See other bills
under the
same topic
                                                       PRINTER'S NO. 648

THE GENERAL ASSEMBLY OF PENNSYLVANIA


SENATE RESOLUTION

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 -