Judge to rule on provision of UPMC, Highmark agreement

HARRISBURG — Should Highmark’s nearly 50,000 Medicare Advantage members get an extra year of in-network access to UPMC facilities beyond the June 2019 expiration date of the two parties’ consent decree agreements?

The final decision will depend on how a frustrated judge interprets the agreements.

But that was the argument made Wednesday by Mark Pacella, chief deputy attorney general for Pennsylvania, in a Commonwealth Court hearing before Judge Dan Pellegrini, a position strongly opposed by UPMC.

At issue is when Highmark’s Medicare Advantage members lose in-network access to UPMC physicians and hospitals. The consent decrees — the state-brokered agreements that both Pittsburgh health giants signed in 2014 laying out a five-year plan for how their separation will unfold — expire

ago after insurance provider Highmark Inc. announced it June 30, 2019. planned to acquire the financially

UPMC argues that access ailing West Penn Allegheny should end when the consent Health System, and decrees expire. UPMC said it would not renew

Earlier this month, UPMC its contract with Highmark filed plans to terminate the since the insurer was Highmark Advantage contract establishing a competing at the end of 2018, at provider network. which point a six-month run On Wednesday, Mr. Pacella out would then allow access said that because Medicare throughJune 2019. contracts run on a calendar

“How that is not in compliance year, Highmark’s with the consent decrees members should receive is absolutely bewildering,” continued access through said UPMC attorney December 2019, followed by Leon DeJulius of the Jones a six-month run out period Day law firm during Wednesday’s to June 30, 2020. proceedings. Judge Pellegrini did not

The hearing was rule from the bench following prompted by allegations by the hour-long hearing, the state and Highmark that but his exasperation was evident any termination before June as it has become clear 30, 2019, violates the consent that neither Highmark nor decrees. UPMC anticipated this disagreement

The two parties’ relationship five years ago. fractured several years Having the consent decrees expire mid-year while Medicare contracts operated on a calendar year “does not reflect the real world,” the judge said.

“I don’t know what people were thinking when they signed on with this agreement, but we’re stuck with it.”

When the Post-Gazette first reported the disagreement in September, a spokeswoman for the federal Centers for Medicare and Medicaid Services said the agency contracts with insurers such as Highmark, not providers like UPMC, so it does not get involved in such disputes.

Now it appears a final decision will be based on the judge’s interpretation of the consent decree agreements.