The agency that provides healthcare for Orange County’s poor and some senior citizens is poised to resume enrolling members into its OneCare plan, which came under fire from federal regulators, officials announced Monday.
The Department of Health and Human Services’ Centers for Medicare and Medicaid Services sent a letter to county officials, dated Friday, that temporarily lifts a freeze on enrolling new members to CalOptima’s OneCare program, effective this Saturday.
County officials will be under a “test period” to see if they have corrected the issues raised by an audit by the Centers for Medicare and Medicaid Services. CalOptima officials pledged Oct. 15 to have the “deficiencies” cited by federal officials fixed by Nov. 1.
“While under this limited enrollment period, CalOptima may engage in enrollment activities and ‘passive marketing’ as defined in the marketing instructions sent to CalOptima at the onset of the sanctions,” wrote Gerald J. Mulcahy, director of Medicare Parts C and D Oversight and Enforcement Group, in a letter to Cal Optima CEO Michael Shrader.
“This passive marketing is limited to plan-specific information that may facilitate enrollment on CalOptima’s website,” Mulcahy wrote. “However, CalOptima shall not engage in active marketing activities aimed to attract new enrollments.”
Active marketing includes advertising via television, radio or newspapers or holding “marketing events,” Mulcahy said.
Another audit of the OneCare plan will be done in January to “determine whether CalOptima’s deficiencies have been adequately corrected and are not likely to recur,” Mulcahy wrote.
If the plan is still running afoul of regulations at that point, the federal agency could terminate its contract with CalOptima and impose other penalties.
“The CMS action signals recognition of significant improvements by CalOptima and our provider partners toward our promise of quality care for members,” Schrader said in a statement.
The OneCare program has nearly 15,000 members.
Orange County Supervisor Todd Spitzer, a member of the CalOptima board, called the agency’s temporary lifting of the suspension “encouraging.”
Orange County Supervisor Janet Nguyen has weathered intense criticism from critics, including an Orange County grand jury, about a shakeup of the CalOptima board she led at the end of 2011 that boosted representation by healthcare providers, giving them a controlling bloc over recipients. Nguyen has said her critics are guilty of “so many inaccuracies,” and that the changes paved the way to reduced costs and improved oversight and customer satisfaction overall.
Long Pham, a Republican who lost to Nguyen in the primary for a state Senate seat, has launched an attempt to have her recalled from office, partly because of the CalOptima issue.
Orange County grand jurors last year noted a mass defection of 16 senior- level CalOptima executives.
Nguyen has said she pushed for reform at CalOptima because it was plagued by mismanagement, wasteful spending and a lack of transparency.
The grand jurors, however, said any issues were prompted by an attorney who lodged more than 100 allegations against the agency’s senior executives. An outside legal firm later determined that the attorney retracted about half of the allegations and the remaining were considered mostly baseless, according to the grand jury.
In March, the Board of Supervisors approved a shakeup in CalOptima’s board. Two county supervisors serve on the board — Spitzer and Nguyen — and a third serves as an alternate. The Social Services Agency director remains on the board as a non-voting member.
The supervisors also changed how they pick among their own to serve on CalOptima’s oversight panel, with no guarantee that the supervisor with the most CalOptima members in his or her district will serve on the board. Nguyen is the supervisor with the most CalOptima recipients in her district.
— City News Service