PRINTER'S NO. 648
No. 60 Session of 2007
INTRODUCED BY EARLL, ERICKSON, PILEGGI, SCARNATI, GREENLEAF, MADIGAN, PIPPY, RAFFERTY, ORIE, D. WHITE, REGOLA, GORDNER, TOMLINSON, ARMSTRONG, BROWNE, CORMAN, VANCE, McILHINNEY, BRUBAKER, PUNT, PICCOLA, ROBBINS, WAUGH, RHOADES, M. WHITE, BAKER, WONDERLING, EICHELBERGER, FOLMER, BOSCOLA, COSTA, DINNIMAN, FONTANA, FUMO, HUGHES, KASUNIC, KITCHEN, LAVALLE, LOGAN, MELLOW, MUSTO, O'PAKE, STACK, STOUT, TARTAGLIONE, WASHINGTON, A. WILLIAMS, C. WILLIAMS AND WOZNIAK, MARCH 20, 2007
REFERRED TO PUBLIC HEALTH AND WELFARE, MARCH 20, 2007
A RESOLUTION 1 Urging the Rendell Administration and the Secretary of Public 2 Welfare to desist in any action that furthers the planned 3 move from a voluntary managed care choice to a mandated fee- 4 for-service system for medical assistance recipients. 5 WHEREAS, The Commonwealth has utilized a managed care model 6 and managed care organizations as the foundation for providing 7 health care access and improved health care quality to medical 8 assistance consumers for nearly a quarter of a century; and 9 WHEREAS, Managed care programs were created to coordinate and 10 manage all physical health care for medical assistance consumers 11 to provide a "medical home" which will ensure continuity of care 12 and access to practitioners and specialists, encourage early 13 detection of serious medical conditions and provide preventative 14 medicine that reduces the need for more costly medical 15 interventions; and
1 WHEREAS, Managed care programs were also created to provide 2 quality health care in a cost-effective manner with an emphasis 3 on controlling health care costs; and 4 WHEREAS, The voluntary managed care programs, which provide 5 coordinated health care, are currently offered to medical 6 assistance consumers in 26 counties within this Commonwealth; 7 and 8 WHEREAS, Approximately 71,000 medical assistance consumers 9 are currently enrolled in a voluntary managed care program; and 10 WHEREAS, Physical health managed care organizations are 11 responsible for managing all physical health services, including 12 pharmaceutical coverage and dental services, for medical 13 assistance consumers who choose to participate in a voluntary 14 managed care plan; and 15 WHEREAS, According to U.S. News and World Report and the 16 National Committee for Quality Assurance (NCQA), which accredits 17 these organizations, the managed care plans in this Commonwealth 18 are ranked in the top 20 among all Medicaid health plans across 19 the United States; and 20 WHEREAS, The Rendell Administration's Department of Public 21 Welfare has unilaterally issued a declaration that, effective 22 July 1, 2007, will move all medical assistance consumers 23 enrolled in a voluntary managed care health plan to Access Plus, 24 a fee-for-service health system which is subcontracted by the 25 Department of Public Welfare to one specific vendor; and 26 WHEREAS, This forced change to mandated fee-for-service 27 health care will be completed without the benefit of any public 28 comment or public hearings that would enable medical assistance 29 consumers and health care providers currently participating in 30 voluntary managed care plans to provide public input; and 20070S0060R0648 - 2 -
1 WHEREAS, Governor Ed Rendell and Estelle Richman, Secretary 2 of Public Welfare, have stated that the Department of Public 3 Welfare will send out notices of this forced change to a 4 mandated fee-for-service system for medical assistance consumers 5 on or about April 1, 2007; and 6 WHEREAS, Medical assistance consumers will be prohibited from 7 continuing to choose voluntary managed health care after April 8 1, 2007; and 9 WHEREAS, The Department of Public Welfare will require that 10 voluntary managed care organizations refrain from prior 11 authorization of any services beyond June 30, 2007, which will 12 unduly delay necessary health care for medical assistance 13 consumers; and 14 WHEREAS, Managed care organizations were created to 15 intensively manage the care of individuals with chronic diseases 16 and complex medical cases who need continual management and 17 monitoring of their conditions and health care in order to 18 lessen the risk of further complications; and 19 WHEREAS, Managed care organizations employ case managers, 20 special needs staff, disease management specialists and outreach 21 health prevention staff who currently serve this medical 22 assistance population; and 23 WHEREAS, A forced move to a mandated fee-for-service system 24 will abruptly stop the continuity of care and management of 25 chronic diseases for medical assistance consumers, including 26 medical assistance consumers with special needs; and 27 WHEREAS, Medical assistance consumers currently in voluntary 28 managed care may be forced to find new providers, which could 29 create transportation challenges and difficulties for medical 30 assistance consumers as well as unacceptable delays in 20070S0060R0648 - 3 -
1 preventative health care and early detection of chronic 2 conditions; and 3 WHEREAS, The Rendell Administration's Department of Public 4 Welfare should continue to recognize that there are medically 5 underserved areas and physician shortages, particularly within 6 the more rural areas of this Commonwealth; and 7 WHEREAS, The change to a mandated fee-for-service system from 8 the voluntary managed care choice will create a serious shortage 9 in the number of primary care and specialist physicians 10 participating in the medical assistance program; and 11 WHEREAS, The Rendell Administration's Department of Public 12 Welfare, along with its fee-for-service contractor, will be 13 unable to conduct the essential outreach efforts needed to 14 create a comprehensive and cohesive network of specifically 15 selected primary care physicians, specialists and other 16 providers to serve this medical assistance population; and 17 WHEREAS, While this extensive outreach effort is being 18 developed, medical assistance consumers will not have access to 19 necessary health care; and 20 WHEREAS, This move from a voluntary managed care choice to a 21 mandated fee-for-service system will disrupt long-established 22 patient-physician relationships and coordination with 23 professional health staff, including disease managers; and 24 WHEREAS, This move from a voluntary managed care choice to a 25 mandated fee-for-service system will only exacerbate the medical 26 problems of this vulnerable population thereby causing an 27 increased future fiscal impact to serve their unmet needs; and 28 WHEREAS, This move from a voluntary managed care choice to a 29 mandated fee-for-service system will result in irreparable harm 30 for medical assistance consumers of this Commonwealth who 20070S0060R0648 - 4 -
1 participate in this managed care system; and 2 WHEREAS, This hastily ill considered move from a voluntary 3 managed care system to a mandated fee-for-service system will 4 cause a breakdown in the continuity of care and cause extreme 5 confusion for medical assistance consumers across this 6 Commonwealth, thereby severely endangering their health care 7 management, especially those consumers with chronic diseases and 8 special needs; and 9 WHEREAS, The Rendell Administration and its Department of 10 Public Welfare have not demonstrated the need to fragment the 11 current managed health care system which has demonstrated a 12 measurable record of success, both in terms of patient care 13 management and the control of spiraling health care costs; and 14 WHEREAS, Access Plus is untested and unproven in achieving 15 the dual objectives of quality health care through responsible 16 patient care management and the sustained reduction of health 17 care costs; therefore be it 18 RESOLVED, That the Senate urge the Rendell Administration and 19 the Secretary of Public Welfare to cease and desist in issuing 20 notices and furthering this harmful and deleterious move from a 21 voluntary managed care choice to a mandated fee-for-service 22 system for the 71,000 affected medical assistance consumers; and 23 be it further 24 RESOLVED, That the Rendell Administration and its Department 25 of Public Welfare continue providing medical assistance health 26 care through the established voluntary managed care system until 27 a comprehensive study and review of the change to a mandated 28 Access Plus program is completed and full input is obtained from 29 affected medical assistance consumers and health care providers 30 as well as an opportunity for public comment and legislative 20070S0060R0648 - 5 -
1 consideration so that a thorough analysis can be done and 2 accountability measures established before such a precipitous 3 action is unalterably implemented; and be it further 4 RESOLVED, That copies of this resolution be transmitted to 5 the Governor and to the Secretary of Public Welfare. C19L82BIL/20070S0060R0648 - 6 -