The decision for Pennsylvania to postpone the implementation of Community HealthChoices (CHC) was announced today. This decision was made as a result of the delays associated with the resolution of several bid protests.
Following the announcement of the selection of the managed care organizations (MCOs) that would deliver health care coverage in Community HealthChoices, several protests were filed. As a result, the progress of major components of CHC implementation was delayed, resulting in the Department of Human Services (DHS) feeling uncertain with moving forward with their established start dates. Some of the impacted activities associated with this decision include:
- Developing an adequate network: DHS has not been able to engage with the selected offerors. The agreement and rate negotiations and finalization typically take six weeks, and the agreements need to be finalized before the MCOs are able to engage in network development activities. The current delays mean the MCOs will not have enough time to meet the network adequacy requirements by July 1, 2017.
- Completing a readiness review: Readiness review is a requirement for the MCOs before they are certified to be able to go live and provide services. Protests prohibit MCO engagement for readiness review and the window to complete the certification continuously shrinks. New programs require a minimum of six months to complete a readiness review.
- Communicating: Communication about selected MCOs and their available networks is a critical component to CHC education and outreach. Individuals who will be enrolling in CHC need to have complete information about the MCO provider network in order to be able to make an informed provider choice. That communication will not be able to take place until the agreements are largely finalized and the MCOs are in a position to provide network information.
Important dates to note include:
- Phase 1 will now begin in January 2018 in the Southwest region of the state.
- Phase 2 will now begin in July 2018 in the Southeast region of the state.
- The January 2019 start date for the rest of the state remains unchanged.