/House bends Medicaid rules to accommodate hospital provider plan

House bends Medicaid rules to accommodate hospital provider plan

Mississippi True is the only insurance company that is supported by state health care providers. It is comprised of 60 hospitals and has support from the State’s Hospital Association. This requirement would allow Mississippi True to bypass Medicaid’s bidding process and award an estimated $300,000,000 contract. It is a move that, according to several legislators, effectively bends agency rules in order to accommodate one company. Here’s what we know. The bid process was held. Three companies were awarded contracts. The legislation was sponsored by Rep. Jason White (R-West). There were many other companies that were in front of the provider-sponsored health plan. “Now, I’m here not to take down a provider-sponsored programme. “I’m for it, that’s why i tried to include them.” This carve-out is part of the House’s Medicaid technical bill. It reauthorizes rules governing the state’s Medicaid program. The bill would require that the agency establish a pilot program for provider-sponsored plans over three years, with the possibility of giving the new company between 5 and 10% of Mississippi’s 500,000 managed-care beneficiaries. This provision is widely considered an attempt to correct what some legislators call a bungled procurement process. The Division of Medicaid granted new managed care contracts this summer to United Healthcare and Magnolia Health. Many lawmakers protested the exclusion of Mississippi True, arguing that the evaluation process was biased. Rep. Becky Currie (R-Brookhaven) stated that she believes the bidding process was flawed. “I want hospitals to have the resources they need to climb out of this hole.” Over the years, lawmakers struggled to figure out how to control Medicaid’s budget. It currently exceeds $6 billion in federal and state funds. The agency introduced managed care in 2011 as a way to reduce costs. Managed care is a system where Medicaid pays insurance companies a flat fee for each beneficiary. This gives these companies incentives to keep their patients healthy and reduce the amount of services they use. The hospitals are at odds with managed care companies for years, arguing that managed healthcare’s reimbursement rates are too low to cover the cost of care. Hospitals can take over these complaints by setting up a provider-sponsored plan in which they would handle the care of their patients. This will allow them to get a slice of the lucrative managed-care pie. Mississippi Medicaid spends $3B a year on managed care programs. The company has a large reach, which is why Mississippi True has received widespread legislative support. Mississippi True, unlike the other three managed care companies that won contracts is not based in the state. Instead, the company is a partnership with 60 hospitals throughout the state. This means that most legislators have a member hospital within their district. Many of these legislators believe that the current carve out doesn’t go far enough to make Mississippi True a success. Currie proposed an amendment to increase the cap on Mississippi True’s program size from 10 percent to 20 percent of the managed-care population. Currie noted that Medicaid had guaranteed at least 20 percent to each of the three other companies its managed care population. “As a business model, and as common sense I don’t believe (Mississippi True), will be able survive with just that. Currie stated that 20 percent is allowed for other companies, so I would like them to have 20 percent. Rep. Steve Holland (D-Plantersville), suggested increasing the cap to 15% after that amendment was defeated. This amendment also failed. Chuck Reece (chairman of Mississippi True), echoed their concerns and said that anything below 20 percent “won’t work”. White, the bill’s author, seemed visibly uneasy, shifting in his chair and shaking his head. White told the committee that any attempt at increasing the size of this pilot program would be a poison pill to the measure. This is because the carve-out has already effected the bidding process legally required for other companies. It’s not a pilot programme if it exceeds 20%. White stated that we are mandating the selection of a winner and will place you with the three other bidders. Voting for this amendment means you are voting to reward hundreds and millions of dollars in a contract with one provider, one provider only. What? There are no performance standards. It is a mandate they receive this bid.” White’s argument didn’t convince Holland or Currie. Both stated that they would bring up the identical amendments to the House floor when the bill is introduced. Holland stated Wednesday that “That’s going be the big contrention at the floor of the House, I can tell you that.” White stated that the Mississippi Today carve-out is a pilot program, according to Mississippi Today. This is because the population cannot exceed 10 percent, and the program’s duration is only three years. Managed care companies have contracts for three years with an option to extend it by two more. For the managed care companies and their supporters it is unjust to try to change the rules for one or more competitors. “Personallly, I would rather have the procurement thrown out and rebid than for the state award non-competitive contracts to any entity. Aaron Sisk, CEO at Magnolia Health, one the three managed care plans in the state, stated that this applies to all areas of health care. I’m open to the idea of a provider-sponsored plan, or even to competing with one. “I would only ask that it be fair competition.” Some worry that Mississippi True could be forced to receive a portion of managed care pie without going through the procurement process. This could create a negative legislative precedent. Jameson Taylor, Mississippi Center for Public Policy, stated that the Mississippi True approach to the carve-out undermines Mississippi’s contracting process. “It sends a message that vendors and other parties that if they don’t get what they want through the normal process of contracting, then they can go through the lobbying process.”