The Maryland Department of Health has agreed to renew Kaiser Permanente’s contract as a Medicaid provider, averting an outcome that one prominent health care advocate said would have been a disaster for public health.
Gene Ransom, CEO of the nonprofit Maryland State Medical Society, said Tuesday that the health department’s interim decision last week to remove the health care giant from its list of managed care organizations (MCOs) that provide care through Medicaid would have left. about 110,000 Marylanders without health care coverage and looking for new doctors with little time to change their situation.
But the two sides reached an agreement on Wednesday, reaching an agreement that allows Kaiser to remain one of nine such providers through 2025. The decision comes with more than a month left before the Nov. 1, the first day of the open enrollment period during which Marylanders must choose for health care for the coming year.
“The Maryland Department of Health is pleased to have reached an agreement with Kaiser Permanente that will enable Kaiser Permanente to participate as a HealthChoice managed care organization by 2025,” the state and HMO said in a joint statement issued late Wednesday. . “The agreement supports historic reforms that increase MCO accountability and responsibility, while aligning with the Moore-Miller Administration’s efforts to achieve health equity and improve health outcomes for Marylanders.”
The health department informed Kaiser Permanente in a letter Friday that it will not renew the appointment as part of its Medicaid delivery system.
The health department establishes requirements for providers to be recognized as MCOs. Kaiser Permanente, which primarily covers residents of Prince George’s, Montgomery and Baltimore counties, has operated as an MCO for the past 10 years.
In a statement issued on Friday, the department said that the administration of Gov. Wes Moore and Lt. Gov. Aruna Miller, both Democrats, proposed several new requirements for MCOs. It listed five such requirements. Each called on MCOs to provide services aimed at improving health equity, including reducing disparities in the quality and availability of such care across racial lines. .
“The terms of the 2025 contract for each MCO include historic changes that increase MCO responsibility and accountability to focus the state’s efforts to achieve health equity and improve the health of Marylanders,” it said. read.
The statement listed eight MCOs it says the agency will award contracts for next year. Kaiser Permanente was not among them. The statement did not identify requirements the company failed to meet, and Betty Hwang, a spokeswoman for Kaiser Permanente, declined to elaborate.
Redemption said Tuesday that if the original decision were to go ahead, it would disrupt parts of the health system. He also said that it is not clear if there are enough doctors accepting new patients to accommodate what would be a huge demand in a short period of time.
He added that he is not to blame for the controversy – “I understand some of the things that the government is trying to do here – they make sense to me – and the concerns that Kaiser raised also make sense to me,” he said so – but. he added that his organization, a nonprofit organization known as MedChi, is concerned that canceling the Kaiser Permanente contract could damage tens of thousands of doctor-patient relationships, an issue the group his follows closely.
Hwang suggested this week that the disagreement between the parties stems from the fact that Kaiser Permanente — whose Medicaid operation in Maryland last year received 4.5 out of 5 stars for “comprehensive treatment, prevention, equity and experience” from National. Quality Assurance Committee, a health care accreditation body – is due to the fact that the company uses a different approach to providing health care than other state-chartered MCOs.
Kaiser is the only MCO in the group that employs its own physicians and requires its patients to use those physicians. Hwang said, it helps to know how to track, record and report patient information.
The two sides made the deal a victory for the state’s patients.
“Working closely with Kaiser Permanente and our 8 managed care organizations, the agency is committed to continuing to provide quality care to the state’s 1.4 million HealthChoice participants,” the statement read.
Originally published:
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