Pennsylvania Medicaid managed care Archives - Safety-Net Association of Pennsylvania

Pennsylvania Health Law Project Newsletter

The Pennsylvania Health Law Project has published its June 2022 newsletter.

Included in this month’s edition are articles about:

Changes in HealthChoices managed care plans that take effect on September 1.
The July 1 transition to Tempus as the financial management services vendor for Community HealthChoices, which means Tempus will take over paying direct care workers hired by Community HealthChoices participants as part of that program’s self-directed care model.
A reduction of the deadline for requesting a fair hearing in response to Medicaid eligibility rejection or termination from the program from 90 days, which it has been since the start of the COVID-19 emergency, back to the 30 days it was before that time. This change is retroactive to May.
A lifting of the pandemic-driven suspension of the need for prior authorization for shift nursing services for Medicaid beneficiaries under the age of 21, which will take effect on November 1.

Read about these subjects and more in the June 2022 edition of Health Law News, the Pennsylvania Health Law Project’s newsletter.

jsteinbock2022-07-06T21:19:51+00:00July 7th, 2022|COVID-19, HealthChoices, Pennsylvania Medicaid, Pennsylvania Medicaid COVID-19, Pennsylvania Medicaid policy|Comments Off

HealthChoices Procurement Again Mired in Litigation

For the past six years Pennsylvania has been trying to rebid its HealthChoices Medicaid managed care contracts but every time it does, the losing bidders sue the state and the procurement process grinds to a halt.

Three times since 2015 the state has issued requests for proposals from managed care companies and all three times at least one of the losing parties has responded to its defeat by filing a lawsuit.

This is happening, many believe, because the state’s Medicaid managed care contracts are so lucrative – a stark contrast with state Medicaid payments to providers, which are generally considered poor.

The matter is now in the state’s Commonwealth Court, and the stakes are great: the contracts are for five years, with a possible option for another three.

The Philadelphia Inquirer has taken a look at the challenges that have prevented Pennsylvania from awarding new HealthChoices Medicaid managed care contracts in the article “Insurers want Pa.’s Medicaid business so badly they keep suing the state.”

jsteinbock2021-07-07T19:42:10+00:00July 7th, 2021|HealthChoices, Pennsylvania Medicaid|Comments Off

PA Health Law Project Newsletter

The Pennsylvania Health Law Project has published its August 2020 newsletter Health Law News.

Included in this month’s edition are articles about:

The Department of Human Services’ selection of new managed care plans to serve Pennsylvania Medicaid’s Community HealthChoices program.
The end of ensured continuity of long-term services and supports for participants in the Community HealthChoices program in northeastern Pennsylvania.
The availability of navigators to help connect people to COVID-19 testing and treatment.

Read about these subjects and more in the Pennsylvania Health Law Project’s August 2020 newsletter.

PA Safety Net Admin2020-08-05T06:00:27+00:00August 5th, 2020|HealthChoices, long-term care, Pennsylvania Medicaid, Pennsylvania Medicaid policy, Pennsylvania Medical Assistance|Comments Off

PA Awards HealthChoices Managed Care Contracts

Last week Pennsylvania’s Department of Human Services awarded new contracts to managed care organizations to provide physical health services under the state’s HealthChoices Medicaid managed care program.
Eight different organizations were awarded 23 separate three-year contracts, to take effect on January 1, 2017, to serve more than two million Medicaid beneficiaries in five state HealthChoices regions.
All of the managed care organizations will be operating under a contractual mandate to increase how much care they provide on a value-based purchasing basis through accountable care organizations, bundled payment models, patient-centered medical homes, and other integrated care delivery approaches. They also will be required to coordinate their efforts more effectively with the behavioral health care organizations that serve their members.
Learn more about who won the contracts and how the winners will be expected to perform differently than HealthChoices managed care organizations have in the past in this state news release.

PA Safety Net Admin2016-05-05T06:00:56+00:00May 5th, 2016|HealthChoices PA, Pennsylvania Medicaid policy, Uncategorized|Comments Off

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