You know the story we are about to tell you. But go ahead and read it to get you in the mood to call the Governor, Lt. Governor and House Speaker. They need to know that YOU know what's going on here.
Repeatedly, the House has voted to set standards for HMOs and PBMs that want to contract with HHSC and the state of Texas for Medicaid managed care. And behind the scenes, someone stripped those standards and replaced them with increasingly meaningless language.
Rep. Fred Brown (R-Byran) offered an amendment in the House to filter out companies that were fined or settled Medicaid fraud allegations of $500,000 or more in the past three years. Why would anyone oppose those standards?
Well, they did, but it wasn't the House of Representatives as a whole. The amendment passed the House, and then survived a motion to table by a decisive vote of 143 to 7. The House then instructed its conferees to hold fast on those standards. But somewhere in the conference committee, the language changed. At first glance, it appeared the HMOs were agreeing to the House requirements, just changing up the words a bit. Closer inspection revealed the Brown amendment and the House's intent were nullified.
The language slipped into the bill in conference committee only prohibits those unscrupulous HMOs and PBMs that are
"subject to a final judgment by a court of competent jurisdiction resulting in a conviction of a criminal offense." And at some point after the conference committee saw the new wording, the language miraculously changed to add "in connection with a bid, proposal, or contract with HHSC."
Two glaring problems with this language:
- HMOs and PBMs are rarely tried in court--their standard operating procedure is to settle at the last minute to avoid being found guilty. These bad actors pay monetary settlements and reach agreements with state and federal authorities (Dept. of Justice, AGs, etc.) about how to remedy their bad behavior (rehabilitative plans). They don't go to trial and they don't get convictions because the authorities and the bad actors don't want the expense and uncertainty of a trial.
- No PBM has ever contracted with the state of Texas!
You probably thought all this was taken care of last week. But for several days they were unable to muster a quorum in the House! So, here we are again. This special session ends Wednesday, so we're certain, or at least as certain as we can be, that this is our last chance to restore integrity to the Medicaid managed care contracting process.
Call the top three elected officials this morning!
Tell them:
- You are not pleased about the behind-the-scenes negotiations, and they shouldn't be either.
- Every taxpayer in Texas has an interest in how HHSC chooses who to enrich with multimillion dollar contracts.
- Every legislator in Texas should stand up for fiscal responsibility.
- That means NOT giving out contracts to businesses that routinely paid huge fines or settlements because they still can net millions in profits.
They should advise their followers to be good stewards of the taxpayer dollar. They should reinstate the Brown Amendment and tell the bad actors to take a hike.
- Governor Rick Perry (512) 463-2000
- Lieutenant Governor David Dewhurst (512) 463-0001
- Speaker of the House Joe Straus (512) 463-1000
And for good measure, forward this PharmPhlash to your state senator and state representative by clicking on the "Forward email" link at the very bottom of this page. Their email addresses are intuitive:
