s (ODM) new managed care program, which starts on July 1, 2022,” Paramount said in an emailed statement. “Entering into this agreement with Anthem will help address concerns related to these top priorities. And, if the transaction closes as planned, Paramount will not pursue further legal action against ODM.” 

The plans were first reported by Hannah News.

If the deal is approved, it will end a bitter challenge by Paramount to a procurement undertaken by Medicaid last year. 

Seeking to reshape the state’s Medicaid system, the department issued a request for applications by managed-care providers to show how they would prioritize the health of individual Medicaid recipients, who make up 25% of the Ohio population. At $22 billion, it was the biggest public procurement in Ohio history.

After years of claims that pharmacy middlemen working for managed-care providers were ripping off the state, the Medicaid department is taking that business away from those companies and is hiring a single drug middleman that will work directly with the Medicaid department.

Also as part of the overhaul, the department is hiring a single company that will create a continuum of services for 60,000 Ohio kids with complex behavioral health needs. The $1 billion program will work closely with the managed care providers under the revamped system, Medicaid officials have said.

Plans call for the new system to be implemented in July.

When the Medicaid department selected six companies to handle managed-care and another to run OhioRISE, the childrens’ program, it passed over Paramount, a longtime managed-care provider in the Ohio system. The department said the company’s application didn’t adequately explain how it would achieve the new goals the state was setting for its Medicaid program.

Paramount sued over the decision, and in court in October and November, it presented evidence that it was penalized for being relatively small and operating only in Ohio.

It also said the procurement didn’t consider that some of the huge companies that were selected had been accused of massive wrongdoing against Ohio taxpayers. 

For example, the Medicaid department restarted talks with Centene-owned Buckeye Health Plan in August —  just six months after the company announced it was paying $88 million to settle claims that it bilked tens of millions from the Ohio Medicaid program. The company also announced that it was setting aside $1 billion more to settle similar claims in other states.

Also, UnitedHealth Group’s United Healthcare Community Plan of Ohio was one of six companies selected for a multi-billion-dollar managed-care contract. It got the business even though the state is actively suing its pharmacy middleman, OptumRx, on claims that it ripped $16 million off of the Ohio Bureau of Workers Compensation.

In addition, Optum and CVS’s pharmacy middleman, CVS Caremark, were the companies accused of improperly inflating the prices of Medicaid drugs — charges they deny. Despite the claims, CVS’s Aetna got the billion-dollar OhioRISE contract.

In court, Paramount also pointed to potential conflicts of interest. 

Medicaid Director Maureen Corcoran has disclosed that in the past she owned at least $1,000 worth of stock in CVS and UnitedHealth Group, but she’s refused to say just how much she owned as she was negotiating and signing huge contracts with their subsidiaries.

And Mercer, the $9 million consultant that facilitated the procurement, refuses to say whether any of the selected clients also have consulting contracts with Mercer.

Franklin County Common Pleas Judge Julie M. Lynch on Nov. 10 dismissed Paramount’s case after disallowing evidence of the possible conflicts. Just after the dismissal, Paramount’s lawyers said they would appeal.

But Paramount and its parent, Toledo-based ProMedica, thought better of the strategy. It says it’s turning its business over to Anthem because it believes it’s the best of the six newly selected companies to provide care to Paramount’s Medicaid clients.

The two companies also are looking for landing spots for hundreds of Paramount employees.

“Anthem and ProMedica are working to identify open roles within both organizations that may interest affected Paramount employees,” Paramount said in a statement. “This would create opportunities for Paramount employees to join Anthem or continue with ProMedica in a different capacity.”

For its part, Anthem said it’s up to the task.

 “Anthem has served the whole-health needs of Ohioans for more than 81 years and we look forward to expanding access to comprehensive, high-quality healthcare services for more Medicaid-eligible individuals,” Greg LaManna, Anthem Blue Cross and Blue Shield’s Medicaid President in Ohio, said in an emailed statement. “This transaction expands our commitment to further the Next Generation of Ohio Medicaid Managed Care in advance of the new Medicaid contract.”

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Clipped from: https://ohiocapitaljournal.com/2022/01/05/medicaid-provider-to-drop-legal-action-against-state/

 
 

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[ MM Curator Summary]: The listening sessions for the next version of Nebraska Medicaid managed care have begun.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

LINCOLN, Neb. — Kevin Bagley, Director of the Division of Medicaid and Long-Term Care (MLTC) within the Department of Health and Human Services (DHHS) has announced a statewide listening tour for Medicaid’s managed care program. The tour will begin Jan. 11, 2022, and will stop at five locations throughout the state.

Nebraska Medicaid will be procuring new contracts for the capitated managed care program, Heritage Health, in 2022. As part of this process, the Medicaid team wants to gather input from community members who would like to share their experiences with Medicaid’s current health plans.

This feedback will help Medicaid develop its next managed care contracts. These listening sessions will take place at the following locations:

 
 

In the area, the tour will stop in Norfolk, Nebraska, on Thursday, Jan. 20, at the Norfolk Public Library — (Meeting Room A) from 1:30-2:30 p.m.

 
 

Clipped from: https://www.yankton.net/community/article_0ecda8a8-5d5a-11ec-9422-d77e485c926f.html

 
 

 
 

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[ MM Curator Summary]: The LA MCO awards are expected “next week.”

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Louisiana’s latest search for contractors to manage the health care services of nearly 1.6 million Medicaid patients is taking longer than expected, blowing past an early November timeline for announcing the contract awards.

The last bid process started by Gov. John Bel Edwards’ administration for the multibillion-dollar Medicaid managed care contracts was derailed two years ago in a legal dispute. The Louisiana Department of Health has been using emergency contracts to keep the current managed care companies in place while it evaluates new bids.

The health department released its request for proposals from contractors interested in handling the taxpayer-financed Medicaid work in June. The deadline for submissions was Sept. 10. At the time the bid solicitation was issued, the agency released a timeline that said it planned to announce the contract awards “on or about” Nov. 5.

That announcement hasn’t happened.

Health department spokesperson Kevin Litten said the agency hopes to have its recommendations to the Office of State Procurement, which oversees the bid solicitation process, by the end of this week.

“The expected dates first announced for awarding the Request for Proposals for Managed Care Organizations was an approximate timeframe, and LDH has continued working through this process over the past month,” Litten said in a statement. “The department is finalizing our internal evaluations.”

The managed care contracts account for roughly one-quarter of Louisiana’s annual operating budget and cover the health care for one-third of Louisiana’s residents. They allow private companies to oversee health services for about 90% of Louisiana’s Medicaid enrollees — mostly adults covered by the Medicaid expansion program, pregnant women and children.

The new contracts will be awarded for up to five years and are expected to start around the beginning of the new budget year in July, according to the bid solicitation.

Until new contractors are chosen, the health department has continued its existing emergency deals with the five companies currently managing Medicaid services: Aetna Better Health, AmeriHealth Caritas of Louisiana, Healthy Blue, Louisiana Healthcare Connections and United Healthcare of Louisiana.

Health Department Secretary Courtney Phillips announced in August that she would redo the Medicaid managed care contractor search, rather than continue a legal fight over the deals that her predecessor approved.

The prior bid process began in early 2019, under then-Secretary Rebekah Gee. Four companies were chosen for the Medicaid managed care work – three of the insurance companies that already hold contracts with health department and one new contractor. The contracts would have been worth an estimated $21 billion over three years.

But two losing bidders currently doing the managed care work that were slated to lose their lucrative contracts, Louisiana Healthcare Connections and Aetna Better Health, filed protests raising objections about the bid solicitation process and contract awards.

After reviewing the protests, Louisiana’s state procurement officer scrapped the contract awards, determining that the health department mishandled the bid process and failed to comply with state law or the agency’s own evaluation guidelines.

The health department and the four insurance companies chosen for the Medicaid deals initially challenged that decision. But Phillips decided it was best to start the process over when she became health secretary near the start of the coronavirus pandemic and as Louisiana’s Medicaid rolls ballooned larger.

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Follow Melinda Deslatte on Twitter at https://twitter.com/MelindaDeslatte

Clipped from: https://www.theintelligencer.com/news/article/Louisiana-Medicaid-contractor-search-slower-than-16683320.php

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[ MM Curator Summary]: Oregon’s next version of its big 1115 waiver will include actual performance dollar measures tied to health equity metrics yet to be defined.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Emily Boerger | Dec 7, 2021 | Oregon

The Oregon Health Authority (OHA) opened the public comment period for the state’s draft 1115 waiver renewal application on Tuesday, signaling the latest step forward in the state’s effort to reform the Oregon Health Plan (OHP). OHA is preparing to submit the new five-year Medicaid program waiver to the Centers for Medicare & Medicaid Services (CMS) in February 2022. 

The new waiver, which would be in effect from 2022-2027, focuses on improving health equity within the Medicaid program. Concept papers released last month identified the five policy concepts that form the basis of the application. They include a focus on maximizing OHP coverage, stabilizing transitions to minimize disruptions in care, value-based global budgets, incentivizing equitable care, and focusing on equity investments. 

The public notice highlighting the public comment period lays out the state’s specific requests related to health equity. 

Through the waiver, the state is requesting authority to allow coordinated care organizations (CCOs) to spend 3% of their per-member per-month capitation rate on health equity investments, and for those to be counted as medical expenses when determining rates. The state is also requesting federal spending for infrastructure to support equity, and investments to support community-led equity interventions. 

The state is looking to change the process of selecting CCO incentive metrics to focus on equity and is requesting an expanded benefit for American Indian/Alaska Native OHP members so that Tribal-based practices are considered covered services. 

These are just a few of the many changes to the program that OHA is seeking public comment on. 

The public comment period will run from Dec. 7 through Jan. 7. The public can submit written comments through email at 1115Waiver.Renewal@dhsoha.state.or.us or through Oregon.gov/1115WaiverRenewal. 

The feedback will then be used to revise the draft and prepare it for final submission to CMS in February.  

 
 

Clipped from: https://stateofreform.com/featured/2021/12/public-comment-period-open-for-draft-medicaid-waiver-renewal-application/

[ MM Curator Summary] Centene has won a new BH contract in AZ.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The payer’s contract to address serious mental healthcare needs in Arizona will last three years, with the opportunity to extend the contract.

By Kelsey Waddill

November 16, 2021 – Centene Corporation (Centene) will be expanding its Medicaid coverage in Arizona to provide serious mental healthcare services in a competitive contract expansion, the payer announced.

“We are honored to continue our long-standing partnership with the state of Arizona to provide access to comprehensive, quality healthcare to members living with serious mental illness and other complex situations and crisis,” said Brent Layton, president and chief operating officer of Centene. 

“Centene has a long history of coordinating integrated physical and behavioral healthcare in Arizona, and we look forward to continuing to work with local providers and community partners to help Arizonans live better, healthier lives.”

The plan’s subsidiaries, Arizona Complete Health-Complete Care Plan and Care1st Health Plan Arizona, will offer physical and behavioral healthcare services to individuals with serious mental health conditions. 

Specifically, the payer will provide services for individuals eligible for Title XIX and Title XXI services. These groups of beneficiaries may all under Medicaid or Children’s Health Insurance Program (CHIP) coverage. Centene’s plans will also address crisis system functions and court-ordered evaluations in addition to services that run on grant funding.

The payer will cover around 22,000 beneficiaries in 12 counties—seven counties in southern Arizona and five counties in the northern area of the state—as well as other regions that require crisis support.

The contract will last three years starting October 1, 2022. Arizona’s Medicaid program will have the option to renew the contract as a two-year contract twice.

“It is a privilege to have been selected to continue serving Arizonans living in crisis or with severe mental illness,” said Martha Smith, president and chief executive officer of Centene’s Arizona plan. 

“Our mission is to transform the health of our communities, one person at a time, which we believe requires a holistic approach to care that addresses mind, body, and social determinants of health, such as nutrition, housing, and employment. The result is improved health outcomes, lower costs, and a higher quality of life.”

The announcement comes shortly after Centene released a report on improving mental healthcare for children.

“Payers are uniquely positioned to play a critical role in advancing mental healthcare delivery through continued support of innovative technology, evidence-based clinical programs, educational programming, and community partnerships,” Centene’s report explained.

Centene is acquiring Magellan Health, a behavioral healthcare platform, in an effort to diversify and integrate its behavioral healthcare capabilities. The payer announced its plans to acquire Magellan Health in January 2021.

In Magellan Health’s 2021 second-quarter financial report, the behavioral healthcare company projected that the acquisition would finalize in the second half of 2021.

Integrating physical and mental or behavioral healthcare services is a key part of Centene’s behavioral healthcare strategy. 

Brett Hart, chief operating officer of medical strategy and former chief behavioral health officer at Centene, told
HealthPayerIntelligence that for the past three to four decades behavioral healthcare has been isolated from physical healthcare services. 

Thus, when instituting new efforts to bridge the gap between mental or behavioral healthcare and physical healthcare whether in the private payer setting or for a public payer such as Arizona’s Medicaid program, Hart noted that payers must address both historic barriers to integration as well as the new challenges that they face with new technologies and frameworks.

These efforts to integrate care are critical for Medicaid programs because Medicaid has proven instrumental in enabling access to substance abuse care and behavioral and mental healthcare treatment.

 
 

Clipped from: https://healthpayerintelligence.com/news/centene-will-address-serious-mental-healthcare-in-az-medicaid
 

 
 

 
 

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Paramount has lost in court (again).

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Appeal likely in dispute over managed care business

 
 

A judge on Tuesday dismissed an attempt to overturn more than $22 billion worth of managed-care business as the Ohio Department of Medicaid tries to reshape the way it works with 3 million low-income and disabled Ohioans.

However, questions remain about potential conflicts of interest on the part of some involved in awarding the business.

Franklin County Common Pleas Judge Julie M. Lynch dismissed an attempt by Paramount Advantage to stop the process by which the Medicaid department hopes to revamp the way it handles prescription drugs, coordinates care for kids with complex behavioral needs and delivers care to traditional Medicaid recipients. The new system is scheduled to go live next July.

Toledo-based Paramount claimed the procurement process was biased against it — and in favor of some of the country’s biggest corporations. Loss of the business will mean the loss of 600 jobs, the company’s lawyers said.

Judge Lynch said the company’s case didn’t pass legal muster.

“Paramount needed to show that the department of Medicaid abused its discretion” with clear and convincing evidence, Lynch said, later adding that Paramount “failed in every respect to meet that burden.”

In a little more than three days of testimony in late October and this week, Paramount’s attorneys entered evidence that they said showed the Medicaid department was biased against the managed-care company, which has worked with the department for more than 20 years.

For example, the Medicaid evaluators in some instances dinged relatively small Paramount for not working out of state, in contrast to huge bidders such as UnitedHealth, which works in many states.

Paramount also pointed out that while two of the successful bidders have been recently sued by the state on claims of fraud, they weren’t penalized, while Paramount got no credit for not being accused of such conduct.

And on Tuesday, the company called a statistician who testified that when they met, Medicaid evaluators lowered Paramount’s scores much more than any of the other applicants’ and in a way that was unlikely to be random.

But Lynch found the testimony and the other evidence unpersuasive, ruling that Paramount failed to show that the Medicaid department acted against it in a “conscious, intentional” way.

“While Paramount is disappointed with the court’s decision, we will continue to explore our strategic and legal options,” said a statement issued by Paramount after the ruling. “We remain committed to helping to ensure the best outcomes for our quarter of a million Medicaid members and our employees who have consistently provided them with the highest quality of service.”

An appeal of the ruling is likely, Paramount’s attorneys said.

Just before Judge Lynch read her ruling, attorney Kirstin R. Fraser complained of how slowly the Medicaid department turned over documents and other materials Paramount requested.

“We only became aware after the fact of the many conflicts of interest involved in this case,” she said.

Among possible conflicts is if Mercer, the consultant that facilitated the procurement, had clients among the companies that were selected for Medicaid contracts. The Medicaid department eventually turned over a memo addressing the matter, but the names of client companies were redacted.

Lynch on Tuesday declined to admit an unredacted version of the memo into evidence.

Another possible conflict is that Medicaid Director Maureen Corcoran seems to own stock in two of the parent companies that won business as part of the massive procurement. 

Corcoran reported owning at least $1,000 worth of each company’s stock last year as part of her regular ethics disclosure. But Medicaid lawyers conceded that Corcoran hadn’t filed an affidavit disclosing exactly how much stock she owned as she contracted with the companies.

Such a disclosure appears to be required by law. But in a court filing, Medicaid attorneys claimed that Corcoran didn’t have a conflict of interest because her investments were with parent corporations UnitedHealth Group and CVS Health, not their Ohio subsidiaries with which the Medicaid department is doing billions worth of business.

Corcoran was expected to testify about such matters, but Judge Lynch so sharply limited what Paramount’s lawyers could ask the Medicaid director that Corcoran ultimately never took the stand.

Foreshadowing issues that could be raised on appeal, Paramount attorney Shawn J. Organ listed some of the things he’d have asked Corcoran had he been allowed. Among them were questions about Corcoran’s stock holdings in managed-care companies, whether she communicated with any bidders during the procurement process and why she decided to restart contract negotiations with Buckeye Health Plan, which had just paid Ohio $88 million to settle claims of fraud.

It’s unclear whether any of these issues will matter legally, but they will likely come up before the Tenth District Court of Appeals.

Clipped from: https://ohiocapitaljournal.com/2021/11/10/attempt-to-block-huge-medicaid-contracts-dismissed/