Monday, October 2, 2017

Medicaid Melee goes back to court.

If at first you don't succeed, try, try again.  Such is the motto of the Mississippi Hospital Association as it tries to get a managed care contract from the Division of Medicaid.  MHA lost when the Division awarded $2 billion in contracts for the MississippiCan program earlier this year.  It lost again when it asked a Chancellor to block the contracts.  It suffered another setback when the Contract Review Board didn't reject the contracts.  However, MHA's managed care company, Mississippi True, sued the Division of Medicaid in Hinds County Circuit Court last Thursday in an attempt to force the Division to award it the coveted Medicaid managed care contract.

The Division of Medicaid adopted a managed care  program in 2011 and named it MississippiCan. The initial contract was awarded to Magnolia Health Plans (Centene) and United Healthcare.  Medicaid pays a capitated rate.  Under a capitated rate plan, Medicaid pays the insurance companies a flat fee per patient. The insurance companies keep the difference between the health care costs for the patient and the capitated rate thus there is a financial incentive to contain health care costs.

The MississippiCan contract expired this year so the Division of Medicaid issued a request for proposals on February 3, 2017.  Seven companies submitted proposals for consideration: Amerigroup, Mississippi True (Mississippi Hospital Association, Molina, Magnolia (Centene), United Healthcare, Trusted Healthplan, and Wellcare.  The Division announced it would award the contract to Magnolia, United, and Molina. Copy of RFP. The new contracts will determine who manages over $3 billion in Medicaid services.  

JJ obtained a copy of the score sheet and posted it below.   Magnolia had the best score while Trusted and Mississippi True brought up the rear:

 Magnolia: 67.58
Molina: 65.40
United: 64.39
Amerigroup: 63.30
Wellcare: 62.72
Mississippi True: 59.84
Trusted: 58.79

As one can see, Mississippi True fared well in some categories such as the work plan but trailed the winners by at least a  point each on experience, organization & staffing, and methodology and work statement.  Mississippi True is the Mississippi Hospital Association's first foray into the Medicaid managed care business.  MHA created Mississippi True as a "provider sponsored healthcare plan" (PSHP).  The legislature gave MHA the authority to create a PSHP in 2015 specifically to serve Medicaid patients.  Although MHA claims that Mississippi True is a "local", MHA contracted with Virginia-based Evolent Healthcare to actually operate Mississippi True.  It is safe to say that Mississippi True is an Evolent operation with the MHA label affixed to it.  Local outsourcing at its finest. 

 Mississippi True waged war against the Division on other fronts as well. Mississippi True also filed a protest with the Division of Medicaid and at the same time asked a Hinds County Chancellor in August to issue a temporary restraining order stopping the Division from awarding the contracts.   Judge Singletary agreed with the winners and ruled that Amerigroup and Mississippi True must complete their appeals with the state before they can sue the Division in Chancery Court at the hearing held on August 14. Earlier post. 

Mississippi True also protested in its pleadings that the RFP and awards were not submitted to the Mississippi State Personal Contract Review Board. The Division claimed it is not required to do so because the contracts at issue are insurance contracts.  The Board simply ensures that the procedures for accepting bids and awarding contracts are followed.  It does not determine the actual merits of each proposal.

However, Governor Phil Bryant ordered the Division to submit the whole enchilada to the Contract Review Board.  The Board met in September, discussed the contracts and proposals for a couple of hours, and then took no action.
The Division said it would implement the contracts within thirty days pending CMS approval. The Chancery Court petition was withdrawn on September 19, the day the Contract Review Board met.

Mississippi True claimed that the lack of approval by the Board meant the contracts were not approved and thus not valid and thus went back to court. 

The Chancery Court petition was withdrawn on September 19, the day the Contract Review Board met.

Mississippi True argued in the Circuit Court complaint:

26.  On September 19, 2017, the PSCRB met to consider the MississippiCAN contracts.  A copy of the official  agenda for this meeting is attached  as Exhibit G.  At this meeting,  the  PSCRB rejected  DOM's request  for exceptions  to make the procurement compliant with Mississippi  law and rejected DOM's  request  for approval  of the contracts.
 27. Also on September 19, 2017, DOM announced that it construed the PSCRB's rejection of its requests as "statutory approval" of the contracts and that it would proceed with contract implementation....

However, Mississippi True curiously omitted from the complaint any mention that the no Board member seconded a motion to reject the MississippiCan contracts.   In other words, the Board rejected a motion to reject the contracts.

The complaint charges the defendants with one count of unlawful contract procurement.  Mississippi True accused the Director of awarding the contracts despite having an alleged conflict of interest.  Mississippi True claims it was the victim of a double standard.  It argued that it was penalized for lacking experience in operating a managed care organization even though it did lack such experience.  The complaint asks for the loss of profits it would have received if it had been awarded a contract, attorney's fees, and other damages. 

Mississippi True also asked the Court to block the implementation of the MississippiCan contracts.  It also requested a refund on the $500,000 bond it had to pay when it filed a protest of the contracts.

The case was assigned to Circuit Judge Bill Gowan.  Wise Carter attorneys George Ritter, John Sneed, and J. Lott Warren represent Mississippi True.

Note: Relax, the complaint is only 17 pages. The rest of the 192 pages is the RFP and other exhibits. 

1 comment:

Anonymous said...

It is time for the AG, Auditor and Insurance Commissioner to investigate the hospital association and its members for their misuse of tax dollars, patient's dollars and insurance company dollars which they are using to fund their corrupt attempts to politically influence state decisions for their own profit. The politicians who have accepted their their donations as a quid pro quo to shill for them also should be investigated for corrupt practices and ethical violations. It is time for some true Mississippi transparency, efficiency and accoutability.

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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

Wrestling returns, except this time it will be a Battle Royal with Othor Cain, Ben Allen, Kim Wade, Haley Fisackerly, Alan Lange, and “Big Cat” Donna Ladd all in the ring at the same time. The Battle Royal will be in a steel cage, no time limit, no referee, and the losers must leave town. Marshand Crisler will be the honorary referee (as it gives him a title without actually having to do anything).

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Jackson Jambalaya is the home of Trollfest '07. Catch this great event which promises to leave NE Jackson & Fondren in flames. Sonjay Poontang and his band headline the night with a special steel cage, no time limit "loser must leave town" bout between Alan Lange and "Big Cat"Donna Ladd following afterwards. Kamikaze will perform his new song F*** Bush, he's still a _____. Did I mention there was no referee? Dr. Heddy Matthias and Lori Gregory will face off in the undercard dueling with dangling participles and other um, devices. Robbie Bell will perform Her two latest songs: My Best Friends are in the Media and Mama's, Don't Let Your Babies Grow up to be George Bell. Sid Salter of The Clarion-Ledger will host "Pin the Tail on the Trial Lawyer", sponsored by State Farm.

There will be a hugging booth where in exchange for your young son, Frank Melton will give you a loooong hug. Trollfest will have a dunking booth where Muhammed the terrorist will curse you to Allah as you try to hit a target that will drop him into a vat of pig grease. However, in the true spirit of Separate But Equal, Don Imus and someone from NE Jackson will also sit in the dunking booth for an equal amount of time. Tom Head will give a reading for two hours on why he can't figure out who the hell he is. Cliff Cargill will give lessons with his .80 caliber desert eagle, using Frank Melton photos as targets. Tackleberry will be on hand for an autograph session. KIM Waaaaaade will be passing out free titles and deeds to crackhouses formerly owned by The Wood Street Players.

If you get tired come relax at the Fox News Tent. To gain admittance to the VIP section, bring either your Republican Party ID card or a Rebel Flag. Bringing both will entitle you to free drinks.Get your tickets now. Since this is an event for trolls, no ID is required, just bring the hate. Bring the family, Trollfest '07 is for EVERYONE!!!

This is definitely a Beaver production.

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