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Nevada Awards Medicaid Managed Care Contracts To Anthem, Centene, Molina & UHC

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By OPEN MINDS Circle

On August 5, 2021, the state of Nevada awarded Medicaid managed care organization (MCO) contracts to Anthem (Community Care Health Plan of Nevada, Inc.), Centene (SilverSummit Health Plan, Inc.), Molina (Molina Healthcare of Nevada, Inc.), and UnitedHealthcare (Health Plan of Nevada, Inc.). The contracts, valued at $11 billion, are slated to begin on January 1, 2022, and run through the end of 2025, followed by an optional two-year extension.

Three of the plans were incumbents – Anthem/Amerigroup, UnitedHealthcare/Health Plan of Nevada, and Centene/SilverSummit Health Plan. Their current contracts are valued at approximately $30.4 million annually. The MCOs manage the Nevada Medicaid and Check Up (Child Health Insurance Program) programs. As of February 22, 2021, more than 810,000 state residents (about 25% of the state’s population) were enrolled in Nevada Medicaid and Check Up. Managed care enrollment is mandatory for most Nevada Medicaid beneficiaries; 75% are enrolled in managed care. The following populations are excluded and are served through fee-for-service:

  • Children in child welfare or foster care.
  • People receiving services in an Intermediate Care Facility with Intellectual Disabilities.
  • People receiving services in a nursing facility for more than 180 calendar days. After that length of stay, the person will be disenrolled from managed care and the remainder of the stay will be covered by fee-for-service Medicaid.
  • People admitted to a swing bed stay in an acute care hospital over 45 calendar days. After that length of stay, the person will be disenrolled from managed care and the remainder of the stay will be covered by fee-for-service Medicaid.
  • People receiving hospice services. On admission to hospice, the person will be disenrolled from managed care. Nevada Check Up members will not be disenrolled on admission to hospice; however, payment for Nevada Check Up hospice services will be carved-out and billed to the state’s FFS program.
  • People enrolled in a 1915(c) Home- and Community-Based Services waiver program.

The new contracts include changes to align the Nevada Medicaid and Check Up programs with the state’s strategic plan, as follows:

  • Promote health coverage
  • Increase access to and use of primary care and preventive services
  • Improve the quality of and access to behavioral health services available to members
  • Ensure all pregnant women, children, and parents have the support they need for a strong start
  • Identify and address ethnic and racial disparities in health care
  • Support justice-involved individuals transitioning to the community
  • Improve health indicators and quality-related outcomes for members and enhance public transparency of MCO performance

The Nevada Department of Health and Human Services (DHHS), Division of Health Care Financing and Policy (DHCFP) released the request for proposals (RFP 40DHHS-S1457) on March 17, 2021. Proposals were due by May 13, 2021. In addition to meeting the RFP requirements for the Medicaid and Check Up programs, the bidders must agree to also offer individual health plans through the state-designated Health Insurance Exchange by the 2024 coverage year. To meet this requirement, the selected MCOs must provide at least one Silver-level Qualified Health Plan (QHP) and one Gold-level QHP. These plans must meet the qualifications of an MCO Transition QHP. The state received eight proposals. The unsuccessful bidders are Aetna Health of Utah; AmeriHealth Caritas Nevada, Inc.; Hometown Health; and SelectHealth.

To evaluate the proposals, DHHS used a three-phase approach. The first phase is a review of mandatory requirements. Any proposal that did not meet the mandatory requirements did not advance to the second phase review of responses to technical questions. The third phase, oral presentations, will take place at the state’s option. For the technical review, the proposals were scored in six topic areas; the maximum score was 1,500. SilverSummit Health Plan received the highest points, at 1,214. Community Care Health Plan of Nevada received 1,149 points. Molina Healthcare of Nevada received 1,162 points. Health Plan of Nevada received 1,035 points.

The maximum points for each area of the technical review were as follows:

  • 250 points for member and provider organization services: SilverSummit Health Plan received the highest points at 181
  • 300 points for benefits and service deliver: Molina Healthcare received the highest points at 292
  • 325 points for network and access to care: Community Care Health Plan of Nevada and SilverSummit Health Plan received the highest points at 260
  • 350 points for clinical and quality: Molina Healthcare and SilverSummit Health Plan received the highest points at 120
  • 150 points for monitoring and reporting: SilverSummit Health Plan received the highest points at 290
  • 125 points for business and operations: Health Plan of Nevada received the highest points at 112

Managed care beneficiaries will have the opportunity to select an MCO, and families will be enrolled with the same MCO when possible. For potential members who do not select an MCO, DHHS will auto-assign the member to an MCO based on the MCO’s capacity to accept new members. Native Americans can voluntarily participate in Medicaid managed care, as can any beneficiary determined be a Child with Special Health Care Needs (CSHCN) or with serious emotional disturbance (SED).

The RFP includes value-based purchasing provisions directing the MCOs to use alternative payment methodologies (APMs) in contracts with network provider organizations. The APMs should support the state’s population health goals and the contractor’s population health program, and reward provider organizations for the following:

  • Addressing members’ needs related to social determinants of health
  • Improving health equity in access to and delivery of health care services
  • Improving maternal and child health outcomes
  • Improving health equity in access to and delivery of health care services
  • Diverting members from emergency room use to more appropriate/less intensive settings
  • Diverting members from psychiatric hospitalization placement into outpatient clinics when appropriate

For more information, contact:

  • Ky Plaskon, Public Information Officer, Division of Health Care Financing and Policy, Nevada Department of Health and Human Services, 1100 East William Street, Suite 101, Carson City, Nevada 89701; Email: Kyril.Plaskon@DHCFP.nv.gov; Website: https://dhcfp.nv.gov/
  • Lori McLaughlin, Communications Director, Anthem, Inc., 220 Virginia Avenue, Indianapolis, Indiana 46204; 317-488-6898; Email: Lori.McLaughlin2@anthem.com; Website: https://antheminc.com/index.htm
  • Marcela Manjarrez-Hawn, Senior Vice President And Chief Communications Officer, Centene Corporation, 7700 Forsyth Boulevard, St. Louis, Missouri 63105; 314-445-0790; Email: mediainquiries@centene.com; Website: https://www.centene.com/
  • Caroline Zubieta, Director of Public Relations, Molina Healthcare, Inc., 200 Oceangate, Suite 100, Long Beach, California 90802; 562-951-1588; Email: Caroline.Zubieta@molinahealthcare.com; Website: https://www.molinahealthcare.com/members/common/en-US/abtmolina/compinfo/newsmed/Pages/newsmed.aspx
  • Christina Witz, Media Contact, Community & State, UnitedHealthcare, 12501 Whitewater Drive, Hopkins, Minnesota 55343; 952-931-4645; Email: christina.witz@uhc.com; Website: https://www.uhc.com/