7 Avenue Victor Hugo,13260 Cassis

Hca Agreement To Pay For Healthcare Services

Non classé

Finally, the complainants allege that HCA violated the PSR requirement that bidders « submit broad access to care and the operating plan of the supplier network, which details how the bidder will establish and operate a network of suppliers that meets all contractual and regulatory requirements and is sufficient to fully meet the needs of the public to serve. » D. 17-3, Section C, point 4.4; 17 to 10 centene and United Healthcare apparently submitted plans for Wahkiakum County, which included only one nurse in that county, and all other publicly traded providers were in other counties. Id. at the 15th CUP submitted an offer for Wahkiakum County with a much broader plan and currently offers services to « virtually all publicly insured patients in the Healthy Options, CHIP and Basic Health Plan » programs in that county, but has lost its contract with HCA. Id. at 15. HCA confirmed during the filings that CUP expelled on an appropriate network in Wahkiakum County. 17-7 to 20-21. Yet Centene was not a successful bidder in Wahkiakum and CUP County.

17th to 15th. This action is the result of a dispute between two managed care organizations, Columbia United Providers, Inc. (« CUP ») and Community Health Plan of Washington (« CHPW ») and the defendant Washington State Health Care Authority (« HCA »). Although HCA has already entered into contracts with the complainants to manage care services for beneficiaries in Washington Medicaid, Disability Lifeline, Children`s Health Insurance Program and Basic Health Plan (together « Medicaid and Basic Health ») in several counties, their current contracts expire on June 30, 2012. 17 to 1. Under a legislative directive, HCA recently entered into an offer that strengthens Medicaid`s basic health care and services. Applications were submitted on September 15, 2011 and bids were due by December 2, 2011. As a result of the tendering process, HCA selected five managed care organizations (« MCOs ») as successful bidders. The contracts will come into effect on July 1, 2012. Id. at 3.

A. Parties The Medicaid Act allows states to require Medicaid recipients to accept McOs as a condition of access to benefits, provided certain conditions are met by the state. 42 U.S.C 1396u-2 (a). One requirement is that Managed Care organizations have sufficient provider networks to serve Medicaid receivers. No. 1396b (m) (1) (A) (i), 1396u-2 (b) (5). Thus, the Medicaid Act allows a state to limit the number of provider agreements with MCOs only to the extent that « such a restriction does not significantly affect access to services. » Id. 1396u-2 (a) (1) (A) (ii). By law, all MCO must argue here that « HCA`s inability to verify and establish the adequacy of the network at the time of awarding the contract and its decision to enter into contracts with health plans, regardless of the ability of these plans to deliver on their promise, may be met in all recognized countries is contrary to the federal requirements of Medicaid. » 17-16-17. The applicants submit that, on the basis of the documents provided by the successful bidders on the adequacy of the Clark and Wahkiakum-Counties network, they cannot provide « truthful » assurances that successful bidders are able to serve the registration expected by an adequate primary supply and other services, such as 42 United States.