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Cut managed-care plan for now, governor urged

Dismang, Gillam: It’s too knotty for session by Spencer Willems, Brian Fanney | April 5, 2016 at 5:45 a.m.

House and Senate leaders told the governor late Monday that they don't want to consider a proposal to privatize parts of Medicaid administration in a special session set to begin Wednesday.

In a letter to Gov. Asa Hutchinson, House Speaker Jeremy Gillam, R-Judsonia, and Senate President Pro Tempore Jonathan Dismang, R-Beebe, said "there's not a consensus on the cost-savings strategy for traditional Medicaid at this time."


Letter from Speaker Gillam to Gov. Hutchinson


Letter from Sen. Dismang to Gov. Hutchinson


J.R. Davis, a spokesman for the governor, said the governor will review the letter, consider the request and make a decision today.

The move came after Hutchinson delayed issuing a formal call for the session, which Davis had said was expected on Monday, and Rep. Michelle Gray, R-Melbourne, postponed publicly releasing a competing Diamond Care proposal.

Gray said she supported the legislative leaders' letter "as long as their intent is that maybe this health-care reform issue is too big to handle in a three-day special session, and there's not enough consensus around the managed-care plan to proceed, then that's fine."

Gray said that if the question of Medicaid savings is not included in the governor's call, she would support presenting legislation during the subsequent fiscal session.

Hutchinson had said his formal call for a special session would include a plan to hire managed-care companies to provide care for the developmentally disabled and the mentally ill, along with a bill to make changes in the state's expanded Medicaid program, the private option, through an initiative called Arkansas Works.

He said he would not put Diamond Care on the call. That plan calls for the state to hire companies to help reduce the cost of caring for those populations while continuing to pay providers directly.

"It was a lot of folks that were just really needing more time. This is complex. It's new," Gillam said. "And so, [with] just that uncertainty there -- we just felt it was prudent to give them more time."

The House speaker said he was leaning toward the governor's managed-care proposal but had yet to decide.

Dismang said: "It wasn't lack of support for the bill itself; it was just members still wanting some more information about what managed care is, how it works, what it does, who's going to be impacted. We're still having those types of conversations."

Dismang said he supported "managed care done correctly," but "you can't debate a bill that no one's had a chance to look at."

"With Diamond Care, that bill is not out there for the members to review," he said. "It's my understanding it's 33 pages. It's going to be a lot of information for members to digest to see where they actually stand on that particular program."

The Stephen Group, a consulting firm, has estimated that Hutchinson's plan would reduce the growth of Medicaid spending by $1.4 billion over five years, while the Diamond Care plan would save $1 billion.

Jim Hendren, R-Gravette, co-chairman of the Health Reform Legislative Task Force and an outspoken proponent of Hutchinson's managed-care proposal, said that the move by Dismang and Gillam was a "wise" one.

"There will be a lot of opposition when you try to cut $1 billion from any program," Hendren said. "Getting that done in a three-day session was a little optimistic."

Hendren said it was clear there is support for Hutchinson's proposed changes to the state's private option.

But the senator thinks that, historically, governors haven't been willing to cause legislative headaches and burn taxpayer money on special sessions where the issues weren't "slam dunks" going in.

Ultimately, Hendren said, it was clear the managed-care issue would remain contentious after an early March task force meeting where eight members voted in support of managed care while seven went the other way.

Hendren said the lack of public support shown for Hutchinson's plan is a combination of resistance from those lawmakers who support the Diamond Care proposal and and reluctance from others who are on the fence and need more time to study the issue.

Rep. Charlie Collins, R-Fayetteville, co-chairman of the Health Reform Legislative Task Force, agreed that it was a mix of uncertainty and opposition. He also said it was wise to hold off on a full-on legislative fight until members had more time.

Asked if this was a political loss or stalemate for Hutchinson, Collins said developing consensus on issues like this is a gradual process.

But Collins thinks it's imperative that lawmakers act sooner rather than wait until the next general session in January.

"I wouldn't want to wait that long. It takes a while to get the ball rolling on [savings]. ... I know the governor is planning on calling a second special session for some number of topics. ... Who knows what will be included in that," Collins said. "We've waited umpteen decades [for managed care in Medicaid] and we're still standing. ... Is it good we waited this long? No ... but the best time to do something is yesterday and the next best time is today and the next best time is tomorrow. The sooner we can get it and get it right and get savings for the taxpayer, to me, that's the best option."

The House minority leader, Rep. Michael John Gray, D-Augusta, said the issue may not wait until January.

He said finding a way to shorten the list of about 3,000 Arkansans waiting for home-based services was also imperative. Hutchinson's proposal would have funneled savings from managed care to expanded services for the developmentally disabled and mentally ill.

"There is a concern out there about costs, on both sides of the aisle, and while there may not be agreement on how to handle it ... it's something that's urgent in the minds of a lot of people," Gray said. "[The waiting list] is something we cannot afford to wait until January to do."

The letters from Gillam and Dismang came after speculation that a proposal outlining the rights of patients under the governor's plan originated with Centene Corp. -- though Dismang said that had nothing to do with their timing.

In one version of the proposed bill of rights, Richard Johnston of Missouri-based Centene is listed as the author. Betty Guhman of the governor's office last saved that document.

In an earlier version of the same file, Johnston is listed as the author, but the document was last saved by former Rep. John Burris, an architect of the private option who is now a lobbyist for Centene, which offers a range of health-care insurance and services, including managed care.

Microsoft Word lists whoever first created the file as the "author," whether the content originated with that person or not.

J.R. Davis, a spokesman for Hutchinson, said Centene did not write the bill of rights.

"[T]his office drafted the patients' bill of rights after receiving feedback from numerous entities," he said.

Hutchinson, during a March appearance in Conway, said his bill of rights is similar to one in place in North Carolina.

"[Centene] provided the original framework that North Carolina had implemented," Davis said. "We liked the idea and wanted to format that for Arkansas."

John Ryan, president and chief executive of Ambetter of Arkansas, which is a division of Centene, provided a list of nine rights included in the governor's list that "were part of the input we (as well as other stakeholders) provided to the state as requested."

"The bill of rights was used in the development of the North Carolina managed care initiative," Ryan said in an email.

The governor has proposed a total of 21 rights for recipients, providers and the state.

Ryan did not directly answer two emailed questions about whether Centene provided a similar list of rights to the North Carolina lawmakers who shaped that state's managed-care plan.

"In general these types of protections are used in many states as good policy initiatives to facilitate the transition from Fee For Service to Managed Care," he said in response to one of the questions.

He did not respond to the question when it was resubmitted.

Centene has five registered lobbyists in North Carolina, according to a review of documents.

North Carolina Gov. Pat McCrory did not include a patients' bill of rights in his effort to transition the state's Medicaid program from fee-for-service to managed care by private companies -- though the state has a broad patients' bill or rights in its administrative code.

Kate Murphy, a spokesman for the North Carolina Department of Health and Human Services, said the state has applied for a waiver from the federal government to pursue a managed-care program, but the program is not up and running and no bids have been requested.

Collins, when asked about the role played by Centene in helping craft Hutchinson's proposed patients' bill of rights, said he didn't think the company had done anything improper in the process and called many of the criticisms of the corporation's role as "grasping at straws."

Hendren agreed.

"First off, [their involvement] is not uncommon, in fact, it's common that stakeholders will have input in the construction of legislation," Hendren said. "To think I'm not going to talk to the people in the industry about the ideas that have merit is a little bit silly. ... There has been a lot of conversations with stakeholders, with the governor's staff ... that's the normal way the sausage is made."

A̶t̶l̶a̶n̶t̶a̶-̶b̶a̶s̶e̶d̶ Tampa, Fla.-based! WellCare Health Plans Inc., a potential bidder for the managed-care contract under Hutchinson's plan, said it had also been able to provide input.

"WellCare has provided feedback to Gov. Hutchinson and to members of the legislature on issues related to Medicaid managed care, including the ability of Medicaid managed care to help patients access the right care, at the right time in the appropriate setting," Charles Talbert, a WellCare spokesman, said in a statement.

Brent Stevenson, a lobbyist who represents AmeriHealth, another potential bidder, said the company's thoughts have been heard.

"As far as our client is concerned, we're okay, and we're satisfied with the input that we've able to have with all of the stakeholders involved in our process," he said.

Information for this article was contributed by Michael R. Wickline of the Arkansas Democrat-Gazette.

Metro on 04/05/2016

*CORRECTION: WellCare Health Plans Inc. is a Tampa-based company. A story in Monday’s editions about an upcoming legislative special session on the state's expanded Medicaid program incorrectly referenced where the company is headquartered.

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