Tag: State News

 
 

Oregon’s proposed five-year Medicaid plan has lofty goals and concepts. They include expanding members’ access to care, making the health care system more equitable and increasing flexibility in how money can go toward quality of life needs that can influence overall health, like housing and green spaces.

Heavyweights in the health care industry, including coordinated care organizations, support much of it, especially the plan’s focus on equity in health care. But the industry is pushing for more answers and has some concerns about the state’s draft Medicaid plan for 2022-2027, records show. In particular, they question where the money will come from to fund new programs and staffing.

Coordinated care organizations — the entities that insure Medicaid members — behavioral health providers and hospitals have weighed in on the initial concepts in Oregon’s proposed five-year Medicaid plan, also called a waiver. In 53 pages of feedback, health care companies, advocacy groups and industry representatives provide a candid assessment of where Oregon’s health care industry needs to go — and potential blind spots in the proposed plan for the state’s roughly 1.34 million Medicaid members. The Lund Report obtained the health care industry’s feedback on the state’s Medicaid proposal concepts through a public records request. 

Earlier this year, the Oregon Association of Hospitals and Health Care Systems prodded the state for more details. 

“Throughout these concept papers, whether around the global budget or the health equity zones, there is a lack of detail, which makes it difficult to interpret how (Oregon Health Authority) is viewing this policy and creates challenges for hospitals and others in providing meaningful feedback,” the hospital industry’s trade group wrote to the health authority.

Oregon officials are still working on the five-year plan and will release another draft with more details in early November. From there, they will negotiate its terms with the federal Centers for Medicare & Medicaid Services before Oregon’s existing waiver expires in June 2022. 

Lori Coyner, the state’s senior Medicaid waiver advisor, said the health authority has “actively solicited input” from a range of people. 

“We have considered all the input that we received,” Coyner said in a statement. “We have made adjustments where it was appropriate, especially if the adjustment furthered our goal of using the waiver renewal to create a more equitable system of health. During upcoming public comment on the application, we will solicit and consider still more input, and we look forward to more engagement with interested parties, community members and Oregon Health Plan members.”

The waiver is key because it lets states use federal Medicaid funding in ways that go outside the scope of the federal cookie-cutter model of Medicaid. For example, in 2012, Oregon’s Medicaid waiver allowed the state to set up coordinated care organizations. 

About 1.34 million Oregonians are on Medicaid, a program that provides medical coverage to people if their income falls below certain thresholds. That’s about 30% of Oregonians.

Many commenters questioned whether the state has the money to fulfill its expanded goals for Medicaid. About three-quarters of the roughly $8 billion the state spends annually on insuring Medicaid members comes from federal coffers; the rest comes from the state.

Here’s a look at the feedback from the health care industry:

Behavioral Health Care 

PacificSource, a Springfield-based CCO, reminded Oregon Health Authority officials of a 2020 Secretary of State’s audit that found the children’s behavioral health care system is fragmented and siloed.

“While providing care for all members of the Oregon Health Plan is paramount, we believe that earlier interventions and care coordination for our youth could serve as a central strategy for meeting the

administration’s goal of eliminating health inequities,” the CCO wrote in its letter to the authority. 

PacificSource, echoing concerns throughout the industry, said worker shortages pose a threat to goals of providing adequate mental health care for children. This comes in the context of a state proposal to keep children enrolled in Medicaid for five uninterrupted years. 

“We share in the belief that children must receive appropriate mental health care,” the group wrote. “We would ask how this idea works with the proposal to maintain enrollment for children uninterrupted for five years.”

The group added that “without ensuring that the Oregon Health Plan can accept dramatically more patients,” the proposal may not ensure children rapidly receive care. 

“Oregon needs a concerted effort to invest in workforce recruitment, retention and development,” the group wrote. 

AllCare Health, a Grants Pass-based CCO, raised concerns about how Oregon will fulfill its stated goal of increasing access, including pharmacy services for people with behavioral health conditions.

That step, AllCare wrote, “generated concern among stakeholders because increased access to services assumes adequate and culturally appropriate mental health providers. However, in many communities available resources are inadequate to handle current crisis caseloads.”

AllCare said the state’s description of that goal, called Step 3, “does not include a plan for providing or funding much needed workforce development. Step Three also troubled stakeholders because it offers no solution for programs that are too often failing, and places an unreasonable burden on CCOs alone.”

Other aspects of behavioral health care proposals drew praise. The Oregon Council for Behavioral Health in its letter, said it supports the state’s goal of a consistent, reliable funding stream for peer support services through the waiver. Peers in the behavioral health workforce can work closely with clients and offer them perspectives and advice based on their life experiences, such as overcoming addiction. 

They are already utilized in Oregon, but funding them can be difficult. 

“A reliable funding source would sustain and support the development of equitable access to peer services across the state, and provide the opportunity to support equitable living wages for this critical and diverse workforce,” the council wrote in its letter to the state.

Cost Growth Target Concerns 

PacificSource also wants nuance added to the state’s draft paper, saying it “seems to imply an inevitable reduction in the rate of growth (of spending on Medicaid) to 3%.”

That’s tied to the state’s cost-growth target reduction efforts, which have the goal of curbing per-capita health care spending to 3.4% annually and then to 3% after 2026. 

State officials hope to negotiate with the federal government for a formula that will provide Oregon with some of the savings the federal government would receive through efforts to limit the growth of Oregon health care costs.

The state hopes that providers and health care insurers will be able to meet the cost-growth limits in part by rooting out waste and inefficiencies.

PacificSource reminded state officials that at this point, the long-term 3% growth rate is aspirational and not a formal state recommendation. 

“We believe that the concept paper (and the plan) must take into account the real possibility that the 3% target is not a given, and unforeseen events may influence whether or not a future successor committee will recommend that particular target,” PacificSource wrote. “Because this number seems important to determining the amount of savings recaptured for community investment purposes, we ask that the concept paper be amended to reflect this important nuance.”

High Drug Costs Eyed

The Coalition for a Healthy Oregon asked the state to consider, for an unspecified period of time, not counting high-cost pharmaceuticals under the 3.4% rate of growth cap. The coalition represents several CCOs and providers, including  Advanced Health, AllCare Health, Cascade Health Alliance, InterCommunity Health Network CCO, Trillium Community Health Plan, Umpqua Health Alliance and Yamhill Community Care.

“Given the effect of pharmaceutical drug prices on cost growth in the Medicaid system, we need a way to deal with this, especially as a safeguard to protect the global budgets concept,” the group wrote.

CCO Oregon, another group that represents CCOs, urged a similar action for high-cost drugs, usually those that don’t yet have a generic equivalent on the market.

“Achieving approval for a true global budget at 3.4% rate of growth is a goal for the OHA, CCOs, and our provider partners,” the group said. “High-cost pharmaceuticals and therapeutics can skew the overall cost and rate of growth for the OHP and CCOs.”

The group said its goal is quality care without being penalized for high-cost drugs.

Health Equity Zones Scrapped 

Oregon Health Authority officials have backed away from an earlier initial concept that would have put so-called “health equity zones” in place for communities to determine funding priorities.

Instead, the authority is moving forward with a central focus on equity. 

Coordinated care organizations, which are assigned to regions, voiced strong concerns that “health equity zones” would create silos and bureaucracy. 

The Coalition for a Healthy Oregon said its members “are concerned about creating equity zones as described in OHA’s draft concept.”

“We understand communities want greater input in health equity investments,” the group said. “This can be done successfully within the CCO model without creating parallel structures. A parallel track could lead to a divergence of spending priorities, whereas community investments should be aligned in pursuing health equity.”

So did other providers.

“Providence appreciates the intent behind this concept but has concerns about the duplication of existing efforts and the potential to create more silos,” Providence Health & Services wrote to the authority. 

CCOs all already have community advisory committees whose purpose is to give community members a voice in CCO policy.

More Dental Access Encouraged 

Dental providers urged Oregon state officials to look for ways to invest in oral health and make it equitable across the state. Oregon Health Plan members can access dental care already. But it can be a struggle to access care or find providers. 

Providence Health & Services wrote: “There is a notable absence of oral health in the concept papers. Oral health is a critical component

of healthcare and should be considered throughout the policies, much as health equity and behavioral health has been considered.”

In an email, Manu Chaudhry, dental director for Capitol Dental Care, a major provider of care for Medicaid members, urged Oregon Health Authority officials to consider the big-picture needs like workforce and the infrastructure as it plans its waiver. This includes coordinating care across physical, behavioral and oral health needs, Chaudhry wrote.

“Addressing issues that impede the ability of those eligible to receive care needs to be a part of Oregon’s ongoing focus to ensure the continuing success of Oregon’s coordinated model and CCOs,” he wrote.

 
 

https://www.thelundreport.org/content/health-care-industry-voices-concerns-over-state%E2%80%99s-medicaid-plan

 

 
 

A Toledo company that’s trying to stop a group of contracts worth billions from going forward on Wednesday focused on what it saw as inconsistencies in the way the Ohio Department of Medicaid procured them. And it again hinted at possible improprieties by Medicaid Director Maureen Corcoran.

It was the second day in a trial considering whether to stop implementation of five-year Medicaid managed-care contracts worth a combined $22 billion — the largest government procurement in state history.

A longstanding Medicaid managed-care company, Paramount Advantage, was not among the six selected earlier this year even though it had been a provider since the start of the state’s managed-care program and it had gotten good ratings.

It says being locked out of the program would result in more than 600 layoffs at Paramount and its parent company, Toledo-based ProMedica.

But if it’s successful in stopping implementation of the contracts, that would at least delay a major overhaul of Ohio’s $30 billion-a-year Medicaid program. The reforms are meant to focus care on individual clients, provide a continuum of service to 60,000 kids with complex behavioral needs and bring transparency to the way it spends billions on prescription drugs.

While the process by which companies were selected was intended to be competitive, it involved many more ambiguities than when state officials take bids for items like asphalt or police cars. Through two days of testimony, Paramount attorney Kirsten R. Fraser has focused on ambiguities and inconsistencies as she tries to make the case that her client was improperly passed over.

Managed-care providers contract with the state to sign up clients, create networks of providers such as doctors and hospitals, help determine what care is covered and see that providers are paid. Managed-care companies are paid a set amount each month for each client they have.

One of the vagaries in the procurement process that Fraser has pointed out is that interested companies were told they’d be evaluated according to three criteria: “method of approach,” “capability” and “experience.” But when she questioned six of the seven Medicaid officials who evaluated proposals, none could point to written definitions of those terms — either in the instructions to submit a proposal, or during the evaluation process.

Paramount contends that the process was biased in favor of huge, out-of-state companies, including Centene, a successful bidder that this year agreed to pay $88 million to settle claims that it ripped off Ohio taxpayers.

Ohio Medicaid Director Maureen Corcoran. Official photo.

 
 

Despite Paramount’s long experience in Ohio, evaluators rated it a weakness that the relatively small company hadn’t operated out of state. Fraser asked Medicaid Deputy Director Patrick Beatty if that didn’t conflict with Corcoran’s claim to a Senate committee that the procurement process would favor companies with deep experience in Ohio. Beatty responded that Corcoran didn’t serve on the panel that evaluated applications.

Even so, Corcoran had the final say in who won contracts.

Corcoran’s role in the procurement is under scrutiny for other reasons.

All of the evaluators who have testified so far said they had to file forms disclosing whether they held a financial interest in the companies trying to win contracts. 

Corcoran has refused to say whether she filed such disclosures even though it appears to be required by law. Documents filed under a separate law show that at least as of last year, Corcoran held stock in two of the companies that were awarded managed-care contracts and in the company that got the contract to create a system of services for kids with complex behavioral problems.

Corcoran also won’t say how much stock in those companies she owns. The law under which she disclosed her ownership only requires officials to say whether they own at least $1,000 worth of stock in a company.

When Fraser asked Beatty if he knew about Corcoran’s holdings, lawyers for the Medicaid department objected and Franklin County Common Pleas Judge Julie M. Lynch sustained the objection.

Fraser also asked Beatty if Corcoran violated the “blackout period” by communicating or having her staff communicate with companies while their proposals were under consideration. Beatty said he knew of no such improper communications.

Several times in her presentation Wednesday, Fraser pointed out that as recently as last year, Paramount scored well ahead on parts of Medicaid’s annual report card than UnitedHealth. That company, the nation’s fifth-largest, was successful in this year’s procurement and Corcoran owned its stock at least from 2018 through 2020.

But the Medicaid evaluators testified that they had strict instructions not to consider their past experiences with companies; they were only to consider what was in the companies’ applications.

Mary Applegate, the department’s medical director, said the point was to re-envision the program and bring about better health outcomes, such as reduced infant mortality. She said that in their application and their oral presentation, Paramount officials explained how they would do things under the current system.

“We wanted resourcefulness,” Applegate said. “We wanted patient-centeredness. We wanted a new paradigm of what ‘managed care’ means.”

The trial will resume Nov. 8.

 
 

https://ohiocapitaljournal.com/2021/10/14/disappointed-medicaid-bidder-focuses-on-inconsistencies/

 
 

 
 

MM Curator summary

 
 

D.C. will re-bid all contracts again in order to appease losing bidder MedStar.

 
 

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 long and winding path D.C. lawmakers have taken to ensure more than 250,000 residents don’t lose Medicaid benefits is nearing the finish line.

The council is expected to vote on extending contracts for three companies for nine months, giving the District just enough time to complete the process all over again.

“Needless to say there’s been a lot of controversy about this,” D.C. Council Chair Phil Mendelson said.

Mayor Muriel Bowser’s administration has essentially dealt with legal concerns over the contracts with three companies to provide Medicaid benefits by re-evaluating each of them, Mendelson said.

“The mayor has rescored the contracts and two of them, Amerihealth and Carefirst, came out on top in the rescoring,” he said.

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The council will approve a separate emergency contract for MedStar Health, which indicated that it did not score third in the administration’s reevaluation. Bowser’s office did not comment on when the reevaluation was completed or where Medstar Health scored.

WTOP reached out to Medstar Health for comment on the anticipated emergency contract extension.

“I think the guiding principles of this solution are avoiding the destabilizing of reassigning folks. Moving forward with a new procurement, it allows any bidder to bid going forward,” Mendelson said of lawmakers’ desire to ensure Medicaid patients were not reassigned to new doctors and risk a lapse in reliable medical care.

The vote before the council extends all three contracts for just nine months, which Mendelson said will give the District time to put out bids and select the health care companies that will provide Medicaid benefits in the future.

“And she has said that can be done in nine months. We are saying it has to be done in nine months. And so I believe the votes are there for this solution to the controversy, which will enable contracts to continue largely uninterrupted or with less risk of disruption,” he said.

Meanwhile, Ward 5 Council member Kenyan McDuffie has introduced a bill expected to be discussed by the council on Tuesday that would attempt to avoid any one company providing Medicaid benefits from raising the costs of other companies by refusing to participate in universal contract pricing.

In August, Deputy Mayor for Health and Human Services Wayne Turnage told WTOP that Medstar Health had informed the two smaller contractors providing Medicaid benefits that if it did not have a contract with the city, it would not provide Medicaid coverage at all. Days later, the mayor declared a state of emergency to allow her administration to enter into a contract with Medstar Health to continue benefits. However, the council issued a resolution of disapproval out of concern that the move would not hold up if challenged in court.

“I just don’t think it’s right that MedStar can say, ‘You know what, unless we have our way, we refuse to serve these people,'” At-Large Council member Elissa Silverman told WTOP at the time.

Mendelson sees the contract extension as a necessary, albeit imperfect solution.

“You know, sometimes in government, it’s incumbent that we find a solution, rather than just stick to a position that doesn’t get anything done,” Mendelson said.

 
 

Clipped from: https://wtop.com/dc/2021/10/dc-council-expected-to-extend-medicaid-benefits-via-emergency-contract/