WHEREAS, In February 2015, Governor Tom Wolf announced the laudable decision that the Commonwealth would adopt the full benefits of Medical Assistance expansion provided by passage of the Affordable Care Act; and
WHEREAS, To transition coverage from the prior program to a value-based model, the Pennsylvania Department of Human Services (“DHS”) issued a Request for Proposals (“RFP”) seeking managed care organizations (“MCOs”) to serve in the Health Choices program, the awards of which resulted in a lawsuit over the award process; and
WHEREAS, After litigation, DHS issued a new RFP, beginning a second round of applications, which was unfortunately complicated due to a scoring error and completion of which has raised a number of procedural and substantive concerns about continuity of care; and
WHEREAS, The final awards significantly affect coverage of proper treatment and preventive services for 1 of every 5 recipients in southeast Pennsylvania, including approximately 87,500 HealthChoices recipients in Philadelphia; and
WHEREAS, The shift from many incumbent MCOs to only three calls into question the early experiences of health providers entering into value-based arrangements and longer-term implications for patient care; and
WHEREAS, Reliable, accessible health care is critical to every Philadelphian, making the transition of MCO a matter of intense public interest; now, therefore, be it
RESOLVED, BY THE COUNCIL OF THE CITY OF PHILADELPHIA, That council does hereby authorize the Committee on the Disabled & Persons with Special Needs to hold hearings regarding Pennsylvania’s HealthChoices initiative.
End