A company that needs to sustain handling the health care policies for Nebraska Medicaid recipients is taking the state to court after losing its bid.
Aetna Better Health of Nebraska claims state officials unfairly withdrew its previous contract award in exchange for a distinctive managed care agency that should not have qualified in the 1st place.
State officials claimed that they are in the best position to evaluate what is good for Nebraskans, calling the selection procedure impartial and built to benefit taxpayers, not individual bidders.
Aetna needs the decision reversed, its lawyers claim in a complaint filed on the day of Tuesday in Lancaster County District Court.
The company is battling for a share of almost $1 billion in long-term contracts to serve few 230,000 Medicaid recipients — potentially the state’s greatest-ever contract procurement.
Those contracts will evaluate which policies are present to Medicaid and Children’s Health Insurance Program participants under Nebraska’s new managed care program, known as Heritage Health. The program starts next year and is designed to cover each sufferer under a single policy, instead of separate policies for physical and behavioral health.
6 managed care organizations, involving Aetna, applied previous year to make their options present available in Nebraska. When the state Department of Health and Human Services chose 3 winners this year, Aetna did not make the list.
The company has operated in Nebraska for 5 years and already manages policies for about 105,000 Medicaid recipients here.
It gained the state’s initial recommendation in the month of February, but the Department of Administrative Services, which assists to oversee state contracts, rescored the proposals following complaints by the proposed losing bidders. That resulted in a different managed care contributor, WellCare, to come out ahead.
“Heritage Health is a significant and exciting transition of our Medicaid delivery system, and we comprehend that Aetna was disappointed in the result of the competitive procedure,” HHS spokeswoman Kathie Oesterman stated in an email. “We are confident that the procedure was fair and hopeful that the facts support a rapid dismissal of this lawsuit so that our resources can be concentrated on making better our programs that serve Nebraskans.”
In an emailed statement, Aetna inquired why the state would finally pick a less-familiar company over a “highly qualified” managed care agency that already has relationships with sufferers and contributors in Nebraska.
The decision “jeopardized the state of Nebraska’s capability to satisfy the basic requirements of hundreds of thousands of its most susceptible citizens,” Aetna’s attorneys wrote in their complaint.
State officials have dismissed that discussion.
“Incumbents aren’t entitled to favoritism,” Bo Botelho, deputy director for Administrative Services, wrote to the lawyers of Aetna after they challenged the decision through an internal procedure in the month of March.
Aetna asserts the state’s rescoring procedure was flawed, ignored standard process and breached the law. The company also claims state officials infringed on its constitutional due procedure rights by contracting with WellCare and 2 other agencies before Aetna could completely protest the decision.
Among Aetna’s complaints about the scoring procedure:
* The 5-person committee selected to evaluate the new scores involved a pair of Administrative Services workers who had no experience with Medicaid managed care and had never reviewed bids for state contracts before.
* That committee was offered merely 48 hours to review and rescore 1,500 pages of proposal materials, when the genuine scoring took a distinctive committee almost 3 weeks.
Furthermore, Aetna claims WellCare should not qualify for the contracts due to legal problems it has faced in other states, and because it will utilize subcontractors in the state of India to process claims.
A WellCare representative could not be reached for comment late on the day of Wednesday.
The state already denied several of Aetna’s discussions after it protested to Administrative Services in the month of March.
State policy offers agencies discretion in awarding contracts, Botelho wrote in an April letter to Aetna’s lawyers. He claimed merely contractors themselves must be within the USA.
Aetna’s argument that the rescoring committee did not have sufficient time to do its job precisely is just “their perception,” Botelho told the Journal Star on the day of Wednesday.
“We considered it was sufficient time,” he stated.
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