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Why is HFS still stonewalling?

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Illinois

* Here are the broad guidelines for the state’s Business Enterprise Program (BEP)…

• At least 51 percent owned and controlled by persons who are minority, women or designated as disabled

• Must be a United States citizen or resident alien

• Annual gross sales of less than $75 million

Rep. Chris Welch, who chairs the House Executive Committee, has been asking the Department of Healthcare and Family Services to provide him BEP spending by Managed Care Organizations. The department has sent him the overall numbers, but Welch wants those numbers broken down by category (race, gender and disabled).

Welch sent HFS Director Theresa Eagleson this polite yet firm letter a couple of days ago asking for more information. He has yet to hear back…

Director Eagleson,

Thank you for your response to my request for information. It was not exactly what I was requesting, but it provided some initial insight into the BEP spending by MCOs. I think we would both agree that while there has been some progress in the last year, compliance is woefully inadequate.

I would like to take this opportunity to commend you and your staff for taking steps to increase compliance with the BEP requirements. Your letter to the MCOs was direct and expressed the necessary urgency. It’s a solid beginning. My goal is to work with you to resolve this issue. Together, we can help develop a new generation of minority entrepreneurs.

I would appreciate some additional information to help me better understand the scope of the problem. In particular, I would like to be provided the following:

1. The BEP spend for each MCO by breakdown of the subgoals in the contract: minority-owned, female-owned, disability

2. All BEP Utilization Plans and letters of intent for each MCO provided to HFS from January 1, 2018 to present. Please also include any waivers that have been granted or any other communication between HFS and the MCOs regarding BEP for same time period.

3. Outreach and Special Initiatives Document (or deck/document in any form) for each MCO from January 1, 2018 to present (includes but not limited to the contracting activity, report on subcontracts, progress towards overall contract goal, outcomes, etc.

4. The MLR calculations, including but not limited to the administrative percentage, for each MCO for FY18, FY19, & FY20. Pursuant to 305 ILCS 5/5-30.1 the MCO MLR info is supposed to be on the website, but I just haven’t been able to find it. Thank you!

5. All quarterly reports to DCMS (or HFS) from the MCOs reporting in on BEP vendor payments for FY18, FY19 & FY20. As you know, I have been frustrated by the lack of timely response to my request for information.

6. The actuarial certification or other documents showing the “administrative allowance” calculation of the capitation. The contracts look like the BEP is only applied to the “administrative allowance”. It would be helpful if you please list both “care management” and “healthcare quality initiatives” amounts separately for each MCO. Please also provide everything that has been excluded from the calculation.

7. You provided the compliance letter HFS sent to BCBS. Can you please provide the corresponding letters you sent to each of the other MCO’s.

As you know, I have been frustrated by the lack of timely response to my request for information. It took 4 weeks just to get the chart your staff provided on Friday. I would hope that this request would be provided in a more timely manner. In the interest of time, please provide these documents as you get them, rather than waiting for the full package to send at one time

As evidenced by your letter to the MCOs, you feel as strongly about this issue as many of us in the Black Caucus. I am anxious to work with you to achieve our mutual goals by bringing the MCO’s into full compliance.

Sincerely,

Emanuel Chris Welch
State Representative - 7th District

Gov. Pritzker has repeatedly said he wants to help create wealth in Black and Brown communities. The BEP program is one way the state can do that, but we have no way of measuring its effectiveness unless and until state agencies start releasing this information. And it cannot be successful if agencies like HFS don’t start enforcing the contracts and clawing back the money which isn’t spent through BEP participants, which apparently isn’t being done.

posted by Rich Miller
Wednesday, Aug 5, 20 @ 3:46 pm

Comments

Team Pritzker just is not up to the job. Perhaps as things continue to go wrong they will make some changes. They did make some changes in the nursing home area so that’s something to keep in mind.
Being Governor in Illinois is no cake walk.

Comment by Back to the Future Wednesday, Aug 5, 20 @ 4:39 pm
Are we shocked?

Comment by Frank talks Wednesday, Aug 5, 20 @ 5:07 pm
Will HFS respond to this as a formal FOIA request?

Comment by Busy Not 1 Wednesday, Aug 5, 20 @ 5:12 pm
In regards to #6 on the list - HFS has denied under FOIA the actuarial certifications for FY 2018 forward because they are draft. They say they are draft because federal CMS has not approved them. So the last MCO rates approved are from FY 2017 which is before HealthChoice.

Comment by Hoping for Rational Thought Wednesday, Aug 5, 20 @ 6:50 pm
“The BEP program is one way the state can do that”
I agree with the statement but offer an observation that the current program is not able to achieve that goal. It comes from the working at 3 agencies and working with subs that helped the prime meet that goal. But most of the workers at the subs were not part of the BEP defintion. It only applied to the owners. How do we extend that to the workers where it can have the greater impact?

Comment by IT Guy Wednesday, Aug 5, 20 @ 7:49 pm
“Why is HFS still stonewalling?”

Running around trying to find SOMETHING to give Welch takes time, Rich, lol.

Comment by Anonymous Wednesday, Aug 5, 20 @ 7:55 pm