IMPORTANT MESSAGE REGARDING MEDICAID VOLUNTARY MANAGED CARE COUNTIES NEWSFLASH - March 2007

Dear Provider,

Last Thursday, DPW announced its intention to move all Medicaid recipients in counties outside of Health Choices that participate in Managed Care Plans to Access Plus, the Fee for Service state program.  Those are referred to as Voluntary Counties (meaning a recipient has choice of a managed care plan or Fee for Service).  They will no longer have choice.  This announced movement will affect 75,000 people across the state (Gateway has 24,000). It is scheduled to happen June 1, 2007, with notices being sent to Medicaid recipients on April 1, 2007.  We have been informed not to authorize any services beyond June 1st for these members.

This announced move will take away choice of plans and force our members into a system which has fewer actively participating physicians, especially specialists, while reimbursing them frequently at lower rates.  Also, members will be disengaged from Case Managers, Special Needs staff, Disease Management specialists, Outreach staff, Preventive Health, staff of Gateway that for years have served them well.  DPW justifies this move based on a study performed by their paid actuaries which has multiple methodological flaws and no attention to quality.  This will disrupt many patient/physician relationships potentially, as well as the relationships with health care professionals as described above.  For physicians, it will disrupt their relationships with health plan staff, whose collaboration, we believe, is of significant value to the physician.

This will also have significant financial impact on the providers as the MCO’s, in most cases, reimburse at rates above the Medical Assistance Fee Schedule. Timely and accurate payments may not occur. Providers will no longer have dedicated provider relations and clinical representatives they could work with to resolve any type of issue.  There will be NO option available to providers and members if they are dissatisfied with the performance of the Access Plus program.     

We would appreciate your attention to this matter.  The deadline for commenting to DPW through the address below is March 9th.  If they receive sufficient concern, they may elect to cancel the transition.

We believe legislative attention will be necessary to stop this transition.  If you share our concerns, we ask you to join us in commenting to DPW and also writing and/or contacting your legislators.

We have attached a draft lette (SAMPLE ADVOCACY LETTERS) and the current addresses of the legislative leadership and the address for comments to DPW.

 The address for DPW Comments is:

Transition to ACCESS Plus

Office of Medical Assistance Programs

515 Health and Welfare Building

P. O. Box 2675

Harrisburg, PA 17105

Sincerely,

Gateway Health Plan^®