Back to the Drawing Board for PH-MCO Procurement


It looks like Pennsylvania will be heading back to the drawing board in the Physical Health Managed Care Organization (PH-MCO) procurement process. That’s because in April 2018, Commonwealth Courtruled in favor of the bidders protesting the contract award process; Aetna, United HealthCare and Vista Health Plan. The three insurers had filed suit challenging that a December 2016 meeting between the Commonwealth and then successful bidder, Centene (PA Health and Wellness), violated the terms of the procurement blackout period.

Pennsylvania PH-MCO procurement process began in 2015. The initial round of bidding resulted in contract awards in April 2016 that were supposed to commence at the beginning of calendar year 2017. However, as detailed in an earlier post on this topic, Aetna successfully challenged that round due to the Commonwealth’s inclusion of a “heritage factor” that resulted in Aetna being bypassed in favor of bidders who scored lower.

After Aetna’s successful challenge of the round one contract awards, the Department of Health and Human Services (DHS) quickly re-issued its RFP in July 2016, and contracts were awarded a second time in January 2017.

This time, Aetna was joined by United HealthCare and Vista Health Plan in protest, claiming that a December 2016 meeting between the Deputy Secretary for DHS and Deputy Chief Counsel for the Office of Medical Assistance Programs (OMAP) and Centene’s CEO and Executive Vice-President violated equal treatment requirements of the procurement code.

The Court’s most recent decision protesting contracts awarded after the second round of bidding reverses an earlier decision rendered by DHS against United Healthcare, in which United Healthcare argued that allowing Centene, which does not yet operate in Pennsylvania, to submit performance scores from other states during the bidding process was unfair.

DHS is currently reviewing the most recent decision. In the meantime, the following current PH-MCOs operating in each HealthChoices zone will remain in place for the foreseeable future.

ZoneCurrent PH-MCOs
Lehigh-CapitalAetna Better Health of Pennsylvania
AmeriHealth Caritas Pennsylvania
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You
Northeast (Formerly New East)Aetna Better Health of Pennsylvania
AmeriHealth Caritas Pennsylvania
Geisinger Health Plan
Northwest (Formerly New West)Aetna Better Health of Pennsylvania
AmeriHealth Caritas Pennsylvania
Gateway Health Plan
UPMC for You
SoutheastAetna Better Health of Pennsylvania
Health Partners Plans
Keystone First Health Plan
United Healthcare of Pennsylvania, Inc.
SouthwestAetna Better Health of Pennsylvania
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You