Governor will not allow vote on DiamondCare alternative to Medicaid managed care during special session | Arkansas Blog

Tuesday, March 29, 2016

Governor will not allow vote on DiamondCare alternative to Medicaid managed care during special session

Posted By on Tue, Mar 29, 2016 at 5:14 PM

UPDATE: Gov. Asa Hutchinson will not allow a vote on DiamondCare during the special session, his spokesman tells me. The only bills on the governor's call will be his Medicaid managed care bill and "Arkansas Works," his plan to continue the private option. Opponents of managed care in the legislature are going to be apoplectic. The special session next week is going to be a wild one. 

UPDATE 2: There are still some procedural options for DiamondCare backers. They could attempt to bring up their bill, arguing that's it's germane to the governor's proclamation for the special session. It would be up to the House Speaker and President of the Senate to determine whether to take up the bill. While the bill arguably would be germane, House Speaker Jeremy Gillam and Senate President Jonathan Dismang would likely be hesitant to foul up the governor's plan. If Gillam and Dismang ruled that the bill was not germane, backers could protest to the Rules Committee but that would almost certainly be a dead end. 

Meanwhile, at the end of the three-day session, with two-thirds support from both houses, lawmakers can bring up any legislation — but only after they’ve taken up and considered the governor’s bills (they can also, with two thirds support, extend the special session to consider additional bills, up to fifteen days). That would be pointless for DiamondCare if the governor's managed care plan has already passed, but it would be an option if managed care opponents block the Hutchinson plan. 

One more approach: DiamondCare backers could try to amend the existing bill. That would require majority support in committee; sabotaging the existing managed care bill in committee would probably be a much harder lift than trying to get a majority of the legislature to support DiamondCare over the managed care plan. 

Finally, if the managed care bill fails in the special session, the DiamondCare backers could attempt to take up their bill during the fiscal session that followed. 

In short, DiamondCare could remain an option if the legislature votes against the governor's managed care plan. Otherwise, the procedural choices are extremely limited. 

Original post: 

A little bit of fireworks at the tail end of today's Health Reform Legislative Task Force meeting: Lawmakers who back DiamondCare, an alternative to Gov. Asa Hutchinson's plan to use managed care for certain high-cost populations in the Medicaid program, expressed concern that the governor may not allow a vote on their plan. 

In an interview after the meeting, Rep. Michelle Gray, one of the key backers of the DiamondCare plan, told me that the governor strongly signaled to her that he will decline to put the legislation on the call for the special session. Procedurally, the governor can control what bills are taken up for vote during the special session he called. The task force was split between managed care and DiamondCare, with neither side getting a majority, so most expected that the legislature would consider both alternatives. However, Hutchinson appears set to play hardball, only allowing a vote on his preferred option. 

Gray said that she met with Hutchinson yesterday and asked whether he would put the DiamondCare legislation on the call. "He said something to the effect of, 'why would I want to do that?'" Gray said. "He's not outright told me no, but he's led me to believe that."

Last week, draft legislation was released for the two competing plans to pursue reforms for the developmentally disabled and behavioral health populations in traditional Medicaid. One, backed by the governor, would use managed care companies. DiamondCare would pursue the same slate of reforms but still have the state pay providers directly on a fee for service basis.

DiamondCare backers were already upset because they said that the draft legislation was drawn up without any input from them. Gray told me that significant elements of their plan were not included in the draft legislation, which lists the task force co-chairs as sponsors. The DiamondCare backers are now in the process of writing a new bill, which will likely be ready by the end of the week (the existing bill will be scrapped).  It's unclear who was responsible for shutting them out of the process of writing their own bill, which was drafted by the Bureau of Legislative Research with input from the state's consultant, the Stephen Group.  Task force co-chair Sen. Jim Hendren, one of the listed sponsors, was apologetic at today's meeting. 

Gray and Rep. Deborah Ferguson, key architects of DiamondCare, said that their draft legislation would likely be released on Friday. The question now is whether the legislature will ever get the chance to vote on the bill. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.


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