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Bid Protests Cause DHS to Delay HealthChoices Implementation

March 03, 2017

Today, the Department of Human Services (DHS) announced a delay in the effective dates of the new managed care organization (MCO) agreements for HealthChoices, Pennsylvania’s mandatory Medicaid managed care program. 

During January, DHS selected six MCOs to negotiate contracts with for the physical health care services of 2.2 million Medicaid consumers across the commonwealth. Subsequently, several of the non-selected bidders filed protests. Due to specific process requirements, the June 1 start date for new contracts no longer is viable.

Prior to a “go-live” or start date, DHS conducts an extensive readiness review (usually during a 90-day period) for each plan. Each MCO must successfully demonstrate that it can meet all the requirements contained in the agreement, including network adequacy, and “pass” this comprehensive review before it can begin formal operations and serve Medicaid consumers. 

Additionally, DHS Secretary Ted Dallas said, “We have heard from advocates, consumers, and providers concerning the timeframe for implementing the new HealthChoices agreements, including how they will interact with the planned implementation for Community HealthChoices (CHC).” CHC is the Commonwealth’s new managed long-term supports and services plan targeted to begin January 1, 2018, in the southwest zone. As a result, DHS now is moving to a phase-in approach for the HealthChoices program beginning during January, 2018. The table below identifies the new start dates by zone: 

Zone HealthChoices Start Date CHC Start Date
Southwest January 2018 January 2018
Northwest January 2018 January 2019
Northeast March 2018 January 2019
Southeast July 2018 July 2018
Lehigh/Capital January 2019 January 2019

The chart below lists the existing MCOs currently delivering care, and the selected MCOs that likely will begin providing services during 2018:

Zone Existing HealthChoices MCOs

HealthChoices MCOs
as of January 1, 2018

Southwest
  1. Aetna Better Health 
  2. Gateway Health
  3. United Healthcare of PA
  4. UPMC for You
  1. Gateway Health 
  2. PA Health and Wellness
  3. UPMC for You 
  4. Vista—AmeriHealth Caritas Health Plan
Northwest
  1. Aetna Better Health
  2. AmeriHealth Caritas
  3. Gateway Health
  4. UPMC for You
  1. Gateway Health 
  2. UPMC for You 
  3. Vista—AmeriHealth Caritas Health Plan
Northeast
  1. Aetna Better Health 
  2. AmeriHealth Caritas
  3. Geisinger Health Plan
  1. Gateway Health
  2. Geisinger Health Plan
  3. UPMC for You 
Southeast
  1. Aetna Better Health 
  2. Health Partners Plans
  3. Keystone First Health Plan
  4. United Healthcare of PA
  1. Gateway Health
  2. Health Partners Plans
  3. PA Health and Wellness
  4. UPMC for You 
  5. Vista–Keystone First Health Plan 
Lehigh/Capital
  1. Aetna Better Health 
  2. AmeriHealth Caritas 
  3. Gateway Health
  4. United Healthcare of PA
  5. UPMC for You  
  1. Gateway Health
  2. Geisinger Health Plan
  3. Health Partners Plans
  4. PA Health and Wellness

 

HAP recommends that member hospitals work with plans entering the specific geographic zones in which they operate in order to provide services to members enrolled in these MCOs.

HAP will continue to monitor the status of the HealthChoices implementation and provide additional updates as they become available.

For more information, contact Jolene Calla, HAP’s vice president of healthcare finance and insurance.

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