PRIOR PRINTER'S NO. 2009 PRINTER'S NO. 2063
No. 207 Session of 1997
INTRODUCED BY O'BRIEN, OLIVER, MICOZZIE AND COLAFELLA,
JUNE 10, 1997
AS AMENDED, HOUSE OF REPRESENTATIVES, JUNE 11, 1997
A RESOLUTION
1 Calling for the Legislative Budget and Finance Committee to
2 conduct an immediate study of the physical health component
3 of the HealthChoices program administered by the Department
4 of Public Welfare in order to evaluate the adequacy of rates
5 for managed care organizations under HealthChoices.
6 WHEREAS, The Department of Public Welfare has contracted with
7 managed care organizations to provide physical health managed
8 care services to eligible medical assistance recipients in
9 southeastern Pennsylvania, with initial program implementation
10 on February 1, 1997; and
11 WHEREAS, The mandatory enrollment of medical assistance
12 eligibles has continued throughout 1997 with the last remaining
13 population groups, Supplemental Security Income and general
14 assistance eligibles, required to be enrolled in a managed care
15 organization plan by September 1, 1997; and
16 WHEREAS, The HealthChoices program represents a policy shift
17 in the delivery of health care services for the medical
18 assistance population from fee-for-service to managed care to
19 improve the overall quality of health care services; and
1 WHEREAS, The enrollees in HealthChoices, the providers of
2 services under HealthChoices and the managed care organizations
3 share the physical health program goals of maintaining adequate
4 funding levels necessary to provide all of the medical services
5 to the enrollees in HealthChoices; therefore be it
6 RESOLVED, That the House of Representatives call for the
7 Legislative Budget and Finance Committee to conduct an immediate
8 study of the physical health component of the HealthChoices
9 program in southeastern Pennsylvania in order to ascertain the
10 adequacy of the rates contained in contracts between the
11 Department of Public Welfare and managed care organizations; and
12 be it further
13 RESOLVED, That the House of Representatives believe that the
14 Legislative Budget and Finance Committee's report should include
15 an evaluation of the adequacy of the physical health rate
16 categories under HealthChoices conducted by an independent
17 actuary with experience in evaluating Medicaid managed care; and
18 be it further
19 RESOLVED, That the actuarial study should include an
20 evaluation of all of the rate categories under HealthChoices and
21 include specific evaluations of the following issues:
22 (1) A comparison of the methodology and assumptions used
23 by the Department of Public Welfare with relationship to the
24 fee-for-service adjustments, managed care adjustment factors
25 and other assumptions made in determining the rates for the
26 managed care organizations under HealthChoices.
27 (2) An evaluation of the assumed utilization, average
28 unit cost and cost per member per month of special needs
29 populations, including children with disabilities,
30 Supplemental Security Income eligibles and individuals with
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1 HIV/AIDS.
2 (3) An evaluation of the Department of Public Welfare's
3 range of assumptions on adjustment factors for
4 disproportionate share and medical education costs to
5 determine whether those assumptions are accurate within the
6 marketplace.
7 (4) An analysis of whether the Department of Public
8 Welfare's interpretation of medically necessary services
9 under HealthChoices has resulted in an expansion of managed
10 care organization responsibility under HealthChoices and
11 whether the rates accurately reflect the service level.
12 (5) An evaluation of the recovery of the full range of
13 administrative costs associated with implementation of the
14 physical health HealthChoices program.
15 (6) An analysis of whether the risk adjustments properly
16 account for demographics and health status in establishing
17 the rates;
18 and be it further
19 RESOLVED, That the Legislative Budget and Finance Committee
20 report its findings to the House of Representatives by September <--
21 30, 1997 DECEMBER 1, 1997. <--
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