Department of Health Care Finance Announces Intent to Award Three Managed Care Contracts for New Five Year Program


Department of Health Care Finance


FOR IMMEDIATE RELEASE: Wednesday, March 27, 2013

CONTACT: Dorinda White, 202.727.9226; dorinda.white

Department of Health Care Finance Announces Intent to Award Three Managed Care Contracts for New Five Year Program

Notice of Intent to be Submitted this Week to District Council for Approval

60-Day Extension Sought For Current Contracts

(WASHINGTON, D.C.) – The Department of Health Care Finance today announced that the Office of Contracting and Procurement (OCP) will submit packages this week to the Council of the District of Columbia with a notice of intent to award the District’s three managed care contracts to AmeriHealth Mercy Family of Companies, Medstar Family Choice, and Thrive Health Plan, Inc. Upon approval, the contracts will take effect July 1, 2013 and will include one base year and four option years.

“We began this process with the goal of revamping our managed care program in the shadows of national health care reform recognizing the many challenges and opportunities posed by the new law.” said DHCF Director Wayne Turnage. “Our primary objective was to populate our managed care program with health plans committed to managing the cost effective delivery of care to Medicaid and Alliance beneficiaries with the overarching of goal of improving patient outcomes. We are very pleased with the outcome of this important procurement and look forward to a collaborative partnership with these health plans.”

AmeriHealth Mercy Family of Companies (AMFC), is a national leader in Medicaid managed care and other health care solutions for the underserved. AMFC operates in 14 states and serves more than 4.7 million Medicaid, Medicare, and CHIP members through its Medicaid managed care products, pharmaceutical benefit management services, behavioral health services and other administrative services.

Medstar Family Choice is a Maryland-based plan that has been ranked number 17 in the nation among Medicaid HMOs by the National Committee for Quality Assurance.

Thrive Health Plan, Inc. is a new entrant into the District’s managed care program. Its senior management team has significant experience in and knowledge of the Washington, DC health care delivery system. The Thrive Health Plan cites its strength as a “hands-on approach to coordinating care” and is committed to improving the health outcomes of District residents.

To allow time for a proper transition of the new health plans, the Centers for Medicare and Medicaid Services has requested that DHCF pursue an extension of the contracts for the current health plans. Accordingly, DHCF will submit a request for a 60-day extension to Council for the period of May 1, 2013 to June 30, 2013 and the new five-year contract will begin July 1, 2013.

For more information on the Department of Health Care Finance, please visit

Kevin Wrege, Esq.

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016


FEMA head: Federal flood insurance to cost more

The Olympian, Published March 26, 2013

FEMA head: Federal flood insurance to cost more

The head of the Federal Emergency Management Agency says people who buy federal flood insurance need to plan for big rate hikes. FEMA director Craig Fugate says some people now paying hundreds of dollars a year could wind up paying thousands because Congress says the program must at least pay for itself.

He said Tuesday that the increases will be phased in over three to four years.

His comments came at the National Hurricane Conference. The National Hurricane Center’s Rick Knabb said the center will start providing three more days of notice about where tropical systems are likely to develop for the hurricane season that starts June 1. The tropical weather outlook has covered two days; now there will be a five-day forecast.

He says the center is working on storm surge watches and warnings, with plans to roll them out in 2015.

Read more here:

Muriel Bowser launches bid for D.C. mayor

Muriel Bowser launches bid for D.C. mayor

By Mike DeBonis and Nikita Stewart, Washington Post, Published: March 23

D.C. Council member Muriel Bowser launched a mayoral bid Saturday, kicking off a year-long Democratic primary campaign that is likely to center on the pace of progress in city government, the ethics of elected officials and the direction of the city’s remarkable growth.

Bowser made her announcement in front of her childhood home in North Michigan Park, a working-class Northeast neighborhood of brick duplexes and modest detached homes that have housed working-class, mostly African American Washingtonians for generations.

Her remarks Saturday and in an interview with The Washington Post indicate that the Ward 4 Democrat is designing her campaign to exploit Mayor Vincent C. Gray’s perceived weaknesses — his deliberate bearing and the federal investigation into his 2010 campaign.

“Will you go the distance with me?” Bowser, 40, asked a cheering crowd of more than 100 people Saturday. “It won’t be easy, but we need a change.”

She did not mention Gray directly but said, “Corruption has robbed us of our focus, our momentum, our need to think big and act swiftly.”

Bowser, a political confidante of former mayor Adrian M. Fenty (D), becomes the first candidate to officially enter the race, leapfrogging Gray (D), who could announce a reelection bid before late fall when candidates begin circulating ballot petitions for the April Democratic primary. Still more council members could enter the race: Tommy Wells (D-Ward 6) has formed an exploratory campaign, Jack Evans (D-Ward 2) has said he plans to run and David A. Catania (I-At Large) is pondering a bid.

Much of her campaign, Bowser said in the interview, will concern how to “manage the growth” the city has experienced in recent years — in particular, how to reconcile the anxieties of longtime residents with the expectations of newer ones. Census figures indicate that the city has reversed decades of population loss in the past five years, leading to pressures on affordable housing and employment.

“You’ll find that a lot of people who have lived here for a long time — white and black — feel like that the growth is pushing them out or causing prices to go up, the senior citizens to get hurt,” she said. “How do we manage it to the point that D.C. is welcoming to people who have lived here for five decades or people who have lived here for five months?”

A name Bowser mentioned only in passing Saturday, but one that will hover over the entire campaign, is Fenty. Bow­ser’s political patron, he served as Ward 4’s council member before launching a mayoral run from the stoop of his childhood home. After winning in 2006, he endorsed Bowser to replace him on the council and paved the way to victory for her. Since then, Bowser has easily won twice.

Besides being a backer of Fenty’s initiatives, Bowser also adopted some of his trademarks: a focus on constituent services over legislative heft, a shared political team and a campaign color known colloquially as the “Big Green Machine.”

Fenty’s 2010 loss to Gray, after his alienation of broad swaths of the black community, threatened Bowser’s future as a citywide candidate, but two revelations — of illegal activity within Gray’s campaign and a separate $650,000 “shadow campaign” for him — have helped burnish her prospects. Gray has denied any wrongdoing.

With Fenty settled in private life, Bowser is well positioned among potential mayoral candidates to assume his mantle in what could resemble a reprise of 2010. But while Bowser retains strong connections to Fenty — her campaign chairman and treasurer, lawyer Bill Lightfoot and businessman Ben Soto, served in the same positions for Fenty in 2010 — she has been wary about making too explicit a connection.

“I have great respect for the mayor, he’s a friend of mine, and we share a lot of ideals for our city,” she said of Fenty. “But I don’t think people confuse me with him.”

Asked about Bowser’s candidacy, Gray said he “refused to engage” her on campaign issues at this point.

Although Gray, 70, has not said whether he will seek reelection, he has rhetorically laid the groundwork for doing so. He has touted the city’s growth, a spate of economic-development projects and steady progress in some city agencies. His administration has also issued a five-year economic development strategy, a 20-year sustainability plan and a long-term affordable-housing framework.

Privately, Gray has told friends that he would run for reelection based on the progress he said the city has made. The Gray administration and some supporters said he continues to win the confidence of the business community and big-money contributors by delivering good city services. But detractors note that Gray’s grass-roots base — those who would canvass and help get out the vote — is fractured because of the federal probe and resentment that many of the 2010 die-hard volunteers did not get jobs and have been shunned by the administration.

Bowser’s brother, Marvin Bowser, who introduced her Saturday, said afterward that the biggest challenge for her campaign going forward is to get locals who have been “disillusioned” with the Gray administration to publicly voice support for her campaign.

Bowser indicated she would renew one of the central debates of the 2010 race, when Fenty’s insistence to move on city projects “as fast as humanly possible” was derailed by Gray’s pledge to move more deliberately to involve communities and interest groups more thoroughly in decision-making.

“Certainly, we want plans. We’ve had plans created in this District for decades,” she said. “But what people really want is action, urgency and energy behind these ideas.”

Bowser said she also intends to rekindle the debate over education — one that moved from center stage during the Fenty years to a less prominent position among the Gray administration’s priorities. The high-pitched debates that characterized the tenure of Schools Chancellor Michelle A. Rhee have been replaced by a less strident tone.

Bowser would not identify a particular policy she would pursue, other than moving more aggressively on schools issues and seeking to “connect the dots” among early childhood education, public and charter schools, the city’s universities and workforce development.

Besides a campaign agenda that appears to be heavier on governing styles than policy prescriptions, Bowser is open to attacks that her resume and legislative record are thin compared with those of her potential council challengers.

Bowser was a mid-level administrator in Montgomery County government before joining the D.C. Council, where her key legislative accomplishment was pushing an ethics law amid a spate of controversies a year ago. But some critics saw the effort as less than thorough because it did not include changes in campaign finance laws.

Although Bowser is critical of former council chairman Gray’s deliberation in running the government, she has been deliberate in determining whether to seek the mayor’s seat.

Friends and supporters said the nudges to persuade Bowser to run began in late 2011 and early 2012 as the investigation into the Gray campaign continued. But Bowser relented, telling close friends that she was focused on reelection.

“She said, ‘Never take anything for granted,’ ” said a friend who requested anonymity to speak freely about their private conversations.

Bowser listened to the refrain more intently after she was reelected to the council and embarked on an informal citywide listening tour. She became more visible outside Ward 4, traveling to other neighborhoods, including those east of the Anacostia River.

Businesswoman LaRuby May recalled spotting Bowser in January at an awards brunch in Congress Heights. “She was warmly received,” said May, 37. “I talked to her and told her I would support her.”

Subtle promises of support became more overt and targeted. May invited Bowser this month to the ribbon-cutting of Roundtree Residences, a 91-unit affordable-housing community built through the National Housing Partnership Foundation and the development arm of May’s church, Allen Chapel AME.

“It was absolutely intentional on my part to invite her to give her some exposure to Ward 8,” May said. “This is in line with her philosophy on economic development.”

Eric Magwood served on Gray’s campaign finance committee but has defected to Bowser’s camp. Magwood, 47, said he is discouraged by the investigation into the mayor’s 2010 campaign. “Unfortunately, I was one of the people on the campaign who didn’t know what was going on,” said Magwood, a political consultant whose conversations with Bowser began about five months ago.

Before deciding to enter the race, Bowser said she called a circle of her oldest and closest supporters. One of them was Fenty.

He had one thing to say, Bowser said: “Go for it.”

Annie Gowen contributed to this report.

Washington Post: Patrick Mara for D.C. Council

Patrick Mara for D.C. Council

By Editorial Board, Published: March 21

THE APRIL 23 special election to pick a citywide representative to the D.C. Council features an eclectic field with seven candidates vying to fill the term vacated when at-large member Phil Mendelson (D) was elected council chairman. Turnout is expected to be low, with as few as 50,000 voters predicted and a small number of votes likely to determine the winner and the direction that will be set for the council and the District.

Patrick Mara , in our judgment, is the best choice, offering a record of energetic service to the community marked by a thoughtful approach to the issues and a willingness to speak his own mind. Currently a member of the state board of education from Ward 1, Mr. Mara has a keen appreciation for the importance of education and the need for continued reforms that will enable both charter and traditional public schools to help their students achieve. Long before ethics became a flash point for a council battered by the missteps of its members, Mr. Mara was committed to integrity and strengthened ethics in government.

Indicative of Mr. Mara’s strength is the fact that the only thing his opponents seem able to attack is his affiliation as a Republican. “The consequences could be disastrous for the residents of the District,” reads a recent campaign e-mail from Anita Bonds (D), the incumbent by virtue of her interim appointment, about Mr. Mara’s possible victory. The socially progressive Mr. Mara — he’s broken with his party on issues such as gay marriage and D.C. statehood — would bring some welcome independence to a council dominated by think-alike Democrats. Mr. Mara has a proven willingness to engage GOP legislators on Capitol Hill to advance D.C. interests — and to stand up to them when necessary. It’s worth recalling that the District has had pretty good results when it’s elected similarly independent-minded Republicans in the past, notably former member Carol Schwartz and current at-large member David Catania, who has since switched to being an independent.

Of Mr. Mara’s opponents, attorney Paul Zukerberg (D) is an authentic new voice with a smart grasp of the issues, a commitment to pragmatism and a powerful message about marijuana laws making criminals out of too many of the District’s young people. No matter the outcome of Mr. Zukerberg’s candidacy, the conversation he has started about decriminalization must continue, and we hope he stays on the political scene. Democrats Matthew Frumin , an attorney and Ward 3 activist, and Elissa Silverman , a former Post reporter now on leave from the D.C. Fiscal Policy Institute, are both committed to improved ethics and have advanced well-meaning approaches. But Mr. Frumin’s support for limiting charters would impede education choice and Ms. Silverman’s past advocacy for the millionaire’s tax and expansion of the sales tax would, we fear, translate into new burdens on residents. Ms. Bonds, along with former D.C. Council member Michael A. Brown (reminted as a Democrat after losing as an independent last year), would take the council in a backward direction.

Muriel Bowser will launch D.C. mayoral run

Advisor role in exchanges causes clash | LifeHealthPro

Advisor role in exchanges causes clash | LifeHealthPro.

CQ: Business Push-Back on Employer Mandate Heightens as 2014 Nears

March 11, 2013 – 4:57 p.m.

Business Push-Back on Employer Mandate Heightens as 2014 Nears

By Jane Norman, CQ HealthBeat Associate Editor

A North Carolina owner of Five Guys burger restaurant franchises has held off on expanding to more locations until he can better understand the costs of the employer mandate in the health care law, he said at a Heritage Foundation forum on Monday.

Franchiser Mike Ruffer also said he will have to consider capping some of his employees’ schedules at 30 hours a week so he won’t have to offer them health insurance under the overhaul law (PL 111-148, PL 111-152). “These have to be rational considerations anyone in my situation has to consider,” said Ruffer.

Further complicating the situation is that he does not yet know what he might be charged for health insurance if he chooses to buy it because insurers have not yet begun disclosing their premium prices for policies to be sold beginning in October for the 2014 benefit year, Ruffer said. Pricing likely won’t be available until July, he said. “I don’t know how to model the economics,” he said.

The forum came as Republicans in Congress and outside opponents of the law ramp up their strong objections to particular sections of the overhaul that will kick in soon, such as the employer mandate. Under the law, businesses with 50 or more full-time employees or full-time equivalents must offer health insurance to workers. A full-time employee is considered someone who works at least 120 hours a month, or roughly 30 hours a week.

Sen. Orrin G. Hatch, R-Utah, introduced a measure (S 399) earlier this month that would repeal the requirement, though that bill is unlikely to pass given that the Democratic authors of the law control the Senate and the White House. Similar legislation (HR 903) was introduced in the House by Republican Charles Boustany Jr. of Louisiana. Boustany also held a hearing last week in the Ways and Means health subcommittee featuring criticism of the employer requirement.

Supporters of the law say the mandate is needed to ensure broad access for workers to health insurance that all Americans will be required to have in 2014. In addition, certain small businesses will qualify for a small-business tax credit to help pay for insurance, and small businesses will have access to an exchange in which they can find more affordable coverage. Supporters also point out that offering health insurance coverage is not required for the very smallest companies, which make up the majority of U.S. businesses.

Ruffer said he has 147 employees on his $2.2 million payroll at eight restaurant locations, and 60 of them would qualify as full-time employees under the law’s complex calculations. If he does not offer them health insurance when the law goes into effect he will pay $60,000 a year in penalties, eliminating a great deal of his profits, he said. “Just take one of my restaurants and wipe out the profits — it’s gone,” he said.

Fast-food chain restaurant owners have not traditionally offered health insurance or taken it into their economic calculations, Ruffer said. “There’s part of me that would love to offer health insurance to my employees,” he said, but the costs are daunting.

He also said that under his agreements with Five Guys, he is expected to add three more restaurants soon, but he said he can’t make the commitment without knowing more about his future health care costs.

Robert Graboyes of the National Federation of Independent Business Foundation said at the Heritage forum that his group will continue to fight for repeal in Congress. Businesses don’t know yet what policies will cost and the details of the final regulations that will affect their costs, Graboyes said. He also cast doubt on whether the health insurance marketplaces that are to offer insurance in the states for individuals and small businesses will be up and running later this year. “My guess is no,” said Graboyes.

Leaders at the Department of Health and Human Services have consistently said that the state-run, state-federal partnership and federally run exchanges will be ready for enrollment in October.

Ruffer said he did not initially realize that the health care law would apply to his business, and he added that he believes few of his employees understand that they soon will be required to have insurance. “It’s nowhere on their radar screen,” he said.

Source: CQ Online News

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