Pa Healthchoices Agreement Exhibits

This week, the Pennsylvania HealthChoices Physical Health Medica Managed Care Request for Applications (RFA) will be reviewed in our In Focus section, published by the Pennsylvania Department of Human Services on October 15, 2019. Medicaid Managed Care Organizations (MCOs) will serve the five HealthChoices zones, covering all 67 counties: Southeast, Southwest, Lehigh-Capital, Northwest and Northeast. The contracts are worth nearly $13 billion. Current Established Medicaid companies are Aetna, AmeriHealth Caritas, Gateway, Geisinger, Health Partners Plans, UnitedHealthcare, UPMC, which have approximately 2.26 million members. The total gross technical bid value for each area must be 75% or more. For each of the five regions, several MCOs are selected. Applications are due on December 17, 2019 and contracts are expected to begin in January 2021 and be for a five-year period, with the possibility of an extension of an additional three years. The award date has not been announced. Pennsylvania failed to implement new contracts and deny awards from 2016, as well as the 2017 Rebid awards. As a result, the HealthChoices program is currently in the process of being extended in 2012. The latest awards in early 2017, which would have been planned for a three-year contract worth $12 billion, are part of the following plans: MCO can still get 3 percent of the total occupancy points of national staff.

However, following protests from Aetna, UnitedHealthcare and AmeriHealth Caritas, the state decided to abolish the RFP and fill in the public procurement. These three plans are established plans that served about half of HealthChoices participants as of July 2019. Aetna and UnitedHealthcare did not receive contracts for any region and AmeriHealth Caritas, which handles more than thirty percent of all HealthChoices participants, was a successful bidder for two of the five regions.

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