BUSINESS CareFirst Questions D.C. Medicaid Contract Process James Wright WI Staff Writer A component of one of the largest health care providers in the Washington, D.C. region wants to continue providing Medicaid services to District residents but its leaders complain the company has been caught up in an administrative and bureaucratic process that threatens its ability to deliver for its patients. Ieisha Gray serves as the chief operating officer for the CareFirst
BlueCross BlueShield Community Health Plan District of Columbia, herein known as CareFirst. Gray said her company has performed well in serving District residents on Medicaid and wants that to continue. “We have a demonstrated record serving Medicaid patients in D.C.,” Gray said. “We have the perspective that Medicaid patients should have the same level of health care quality that District government officials have access to.”
5 A patient receives a medical examination. (Courtesy photo/Stock)
Medicaid serves as the federally-funded, locally-managed health care plan for those who count as low-income, disabled, under the age of 19, pregnant, some senior citizens and needy single parents. In the District, managed care organizations (MCOs) like CareFirst serve Medicaid patients who do not pay for their medical care. Those who qualify for the
CAREFIRST’S COMPLAINTS ABOUT THE PROCUREMENT PROCESS
Invitation For Bid (IFB) Solicitation GAGA-2022-I-0296 Audio Visual (AV) System Services DISTRICT OF COLUMBIA PUBLIC SCHOOLS OFFICE OF CHIEF OPERATION OFFICER The District of Columbia Public School (DCPS), Office of Data and Technology (ODT), is seeking a qualified vendor who will provide support, repair, maintenance, design, and installation services for audio-visual (AV) systems and equipment at DCPS Locations. The services will comprise ongoing maintenance, assessment, repair and replacement, design and installation, and reporting. Solicitations will be available Friday, August 12, 2022. This solicitation can be downloaded from the OCA website delineating all the details of the solicitation at http://dcps.dc.gov/DCPS/About+DCPS/Doing+Business+with+DCPS/Procurement. The bid will be accepted at DCPS/OCA on Thursday, August 25, 2022, no later than 11:00 am at dcpsoca.inquiries@k12.dc.gov. 14 AUGUST 11 - 17, 2022
program range from an individual who earns up to $19,000 annually to a family of four with a combined income of no more than $37,000 a year. Statistics reveal over 230,000 residents – 33% of the city’s population, utilize Medicaid. The multi-year contract MCOs operate under amounts to $3 billion collectively.
CareFirst leaders said the recent MCO procurement process “was deeply flawed and highly unusual” in documents obtained by the Informer. “It was marred by the disqualification of three-out-of-four plans for unimportant minutia – whether the listed certified business enterprise (CBE) numbers were the new ones or old ones and for simple typos in the numbers of bona-fide CBEs,” the documents said. “The District’s choice of Medicaid MCO plans has serious implications for its ability to address chronic diseases that disproportionately afflict low-income District residents.” According to CareFirst documents, the first Request for Proposals took place in November. In January, the District’s Office of Contract and Procurement (OCP) disqualified three of the MCOs, including CareFirst for what it termed “non-substantive” errors in their subcontract-
ing plans. Two competing plans – MedStar Family Choice and Amerigroup – used old CBE numbers given to them by subcontractors which terminated them from consideration while CareFirst received disqualification from the process due to small typos in its subcontracting plan. In the District by law, there must be three MCOs to move forward with granting Medicaid contracts. As a result, the process moved into February in which OCP opened up a second round for consideration because only one MCO, AmeriHealth, had been selected. Meanwhile, the three MCOs that received denial appealed the decision to the District’s Contract Appeals Board (CAB). In consideration, CAB upheld MedStar’s disqualification but overturned Amerigroup’s. CareFirst’s disqualification remained with CAB ruling that the contracting officer had the right not to give it a contract based on the typos of which the company labeled “minor” and “non-substantive.” In its documents, CareFirst officials said, ‘what happened next defies logic.” It said Amerigroup “was put back in the original procurement, the one that began in November 2021.” The two remaining plans in the original procurement – AmeriHealth and Amerigroup – received contracts by the OCP by default. As a result, CareFirst and MedStar had to compete for the third MCO spot in February.
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