Medicaid Protests Start Coming In
Last Friday was the deadline for protests to be filed against the decision by the Health Care Authority to contract with 5 of 7 interested health plans.
While it might make sense that one or two plans might appeal – Premera and Columbia United Providers both having come up short in their bids – we’re hearing that as many as 4 plans have protested the HCA decision. We have some asks out to contacts at plans, so we’ll be able hopefully to confirm one way or another soon.
But, in any case, it appears that CUP is organizing throughout Clark County to protest the termination of their Medicaid activity.
A new website – www.patientsloseout.com – is up and appears to be hosted by CUP. The site
A few of the important items discussed are below:
– The Health Care Authority said that if no “apparently successful plan” was able to secure a provider network, and if CUP was not able to increase its RFP score through review, then Clark County would be forced to revert to fee-for-service for Medicaid.
– CUP’s quality metrics were said to be generally in line with every other plan, and in some cases, higher. CUP’s bid was scored low due to the rates it pays to providers, per the HCA.
– Contrary to what the RFP said, other plans submitted bids with rates without having secured contracts from providers. Those plans submitted low rate bids, which caused the CUP score to be artificially lower than had the HCA required other plans to follow the RFP and secure contracts prior to submitting the bid.
– Clark County was singled out in the State’s process. Every other county was grouped together into a larger geographic area. Clark stood alone. Every other county had a range for bids of from “actual” to 3% lower. The HCA gave Clark a range from “actual” to 12% lower.
– CUP worked with providers to lower reimbursement rates from 5%-40%, and submitted a bid 4% lower than the top of the range – a bid that would have been deemed too low in every other region with a range of only 3%.