[{"_1":2,"_111":-5,"_112":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87,99],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},"mediaId",6453803,"mediaKeyId","5873685-1ef06b9d1afe95f1cef2145f8edad91f","parentId",5873685,"title","Connected Care Network signs value‑based deal with WellPoint; FQHC leaders say early gains in preventive care","audioSeconds",7720,"startMs",1745000,"endMs",9465000,"viewUrl","/Search/View?dp=1&key=5873685-1ef06b9d1afe95f1cef2145f8edad91f&start=1745&end=9465","thumbnailUrl","https://assets.pipeline.soar.com/5873685-1ef06b9d1afe95f1cef2145f8edad91f/thumbnail_1745000.jpg","articleUrl","/articles/6453803/Connected-Care-Network-signs-valuebased-deal-with-WellPoint-FQHC-leaders-say-early-gains-in-preventive-care","mediaUrl","https://secure.pipeline.soar.com/6453803-706e434382b48122ae4f07ebe2f940ce/orig.mp4?Expires=1771160718&Signature=hpH~-q-j-b0knBLDFX8Hki8Nz1eUL0PrBMlSy9zax638sDtO5g4rvUj3NZ1R8p1JNdfJkY2~7QPQcgVCeXQvG5ZIUjIiNSjl~-RKMnWKVefh3xqDl7Wh7rB81CHZXRpcrrzo6YlTe2icYdnC~baUib12ymaCeTTiQavZ6eUb5i9bo15YGU1gvLkNmxOFaGqxUtc4XQNxkNBhrlx8k9buOVpZLVrAEXzURRQ01Apq8TejwvHxWbvCJw7Tbcx6NX9Tp-O8GwPBP7~yoc~-jLYrYA8jNExvYcwJLDL0aaDE1kA6N6HIpiFokFur5iasDHpzZNEKTcxwUaBLt5yjnHJzQg__&Key-Pair-Id=KUT5TJCACFTXG","author","District of Columbia (Health)","date","2025-09-30T00:00:00Z","article","Charles Rosato, vice president of network operations for the DC Connected Care Network, told the Committee on Health that CCN’s first year focused on building data sharing, communication and trust across seven Federally Qualified Health Centers (FQHCs) and community partners.

Rosato said the CCN is responsible for attribution and care pathways for more than 121,000 DC Medicaid beneficiaries attributed to participating health centers. The group has been working with CRISP and the DC Primary Care Association to unify electronic health record views and create physician‑led advisories to design care pathways and negotiate value‑based contracts.

Rosato said the CCN signed a multi‑year blended savings arrangement with WellPoint DC in 2025 that includes quality measures and cost‑savings targets. Early results include increased preventive screening rates across pediatric and adult populations and improved outreach and follow‑up for chronic disease care.

Patricia Quinn of the DC Primary Care Association supported the network’s approach and recommended policy changes such as centralized credentialing and stronger third‑party liability rules modeled after Maryland to reduce administrative burden on community health centers. She told the committee that centralized credentialing and clearer MCO requirements on third‑party payers could substantially lower billing and credentialing friction.

Why this matters: CCN’s initial performance suggests FQHC integration and value‑based contracting can increase preventive care and support primary care as the “quarterback” for Medicaid patients, potentially reducing avoidable emergency care and overall costs.","mediaType","Video","parentTitle","District of Columbia (Health) - Committee on Health, Public Oversight Roundtable, Christina Henderson, Chairperson","oneSentenceSummary","The DC Connected Care Network said it signed a first multi‑year blended savings agreement with WellPoint DC and reported early increases in preventive screenings and outreach among seven Federally Qualified Health Centers.","taxTitle","Committee on Health, Committees, Legislative, District of Columbia","taxId",16182,"location","","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6453808,"Families praise HSCSN as lifeline for children with complex needs; program faces home‑health access bottlenecks",8083,1982000,10065000,"/Search/View?dp=1&key=5873685-1ef06b9d1afe95f1cef2145f8edad91f&start=1982&end=10065","https://assets.pipeline.soar.com/5873685-1ef06b9d1afe95f1cef2145f8edad91f/thumbnail_1982000.jpg","/articles/6453808/Families-praise-HSCSN-as-lifeline-for-children-with-complex-needs-program-faces-homehealth-access-bottlenecks","https://secure.pipeline.soar.com/6453808-184961d5a67b9e793f581458c1bd6b6c/orig.mp4?Expires=1771160718&Signature=g7FLYAdp3vwsGrZ6BJTXlDtJgO64bZ~ET-c-t~XbsqVWAH5puxEcPG0HIN8-ja9uwI6Zhz7iUqwZ15WjW4DBEUYPSFUtuRFqqeYmOIQVQaxApIIeTh1J2VKSqCqcmxMlfF08AtY2Uqmgy5y7olxhZEkNuLtfJCo848g0YJeWggk583fWbJI5amAKvslcejS1R6bnD~b7A-9dP45KzMxtTqao3m5bPuIYWBEk7Tt5hK4rWyt7BinxZAke59gT6k6QjHkZSTTKmcI2ffMjYPNUoVaI9S5pdqrVbIPMhwhDyV5iSx-QV2M5DcbN7MweTSJMLMg8Y7jKd4t2i6T5xcQW4Q__&Key-Pair-Id=KUT5TJCACFTXG","Several parents testified at the Sept. 30 roundtable about the role of Health Services for Children with Special Needs (HSCSN) in enabling complex pediatric care at home.

“My name is Erin Sabonsky. I am here to express my gratitude for my son Anthony’s health care coverage through Health Services for Children with Special Needs,” said a parent who described HSCSN as essential after her son’s brain injury required ventilator and 24‑hour skilled nursing supports. She credited HSCSN case managers with coordinating home nursing and growth‑hormone therapy that allowed the family to leave long‑term inpatient care and return home in 2012. “We do not have the financial resources or very much extra time to take legal actions to hold them accountable. HSCSN is different. We have a case manager who is familiar with Anthony’s situation, who will return my messages on the same day,” she said.

Other caregivers gave similar accounts. Melissa Coppolo testified HSCSN’s outreach upon discharge from the NICU was a “lifeline” after extremely premature births and dozens of surgeries for her daughter in the first years of life; she said HSCSN’s case managers and Children’s National clinicians enabled the family to remain in DC. Thomas Cunningham described HSCSN enrollment through the Katie Beckett pathway and credited case management with supplies, therapies and the home nursing that helped his son make functional gains.

Anna Dunn, president of HSCSN, described the organization as a pediatric‑focused managed‑care plan serving about 5,000 children and young adults up to age 26, many with multiple comorbidities. HSCSN told the committee it is accredited by NCQA, operates a provider portal to prioritize authorization requests, assigns every enrollee a care manager and reports average credentialing performance (three‑year recredentialing cycle) of 15 days. HSCSN said 65 percent of enrollees receive primary care at Children’s National and more than 90 percent receive specialty care there.

Despite high marks for coordination, witnesses and HSCSN leadership identified access problems in pediatric home health and personal care aide (PCA) availability: families face delays far exceeding 30 days in securing home nursing services even after authorizations, HSCSN said. Attorney testimony highlighted shortages of vision‑therapy providers and other pediatric specialists; plaintiffs’ counsel suggested DHCF could allow managed‑care plans to authorize out‑of‑network services and expedite caregiver reimbursement when no in‑network provider meets a child’s needs within the district’s 30‑day timely‑access standard.

Why this matters: HSCSN serves a small but medically complex population whose home health coverage and case management can prevent institutional care. Committee members were urged to preserve and strengthen HSCSN while addressing workforce shortages for pediatric home health and PCAs.","Parents told the Committee on Health that Health Services for Children with Special Needs (HSCSN) enabled children with complex conditions to go home and receive ongoing care, but HSCSN and legal advocates warned of lengthy delays for pediatric home health and shortages of personal care aides.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6453817,"Council roundtable flags denials, prior‑auth delays and credentialing gaps in DC Medicaid managed care",14266,84000,14350000,"/Search/View?dp=1&key=5873685-1ef06b9d1afe95f1cef2145f8edad91f&start=84&end=14350","https://assets.pipeline.soar.com/5873685-1ef06b9d1afe95f1cef2145f8edad91f/thumbnail_84000.jpg","/articles/6453817/Council-roundtable-flags-denials-priorauth-delays-and-credentialing-gaps-in-DC-Medicaid-managed-care","https://secure.pipeline.soar.com/6453817-53d49e84ae8b776706fb682a359419e0/orig.mp4?Expires=1771160718&Signature=S7H2lBnUCSeHwWEEeQcbHARI~-S6fcRawfIHm902dWH7xxfCZ-NHYojSlrc4H6XnC1X2vyDZi6iwJ6ZWrNfYfIbZvNxfLGac98DKu~Vpkm~bJ1plYf3VyHYW3zqaa-n20IkfUSVm3a7eo4d3~ay54pSINGcsDyHsQXtQ0i5q8xgtquSMXyZohTs4GuRQwz2C~9qb8wVsz~TK9TZfY-LDIAeY28YV432a6QyZlUjEgGGE4MkzuBX6ELyOcxkjrPvKKSics6l~jBTwtuCF2d1tNOmIlCzgAVqVYNAaCCGtLqKL7Wv-7helq4775bKKu~8wrXj-jUuFt~yXtu3xOOJ41A__&Key-Pair-Id=KUT5TJCACFTXG","Councilmember Christina Henderson, chair of the Committee on Health, convened a roundtable Sept. 30 to examine performance and provider experiences with the District’s Medicaid managed‑care organizations (MCOs). The hearing gathered testimony from the three MCOs that contract with the Department of Health Care Finance (DHCF), provider groups, legal advocates and families.

The committee opened with context about scale and spending: “As of June 2025, there were over 240,000 people — approximately 88 percent of all Medicaid enrollees — enrolled in these managed care plans,” Henderson said. The council noted that the District spent nearly $2,000,000,000 in 2022 on services administered by MCOs and that two‑thirds of provider payments were delivered through managed care by FY2024.

Witnesses described recurring operational problems. Community providers and doulas told the panel that credentialing and contracting times vary widely across plans, that paperwork is sometimes lost, and that claims denials and inconsistent coding practices have led to delayed or missing payments. “After a lengthy process, I did establish a contract with two other MCOs, which took about six months,” Crystal Jackson, owner of Aqui Grama Doula Services, testified. Gina Vallow, owner of BirthingKind, said her firm had “around $44,500 to $45,000 unpaid” and described thousands of dollars in postpartum claims denied because contract code sets omitted postpartum care.

Medicaid providers and the Medical Society of the District of Columbia raised concerns about “downcoding,” a billing practice they described as automated reductions of evaluation-and-management codes without adequate clinical review. Dr. Flint Peebles, chair of the MSDC advocacy committee, urged the council to require reviewer credentials and deny automatic downcoding without physician review. “Downcoding is not just a billing tactic. It is a barrier to care,” said MSDC testimony.

MCO executives said denial rates and prior‑authorization delays are priorities for improvement. WellPoint (formerly Amerigroup) reported that clean‑claim performance had been strong in 2023 and that the plan achieved NCQA accreditation; MedStar Family Choice said average credentialing processing times were about 28 days and that it had addressed a spike in member appeal inventory by adding staff and vendor support. AmeriHealth Caritas noted that incomplete provider applications — expired CAQH records, missing state DEA/DC licensure documents — are a frequent cause of credentialing delays.

Committee members pressed MCOs for data. Councilmember Zachary Parker asked the plans to provide counts of: (a) claims initially denied and overturned on appeal and (b) claims initially approved and later reversed during audits. WellPoint reported that about 2.5% of denied claims were overturned on appeal in the reported year; the chair asked all plans to supply full reversal counts and timelines. The council also requested plan‑level detail on pharmacy denials (the DHCF reporting excludes pharmacy claims), out‑of‑network payments, and a breakdown of high‑utilizer (“frequent flyer”) populations responsible for a disproportionate share of readmissions and cost.

Several witnesses and council members discussed readmissions and avoidable inpatient spending. MCOs said they run monthly risk and readmission rounds, identify small cohorts of high utilizers (plans reported roughly 20–100 members depending on plan size) and deploy care coordination, community health workers and partnerships (for example, med‑respite or longer‑acting injectable medications) to reduce repeat admissions. Behavioral‑health conditions and homelessness were repeatedly cited as drivers of repeat hospital use.

The panel also examined prior‑authorization practices after the District’s recent prior‑authorization reform law. MCOs said clinical reviewers — nurses and physicians licensed in the tristate region and matched to specialties — handle requests; some plans are piloting AI to accelerate approvals but said AI is not used for denials. Committee members pressed plans on weekend staffing for urgent determinations after seeing weekend turnaround delays.

Committee staff flagged next steps: follow‑up data requests to each MCO on claim reversal counts, out‑of‑network reimbursement timelines, the universe of members without a claim in 36 months, and plan responses to credentialing centralization proposals. Councilmember Parker said the committee will hold a follow‑up oversight hearing on Medicaid/Alliance program changes on Nov. 20 and solicited written public testimony through Oct. 14.

Why this matters: the MCO model concentrates Medicaid spending and care management responsibilities in three contractors; the council’s oversight aims to ensure timely payment to providers, adequate networks for specialized services and transparent adjudication of claims so enrollees get medically necessary care.

The committee will continue to monitor denial trends, prior‑authorization timeliness, credentialing reforms and pilot programs that target frequent users of high‑cost services.","The Committee on Health heard from MCO executives, providers and families about denials, prior‑authorization delays, credentialing backlogs, high inpatient/readmission costs and gaps in behavioral‑health and pediatric home‑health networks in the District’s Medicaid managed care program.",{"_33":100,"_35":36,"_37":38,"_39":101,"_41":102,"_43":103,"_45":104,"_47":105,"_49":106,"_51":107,"_53":108,"_55":56,"_57":58,"_59":109,"_61":62,"_63":64,"_65":110,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6453813,"Doulas say Medicaid benefit hampered by credentialing, billing and delayed payments",122,546000,668000,"/Search/View?dp=1&key=5873685-1ef06b9d1afe95f1cef2145f8edad91f&start=546&end=668","https://assets.pipeline.soar.com/5873685-1ef06b9d1afe95f1cef2145f8edad91f/thumbnail_546000.jpg","/articles/6453813/Doulas-say-Medicaid-benefit-hampered-by-credentialing-billing-and-delayed-payments","https://secure.pipeline.soar.com/6453813-d0a883f1936eba49a18254474f4d0fdd/orig.mp4?Expires=1771160718&Signature=GNMow7BnaSef0QShyDaP9GmvsmeDiqer~hVfq~lqGtMFygvv5na~Jhbrh8C7khnYPxe55-Rkb1ciAlbtVIGzxaLHMqJRPB94gIamFkaIvx-uIod7i0kjli3fpBjSTGjx821Wy56wgB5hc5GjdoujRjD29aIvYHspMIv1dG6RsuaDGvLIiccGfZNdAIUej6gNQKQfXOfhM4jccdfRvm3wxtTjbEUS2fEQAU7BKM9HH1VMhQTwMFRai8rDVHJG8gay4MEQPWdeAvFjc27D0ZvIJVTezRLmQr6F7vSMNE5HEsYiW9zN~rsQliv9Mec73Spoj1YJA9ZBHH~qNaMouWAWPw__&Key-Pair-Id=KUT5TJCACFTXG","At a Sept. 30 roundtable, multiple doulas described administrative obstacles that they say are limiting the District’s Medicaid doula benefit and constraining service to birthing parents.

Crystal Jackson, owner of Aqui Grama Doula Services and co‑lead of the Doula Learning Action Collaborative, told the Committee on Health she spent about a year enrolling with DHCF and then months attempting to contract with MCOs. “After a lengthy process, I did establish a contract with two other MCOs, which took about six months,” Jackson said. She reported that she has not received reimbursement for services delivered since March and has paused a WellPoint contract because of nonpayment.

Gina Vallow, owner of BirthingKind, testified that she began credentialing with three of the four MCOs 18 months ago and still cannot operate reliably as an in‑network provider. Vallow described inconsistent rules across plans, lost paperwork and one contract that omitted postpartum care codes, producing thousands of denied postpartum claims. “That is not an abstract administrative problem. It is direct interruption of life‑saving support,” she said.

Doulas and council members recommended several fixes: a single centralized credentialing process, clear publicly available billing guidelines for doula services, service‑level agreements (SLAs) for credentialing and payments with automatic interest or penalties for late payment, automatic reprocessing and retroactive payment when denials stem from roster or contract errors, and quarterly public reporting of credentialing and payment metrics.

MCO leaders acknowledged doula credentialing posed special challenges because doulas are certified rather than licensed clinicians and require nonstandard documentation in some systems. MedStar Family Choice said its average processing time for credentialing is about 28 days where applications are complete; AmeriHealth Caritas and WellPoint said missing CAQH or state documentation commonly extends timelines. Several plans said they would engage if the council or DHCF develops a centralized credentialing mechanism and requested involvement in the design to preserve NCQA reporting workflows.

Councilmember Henderson and others pressed the CEOs to help resolve individual unpaid claims. Henderson noted she sponsored the law that created the Medicaid doula benefit and expressed frustration that a four‑year effort still faces operational “kinks” that curtail postpartum support during a maternal health crisis.

Why this matters: the doula benefit was intended to expand maternal supports and reduce disparities. Doulas testified that administrative barriers and payment uncertainty reduce small provider participation and can interrupt postpartum care for Medicaid enrollees.","Local doulas told the Committee on Health that DC’s Medicaid doula benefit is difficult to access because of long credentialing times with DHCF and individual MCOs, inconsistent billing rules across plans and unpaid claims that forced some providers to stop services.","actionData","errors"]

Article not found

Connected Care Network signs value‑based deal with WellPoint; FQHC leaders say early gains in preventive care

Families praise HSCSN as lifeline for children with complex needs; program faces home‑health access bottlenecks

Council roundtable flags denials, prior‑auth delays and credentialing gaps in DC Medicaid managed care

Doulas say Medicaid benefit hampered by credentialing, billing and delayed payments