CUP Gains Ally In Its Medicaid Lawsuit
By Marissa Harshman, The Columbian, Vancouver, Wash. |
The state
Columbia United Providers, a community-based health insurance plan owned by
CUP filed a lawsuit against the state earlier this month in
CUP recently found an unlikely ally in Community Health Plan of
"We felt the evaluation by the state did not follow the process as outlined by the RFP (request for proposals)," said
Meanwhile, the
Molina, a for-profit company based in
Now that the contracts are signed, HCA staff is working to ensure the plans can meet the terms and conditions required by the state, said
The HCA is also holding biweekly meetings with current and new plans and meeting one-on-one with the plans to ask more detailed questions, Cody said.
"Ultimately, we're concerned about making sure clients have adequate care, not only in
Network adequacy
Adequate care is the crux of the lawsuit filed by CUP and Community Health Plan of
The lawsuit argues the state signed contracts with health plans that do not have adequate provider networks in order to "enter into agreements with national health plans that offered dramatic but illusory savings through low bid rates," according to court documents.
Network adequacy is determined based on the number of clients in a geographical area and the types of providers. A computer program calculates a score for each plan based on those factors and the number of providers contracted with the plan. The plans must receive a score of at least 90 percent, Cody said.
During the bidding process, the state required each plan to demonstrate they could develop a network to the state's standard. The plans needed to have letters of commitment from providers in order to submit a bid application but did not need to have a provider network in place at the time of applying, Cody said.
Plans must now turn those letters of commitment into signed contracts with providers, Cody said. The plans have until
Cody wouldn't comment on the number of
"In
CUP officials believe there is significant progress that needs to be made.
Last week, CUP issued a survey to its providers in the community asking about their contract status with Molina and Coordinated Care. Nearly 40 medical groups representing more than 700 providers responded to the survey, including
The survey results were included in the lawsuit.
A
Sufficient capacity
Federal
"We won't assign clients to any plan without an adequate network," Cody said.
If only one plan is able to meet the requirements, everyone would be assigned to the successful plan or be given the opportunity to switch to fee-for-service
If neither plan meets the requirements, the state would assign everyone to fee-for-service and then rebid the area to find plans, Cody said.
Community Health Plan
Community Health Plan of
The state told the nonprofit that, after further review, it didn't meet the requirements for access. Based on the raw data, the plan believes it met the requirement in all but
"Kicking us out of the counties, it really not only hurts us as a company but also the local nonprofit groups," he said.
Community Health Plan is a nonprofit owned by a network of community and migrant health centers in the state. Any savings are given back to the community health centers to care for the uninsured, Springer said. The plan also uses money to help provide additional services, such as interpreters, transportation and care coordinators for people with disabilities, he said.
In
"We've made a long-term commitment to the state and feel like we're being displaced by out-of-state, for-profit plans that haven't made any commitment," Springer said.
Cody, with the HCA, said the state didn't target nonprofit or for-profit groups. The state administered a fair and equitable review process and selected the groups that could meet the requirements, he said.
The goal, Cody said, is to improve the quality of care for
"Community Health Plan and CUP have been good business partners," he said. "This is certainly not a statement on them at all."
The new contracts will be in effect from
.
___
(c)2012 The Columbian (Vancouver, Wash.)
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Source: | McClatchy-Tribune Information Services |
Wordcount: | 1238 |
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