Pennsylvania senators and representatives have written to CMS to see if the agency can give more information to patients who will be affected in six months by a split between Pittsburgh-based Highmark and UPMC, according to the Pittsburgh Post-Gazette.
Starting July 1, 2019, approximately 175,000 Highmark Medicare Advantage plan members in the greater Pittsburgh and Erie, Pa., areas will lose in-network access to 11 UPMC hospitals and "most UPMC doctors," according to a UPMC spokesperson cited by the Post-Gazette. The Highmark-UPMC consent decree, struck in 2014, expires June 30.
In the state-mediated consent decree executed in summer 2014, Highmark and UPMC agreed to terms of their breakup after several years of conflicts related to coverage and reimbursement rates.
Earlier this month, two senators and three representatives wrote to CMS Administrator Seema Verma describing "significant confusion among beneficiaries" during the latest Medicare open enrollment period.
Their letter follows a November 15 report from the Pittsburgh Post-Gazette that noted the confusion patients, especially the elderly, face in navigating in- and out-of-network providers.
UPMC physicians do not need to provide termination letters to Highmark until 60 days before the consent decree expires. This means elderly patients lacked clarity during the 2019 Medicare open enrollment period about whether they needed to switch health plans to keep their providers.
In their letter, the lawmakers did not ask Ms. Verma or CMS to take any specific action, but did ask Ms. Verma to "provide information on what CMS may be able to do or has done to ensure that both parties have provided beneficiaries in Western Pennsylvania with the information necessary to appropriately plan for their care for the entirety of plan year 2019.
Read the full Post-Gazette report here.