PRINTER'S NO. 2652
No. 2 Session of 1997
INTRODUCED BY O'BRIEN, DECEMBER 3, 1997
REFERRED TO COMMITTEE ON RULES, DECEMBER 3, 1997
A RESOLUTION
1 Amending House Resolution No. 207, adopted June 11, 1997,
2 entitled "A resolution calling for the Legislative Budget and
3 Finance Committee to conduct an immediate study of the
4 physical health component of the HealthChoices program
5 administered by the Department of Public Welfare in order to
6 evaluate the adequacy of rates for managed care organizations
7 under HealthChoices," further providing for the report of the
8 committee.
9 RESOLVED, That House Resolution No. 207, adopted June 11,
10 1997, be amended to read:
11 A RESOLUTION
12 Calling for the Legislative Budget and Finance Committee to
13 conduct an immediate study of the physical health component
14 of the HealthChoices program administered by the Department
15 of Public Welfare in order to evaluate the adequacy of rates
16 for managed care organizations under HealthChoices.
17 WHEREAS, The Department of Public Welfare has contracted with
18 managed care organizations to provide physical health managed
19 care services to eligible medical assistance recipients in
20 southeastern Pennsylvania, with initial program implementation
1 on February 1, 1997; and
2 WHEREAS, The mandatory enrollment of medical assistance
3 eligibles has continued throughout 1997 with the last remaining
4 population groups, Supplemental Security Income and general
5 assistance eligibles, required to be enrolled in a managed care
6 organization plan by September 1, 1997; and
7 WHEREAS, The HealthChoices program represents a policy shift
8 in the delivery of health care services for the medical
9 assistance population from fee-for-service to managed care to
10 improve the overall quality of health care services; and
11 WHEREAS, The enrollees in HealthChoices, the providers of
12 services under HealthChoices and the managed care organizations
13 share the physical health program goals of maintaining adequate
14 funding levels necessary to provide all of the medical services
15 to the enrollees in HealthChoices; therefore be it
16 RESOLVED, That the House of Representatives call for the
17 Legislative Budget and Finance Committee to conduct an immediate
18 study of the physical health component of the HealthChoices
19 program in southeastern Pennsylvania in order to ascertain the
20 adequacy of the rates contained in contracts between the
21 Department of Public Welfare and managed care organizations; and
22 be it further
23 RESOLVED, That the House of Representatives believe that the
24 Legislative Budget and Finance Committee's report should include
25 an evaluation of the adequacy of the physical health rate
26 categories under HealthChoices conducted by an independent
27 actuary with experience in evaluating Medicaid managed care; and
28 be it further
29 RESOLVED, That the actuarial study should include an
30 evaluation of all of the rate categories under HealthChoices and
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1 include specific evaluations of the following issues:
2 (1) A comparison of the methodology and assumptions used
3 by the Department of Public Welfare with relationship to the
4 fee-for-service adjustments, managed care adjustment factors
5 and other assumptions made in determining the rates for the
6 managed care organizations under HealthChoices.
7 (2) An evaluation of the assumed utilization, average
8 unit cost and cost per member per month of special needs
9 populations, including children with disabilities,
10 Supplemental Security Income eligibles and individuals with
11 HIV/AIDS.
12 (3) An evaluation of the Department of Public Welfare's
13 range of assumptions on adjustment factors for
14 disproportionate share and medical education costs to
15 determine whether those assumptions are accurate within the
16 marketplace.
17 (4) An analysis of whether the Department of Public
18 Welfare's interpretation of medically necessary services
19 under HealthChoices has resulted in an expansion of managed
20 care organization responsibility under HealthChoices and
21 whether the rates accurately reflect the service level.
22 (5) An evaluation of the recovery of the full range of
23 administrative costs associated with implementation of the
24 physical health HealthChoices program.
25 (6) An analysis of whether the risk adjustments properly
26 account for demographics and health status in establishing
27 the rates;
28 and be it further
29 RESOLVED, That the Legislative Budget and Finance Committee
30 report its findings to the House of Representatives by [December
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1 1, 1997] February 13, 1998.
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