Issue: The Pennsylvania Department of Public Welfare (DPW) is in the process of transitioning new physical health managed care organizations into the Southeast PA zone. There are two new plans entering the zone, namely, Aetna Better Health and Coventry Cares. DPW has completed readiness reviews on these two plans. In addition, the plans have met the Pennsylvania Insurance Department’s licensing requirements and the Pennsylvania Department of Health’s regulatory requirements. Effective April 1, 2010 these new plans will provide coverage for Medical Assistance recipients in the Southeast zone. There will be no changes to medical assistance managed care coverage for behavioral health services.

Update on the HealthChoices Transition for Southeast PA: As of November 2009 there were 693,112 medical assistance recipients in Southeast PA. Currently there are approximately 549,000 medical assistance recipients enrolled in managed care plans. The DPW is working with the plans that currently provide medical assistance benefits in southeastern PA, namely Americhoice, Health Partners, and Keystone Mercy Health Plan and the two new plans, Aetna Better Health and Coventry Cares, on a coordinated transition for April 1, 2010. The transition process is as follows:

• In early February, the DPW will mail HealthChoices open enrollment packets to all individuals who are eligible to receive Medical Assistance benefits. In these packets, Medical Assistance recipients in Southeast Pennsylvania will see that they have two additional managed care plans from which to choose. Members who want to remain with their existing HealthChoices plan, will not have to do anything in order to stay with their current health plan however if an individual want to switch to one of the new plans they need to request a change in enrollment. The HealthChoices program has no lock-in therefore medical assistance recipients can change their enrollment at any time during the year.
• In Mid-February new medical assistance enrollees will be offered the opportunity to choose any of the five plans being offered in southeast PA for physical health benefits. If a new enrollee does not voluntarily select a plan, they will be automatically assigned to either Aetna Better Health or Coventry Cares. Comparison charts about the five plans will be posted on the DPW website so that medical assistance beneficiaries can make informed decisions about their plan selection.
• Effective April 1, 2010, Aetna Better Health and Coventry Cares will begin operating as HealthChoices plans in Southeast PA.

Information about Aetna Better Health: Christopher Bruette is the Provider Relations Director for Aetna Better Health and can be reached at 610-348-3338. Currently Aetna Better Health is operating out of Aetna’s office in Blue Bell, PA however in early May they will be relocating to 2000 Market Street in Philadelphia. Aetna Better Health is in the process of finalizing its agreements with the behavioral health HealthChoices plans and continues to recruit ancillary providers for its network. Aetna Better Health has planned individual hospital and health system trainings to be held at the end of February. The trainings will cover the following topics: claims submission; credentialing; utilization management processes; disease management systems; and general policies and procedures and contact information will be provided.

Information about Coventry Cares: Jason Renne is the Director of Network Development and Vendor Relations for Coventry Cares and can be reached at 610-729-7525. Coventry Cares, the Medicaid product offered by Health America/Coventry is managed in concert with Health America’s other products. Health America/Coventry has an office in Plymouth Meeting at 401 Plymouth Road, Suite 350 for provider relations and sales. Their corporate headquarters are in Harrisburg where they conduct medical management and case management services. Their customer service and billing operations are located in the Newark Delaware office. Coventry Cares will conduct provider training in March of 2010 utilizing a town hall type environment. They will offer several trainings across the region and invite the provider community to participate at the one that is most convenient for them. The training will focus on the key aspects of the provider manual, which will be distributed to network providers upon approval from DPW. Coventry Cares is in the process of ramping up its network as its provider recruitment is ongoing.

DVHC Action: The Delaware Valley Healthcare Council of HAP (DVHC) has added representatives from the two new HealthChoices plans to the DVHC HealthChoices Committee that meets quarterly. DVHC will continue to monitor the transition and will provide updates to its members as critical information regarding the transition becomes available.

For more information: If you have questions regarding the HealthChoices program in Southeastern PA, feel free to contact Pamela Clarke, DVHC’s Vice President of Healthcare Finance and Managed Care at 215-575-3755.