Vancouver Medicaid Provider CUP to File Lawsuit Against State

Republished courtesy of the Vancouver Columbian

March 2, 2012--Columbia United Providers will file a lawsuit against the state Health Care Authority in federal court Monday afternoon.

CUP will also request a temporary restraining order to prevent the Health Care Authority from issuing contracts to the organizations selected to provide Medicaid services to Washington residents, said Dr. Lisa Morrison, CUP’s medical director.

The hearing was initially scheduled for Thursday afternoon in U.S. District Court in Tacoma but was delayed until 2:30 p.m. Monday.

The state Health Care Authority in January selected five health insurance plans that appear to have successfully bid to provide Medicaid services. The selected insurance plans will manage care for the state’s Healthy Options and Basic Health members, who are mostly low-income women and children.

Columbia United Providers, a Vancouver-based group which has provided those services in Clark County since 1994, was not selected. CUP currently serves about 47,000 Clark County residents and employs 80 people.

CUP filed a formal protest to the Health Care Authority decision on Feb. 3. After an internal review, the Health Care Authority determined the protest lacked merit and upheld its earlier action. The state’s ruling prompted CUP to take legal action this week.

State Sen. Craig Pridemore, D-Vancouver, has also taken action.

Pridemore added proviso language to the Senate’s proposed budget, released Tuesday, that would require HCA to certify the contractor has established a network of acute, primary and specialty care providers sufficient to meet the needs of the anticipated enrollees. If no plan is able to certify an adequate provider network in a county, HCA would be required to accept new bids from each of the original applicants and continue the process until finding a plan that meets the requirements.

The proviso also would prevent HCA from reverting any county with Medicaid managed care services to a fee-for-service program as a result of the bidding process.

Pridemore said he didn’t include the proviso language to defend any specific provider but rather to ensure Southwest Washington has an adequate number of medical providers.

“While the Legislature can’t, and shouldn’t, interfere in an RFP (request for proposal) process if it’s conducted fairly, we do have an absolute responsibility to ensure that our communities aren’t left out in the cold,” Pridemore said Thursday. “The budget proviso provides that surety in the appropriate way.”

Pridemore said he’s fairly confident the proviso will survive budget negotiations and stay in the final budget.

Last month, state Rep. Jim Moeller, D-Vancouver, met with HCA officials who said if the selected insurers couldn’t establish an adequate network of providers, the state would eliminate Medicaid managed care in Clark County and revert to fee-for-service.

That would mean providers would treat the patient and then bill the state. However, virtually no primary care practices accept fee-for-service Medicaid members in Clark County.

News source: