AHCCCS, Arizona’s version of Medicaid, has decided to press on with plans to transition the health plans of thousands of elderly and physically disabled members to new ones. The decision means the agency is disregarding a judge’s recommendation that it cancel the new contracts and start the process over again after it was determined their process was flawed.
Last month, that judge said that AHCCCS had improperly issued contracts to United Healthcare and Arizona Complete Health. The agency had 30 days to figure out what it was going to do. In the meantime, it had paused the planned transition, leaving some families uncertain. But on Monday, AHCCCS issued a Director’s Decision that found the agency exercised its discretion in the procurement process in accordance with law.
David Voepel is the CEO of the Arizona Health Care Association, which represents skilled nursing homes
“We're just unsure of when the transition is going to restart, which is a little confusing for our providers and maybe could be confusing for the residents as well," Voepel said.
In a statement AHCCCS said no determination has been made on when planned transition activities will resume, despite pressing forward with the new plans.
AHCCCS did state that the non-awarded health plans, which includes Mercy Care, Banner and Blue Cross and Blue Shield, will have the opportunity to either file a "Motion for Rehearing or Review" with the agency or file an appeal in Superior Court.
AHCCCS issues director’s decision regarding EPD procurement and gives the following statement:
"On September 8th, The Arizona Health Care Cost Containment System (AHCCCS) issued a Director’s Decision (Decision) which denies the appeal of Mercy Care, BCBS of Arizona HealthChoice, and Banner-University Family Care regarding the EPD Procurement process and awards. The Decision found that AHCCCS properly exercised its discretion in the procurement process in accordance with law and that the non-awarded health plans failed to timely protest alleged procurement deficiencies as required by state administrative rules. Further, the Decision found that even if the non-awarded health plans timely filed protests, they failed to show that the alleged errors created a disadvantage to them, that the procurement process operated in a manner contrary to the law, or that they had a substantial chance at receiving an award. AHCCCS applied the procurement process fairly to all bidders, including the non-awarded health plans.
Based on the Director’s Decision to deny the appeal, the agency plans to move forward with the award of the EPD contracts to Health Net Access, Inc. (dba Arizona Complete Health-Long Term Care Plan) and Arizona Physicians IPA, Inc. (dba UnitedHealthcare Community Plan). By law, the non-awarded health plans will have the opportunity to either file a Motion for Rehearing or Review with the agency or file an appeal in Superior Court to seek judicial review.
At this time, no determination has been made on when planned transition activities will resume. AHCCCS will be evaluating operations and processes and will be utilizing feedback the agency received from members and interested stakeholders to inform the transition process. AHCCCS will keep members, providers, and stakeholders informed of updates regarding the transition process. Members and providers will be receiving notice of the transition processes well before they begin. The smooth transition of members remains the top priority of the agency. At this time, members will remain with their currently enrolled health plan."
