More protests have been filed by firms that lost a chance to participate in the Jindal administration’s private insurance-based health-care system for the poor.
Aetna Better Health and Coventry Health Care of Louisiana filed the new complaints with state health chief Bruce Greenstein and Denise Lea, the state’s purchasing director .
They were among the dozen private entities that wanted to run coordinated-care networks that would take over $2.2 billion of the state’s $6.7 billion Medicaid program.
Under the program, companies form networks of physicians, specialists, clinics, hospitals and other providers responsible for health-care delivery.
Both Aetna and Coventry complained about the way the state agency scored proposals. They also complained that the three winners of the contracts have gone to court in an effort to keep secret some of the information used to win the bids.
Ruth Kennedy, the state Department of Health and Hospitals official in charge of implementing the coordinated-care networks, said contract negotiations must stop while dealing with the protests.
So far the protests have not delayed DHH plans to start the new Medicaid managed-care plans in the New Orleans area in January, Kennedy said.
Aetna executive Pat Powers said the company has “already identified several areas of inconsistency in the scoring of the proposals” even without full information provided.
“Given the size of the award, and the importance of the services that will be provided, it is in everyone’s best interest to have a thorough and transparent review of how the contracts were awarded,” Powers said in a news release.
Aetna’s protest alleged that the proposal reviewers used a methodology that conflicted with instructions — judging proposals against one another instead of how well they met the criteria sought.
Coventry attorney Perry R. Staub Jr. wrote to Greenstein that, “the fairness of the proposal evaluation process appears to have been compromised.”
Staub detailed alleged scoring problems in four specific areas, including failing to do an independent assessment of whether Medicaid recipients would be getting “added value” in the services to be offered.
Louisiana Healthcare Connections Inc., Amerihealth Mercy of Louisiana Inc. and AmeriGROUP Louisiana Inc. beat out the two firms for the business.
The new protests came as Greenstein issued letters rejecting protests filed by Automated Health Systems Inc. and Louisiana Physicians Connections.
He said neither convinced him there was sufficient reason to overturn the decisions of the health agency teams that evaluated the proposals.
AHS, of Pittsburgh, Pa., had challenged Maximum Health Services’ selection as the program’s enrollment broker — the entity charged with signing up Medicaid recipients in health plans that meet their needs.
Louisiana Physicians Connections wanted to operate one of the coordinated-care networks that will provide care to about two-thirds of the state’s 1.2 million Medicaid recipients. It had sought to run a coordinated-care network on a fee-for-service basis.
UnitedHealthcare of Louisiana Inc. and Community Health Solutions of America Inc. beat out Louisiana Physicians Connections.
AHS and Louisiana Physicians Connections can now take their appeal to the state Division of Administration’s office of state purchasing.