The Public Employee Benefits Program meeting to iron out the battle over whether an innovative pilot program with Saint Mary’s Hospital and Carson Tahoe Health violates the existing contract with Hometown Health was abruptly canceled Friday.
That move came after lawyers for Saint Mary’s filed a complaint saying they weren’t appropriately notified of the meeting and acting to suspend the pilot program would violate the law.
After the board approved the pilot program in March, officials at Hometown Health and its partner Renown Hospital said ending their exclusive right to serve state workers would require them to raise rates significantly in the Preferred Provider Organization network that covers the majority of state workers.
With just three weeks until open enrollment, PEBP Board Chairman Patrick Cates said rate hikes would throw state workers into chaos trying to decide what to do about their healthcare.
The pilot program approved in March was created to try to install some cost controls since, under the existing contracts, providers including Hometown Health can raise rates at any time. Executive Director Damon Haycock’s briefing to the board said the pilot program was designed to replace the existing HMO contract because Hometown Health had announced double digit increases in rates that would have to be absorbed by PEBP members. The pilot program would effectively move the HMO plan members into the PPO plan with rates set based on Medicare rates plus a premium. That would effectively take away patients currently served by Hometown Health.
Cates said negotiations have been going on since the March decision. He said Hometown Health and Renown Health have offered a compromise that would hold rates flat until the end of 2019 and cap increases in 2020 and 2021 at just 2 percent a year. Haycock told board members the offer is reasonable and puts some cost controls on state worker healthcare.
In return, PEBP must suspend the pilot program with St. Mary’s and Carson Tahoe Health.
Saint Mary’s filed its complaint saying it has a contract signed with PEBP to operate the pilot program.
The state, however, is arguing the contract isn’t actually finalized until and unless approved by the Board of Examiners on May 8.
Haycock’s briefing to the board recommends suspending the Saint Mary’s/Carson Tahoe pilot program.
PEBP will take up the issue next Friday.
“This decision needs to proceed,” Cates said.
