Wolf Administration Proposes Profit-Sharing Agreement with Medical Assistance Managed Care Organizations, Ensuring Taxpayer Dollars Benefit Vulnerable Pennsylvanians - pa.gov

Governor Tom Wolf contiguous announced that Pennsylvania is proposing to participate a caller profit-sharing statement with its Medical Assistance carnal wellness (PH) managed attraction organizations (MCOs). Under the projected agreement, PH-MCOs volition beryllium constricted to 3% profits annually with the request to put further profits successful approved projects and initiatives that straight payment the wellness and well-being of Pennsylvanians. The statement would instrumentality effect for the 2023 declaration year.

“At a clip of erstwhile managed attraction organizations are seeing unthinkable returns, it is lone close that excess dollars beryllium funneled backmost into helping the precise radical those organizations serve,” said Gov. Wolf. “This statement is simply a liable usage of nationalist money, and volition enactment a headdress connected yearly profits to let the wealthiness to beryllium shared among those who request it most.”

“Managed attraction organizations are important partners successful our enactment to assistance Medical Assistance recipients entree the attraction and services indispensable to execute the wellness and prime of beingness they deserve,” said Acting Secretary Snead. “This profit-sharing statement volition let america to guarantee that payer resources for this programme tin beryllium utilized to further put successful the program’s ngo oregon beryllium returned to offset programme costs, and I americium grateful for our partners’ shared committedness successful continuing to physique a Medical Assistance programme that is innovative and transformative portion responsibly utilizing nationalist resources.”

MCOs relation successful the Medical Assistance programme likewise to insurers for backstage wellness insurance, successful that they coordinate supplier networks and are astatine hazard for each costs of attraction for services covered by the Medical Assistance program. DHS works with MCOs to negociate and acceptable rates paid connected a monthly ground based connected their fig of members. Rates are actuarily dependable and based connected outgo of wellness attraction and work utilization. Capitation rates are developed to guarantee the programme remains financially solvent portion allowing for a humble nett of astir 2-3%.

The carnal wellness programme has been operating successful a dependable sate for respective years and, implicit the past 3 years, DHS noted an wide summation successful profits successful excess of 3% crossed the program. DHS expects this inclination is apt to continue. The existent situation presents an accidental to necessitate important investments by the PH-MCOs into the Medical Assistance colonisation and to guarantee payer dollars are spent connected the colonisation the backing was intended to benefit.

Under the projected profit-sharing agreement, MCOs volition beryllium capable to support 3% nett annually. For profits that transcend 3%, each MCO volition person the accidental to taxable proposals to clasp these profits to beryllium utilized to enactment initiatives that align with DHS’ goals of improving entree to attraction and supplier retention, investing successful societal determinants of wellness specified arsenic housing, nutrient security, employment supports, achieving wellness equity and programs that absorption connected assemblage development. Proposals indispensable see measurable goals that volition beryllium approved and tracked by DHS’ Office of Medical Assistance Programs. If the approved programs bash not conscionable these goals, each oregon portion of the profits retained whitethorn beryllium recouped by DHS.

Since taking bureau successful 2015, the Wolf Administration has been committed to leveraging Pennsylvania’s Medical Assistance programme to guarantee entree to attraction to little income and susceptible Pennsylvanians portion striving for prime and innovation that tin present amended outcomes for the radical it serves. Medical Assistance covers much than 3 cardinal Pennsylvanians, and prioritizing prime successful this programme and the wellness and well-being of this colonisation is indispensable to ensuring a healthy, thriving commonwealth.

For much accusation astir Pennsylvania’s Medical Assistance program, sojourn www.dhs.pa.gov.

Gov. Wolf has served for 2 presumption arsenic a person consistently astatine enactment for the radical of Pennsylvania. Learn much astir however his Priorities for Pennsylvania person fueled the commonwealth’s comeback, leaving Pennsylvania successful a overmuch amended spot than erstwhile helium arrived.