CUP Gains Ally In Its Medicaid Lawsuit

March 30--The state Health Care Authority is pressing forward with efforts to implement new insurance plans for the state's managed Medicaid population, despite efforts by Vancouver's Columbia United Providers and its supporters.

The state Health Care Authority in January selected five health insurance plans to provide Medicaid services to more than 700,000 Washington residents, including more than 65,000 in Clark County. The selected insurance plans will manage care for the state's Healthy Options and Basic Health members, who are mostly low-income women and children.

Columbia United Providers, a community-based health insurance plan owned by PeaceHealth Southwest Medical Center and other Clark County health care providers, has provided those services in Clark County since 1994 but was not among the five plans selected.

CUP filed a lawsuit against the state earlier this month in U.S. District Court in Tacoma. An injunction hearing has been scheduled for April 9.

CUP recently found an unlikely ally in Community Health Plan of Washington, another Medicaid health plan and competitor in Clark County. Community Health Plan of Washington, a Washington-based nonprofit insurance plan, joined CUP's lawsuit after the state reversed its decision to award the group contracts in Clark and three other counties.

"We felt the evaluation by the state did not follow the process as outlined by the RFP (request for proposals)," said Howard Springer, senior vice president for business development. "We felt they discriminated against us."

Meanwhile, the Health Care Authority has signed contracts with the five health plans selected to provide services. Two plans will serve Clark County: Molina Healthcare of Washington and Coordinated Care Corp.

Molina, a for-profit company based in Long Beach, Calif., currently provides services in Clark County and has contracts with 30 primary care providers, according to its website. Coordinated Care Corp. is a subsidiary of Centene, a Fortune 500 company, and is a new provider in Washington state.

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 Preston Cody, deputy director of HCA. State nurses and clinical staff are making on-site visits to the five plans, he 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 Clark County but in the other 38 counties," he said.

Network adequacy

Adequate care is the crux of the lawsuit filed by CUP and Community Health Plan of Washington.

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 May 16 to secure the contracts, he added. In the interim, the plans must submit progress reports every 10 calendar days. The first report was due March 23.

Cody wouldn't comment on the number of Clark County providers who have signed contracts.

"In Clark County, there's still progress that needs to be made," Cody said.

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 Vancouver Clinic, PeaceHealth Medical Group, Legacy clinics, Evergreen Pediatrics and Oregon Health & Science University. Of them, none had signed a contract with Coordinated Care/Centene. Eight of the groups had signed contracts with Molina; however, many have existing contracts with the plan.

The survey results were included in the lawsuit.

A Centene spokeswoman said earlier the company would not comment until the contract process was complete. Glen Bogner, president of Molina Healthcare of Washington, said earlier that the company would continue to work with its partners in the state to provide quality care to Medicaid members.

Sufficient capacity

Federal Medicaid laws require two plans in each county. Each plan must have the capacity to serve the entire county's Medicaid population.

"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 Medicaid, Cody said. Another option would be to rebid the service area to find a second plan that meets requirements, he said.

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 Washington was originally awarded 32 counties. But on Feb. 16, the plan learned that the state reversed its decision for four of those counties: Clark, Columbia, Wahkiakum and Whitman. Community Health Plan currently serves all four of those counties, Springer said.

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 Wahkiakum County, Springer said.

"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 Clark County, Community Health Plan has several providers at the Vancouver SeaMar Community Health Center, as well as numerous independent providers who are not affiliated with health centers, Springer said.

"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 Medicaid patients and improve the cost to the state.

"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 July 1 to Dec. 31, 2013.

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; [email protected].

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