punctuation, and grammar of this document are unchanged from the
District of Columbia Primary Care Association
1411 K Street, NW
Washington, DC 20005
www.dcpca.org - web site
Health Justice Alert May 22, 2001
Subject: Health Justice Alert, The Alliance on Fast Track
Message: This Health Justice Alert focuses on the momentus transition
from the District govenment uninsured care is shifting from the PBC to the
PLEASE, please, please.... Get this document into the hands of front
line providers: medical providers, social workers, people who make
appointments, emergency room providers, soup kitchens, free clothing
programs, public lawyers, day care workers, WIC staff, constituent
services workers, hotline workers, ministers, NA/AA meeting organizers....
Anyone and everyone who works with and answers questions from people
who are uninsured. Please encourage the front line staff to come to the
FREE international sessions at the DCPCA on Tuesday morning at the
Patients are going to be confused. The more the frontline folks
understand, the less fear and confusion for the patients.
Back to top of page
"Of all forms of inequality, injustice in health care is the most
shocking and inhumane." — Martin Luther King, Jr.
Included in this Alert:
Meet the Alliance on Tuesday mornings at the DCPCA -- 8:30 to 10:30 for
five weeks, you can listen, ask questions and learn. . . . JOIN US!
A New Beginning for the Uninsured:
The Alliance Gears Up for a June 24 Start
Learn more at DCPCA Tuesday Morning Meetings
Primary Care and the AIliance: Unity Takes Center Stage
The Alliance Gears Up for an Early Start
The Alliance, or the Washington Healthcare Alliance, is the name of the
new integrated network of providers who will be offering comprehensive
health care services to the medically vulnerable.
These services will replace those previously offered by tho Public
The contract for the services is with Greater Southeast Community
Hospital, which is a for-profit company. Greater SE is legally responsible
for the contract services to the District government.
The contract, which is expected to a last a minimum of five years, if
contract performance is standards are met, will be the largest health care
contract in the District of Columbia. It will replace the previous policy
of using an annual subsidy of $45 million to the Public Benefit
Corporation, augmented annually for the last five years by loans at the
end of the year. The loans were never repaid. The PBC was costing the city
between $70 and $100 million annually, with costs increasing as the number
of uninsured patients declined.
Learn more at DCPCA Tuesday Morning Meetings
DCPCA is hosting an open meeting on Tuesday mornings, from 8:30 to
10:30, so that providers, social workers, Board members, advocates and
others can meet with the Alliance to get a better understanding of how
uninsured people will get care under the new plan. Come and join us! Call
Kelly Ferrell at 638-0252 for a fax information sheet with details.
Control Board signs legislation autborizing privatization of services:
April 30, 2001
Control Board Assumes oversight/management of PBC: April 30, 2001
Court refuses to stay Control Board legislation: May 1, 2001
Department of Health establishes Healthcare Safety Net Administration to
oversee contract and keep FEC operating during transition: May 1,
Subcontracts with Alliance partners finalized: Mid-May, 2001
Still to Come:
Mayor will appoint Health Services Reform Commission Oversight
Commission to review and comment on transition: Mid-May, 2001
Enrollment process and enrollment sites finalized: June 8, 2001
Court to hear challenge of Control Board legislation: June 8, 2001
Enrollment begins: June 13, 2001
DC General in patient closes: June 24, 2001
Billing begins for Alliance: July 1, 2001
Washington Healthcare Alliance Partnership:
Greater SE Community Hospital
George Washington University Hospital
Children's National Medical Center
Chartered Health Plan
Unity Health Care
What is happening over the next few weeks?
The Alliance, which is lead by Greater Southeast Community Hospital as
the contracting agent will be administered by Chartered Health Plan. It
was initially set to resume full responsibility for the new uninsured
contract on August 1, 2001.
Unfortunately, a resident shortage at the Public Benefit Corporation is
causing an early shut down of DC General Hospital's inpatient services.
Inpatient care at DC General will cease on June 25, 2001. Currently,
patients are being shifted to other hospitals. According to The Post last
Saturday, only 80 patients were receiving hospital care at DC General,
down from 140 in the fall of 2000.
Please advise all uninsured patients who have been using the PBC for
primary care to continue. While eligibility criteria will soon be used for
the first time, it will take several months to straighten out who is and
isn't qualified, and to shift patients from one system to another. As this
change takes place, former PBC patients should keep going to their
Overview of How Alliance Will Work:
Patients will enroll at designated enrollment sites. Currently, DC
General ambulatory clinic, the six neighborhood clinics, and Greater SE
have been identified as enrollment sites.
Patients will sit down with an enrollment worker and complete the
application. If they are eligible, and have required documentation, they
will be approved immediately. If they need to bring in paperwork, they
will be given one-month eligibility.
Who is eligible? People who are:
- living at or below 200% of poverty
- DC residents,
- were patients of the FEC over tho last two years (includes primary,
specialty and hospital care)
- are uninsured.
The Alliance is taking all of the PBC's patient records and
"dumping" them into a new data base system for determining
eligibility. If all goes well, eligibility should be fairly easy to
determine. However, this may prove to be difficult, and may become one of
the first major hurdles for the Alliance to overcome.
Patients will also be screened for Medicaid, Healthy Families and other
programs. If eligible, applications wilt be completed and the Income
Maintenance Administration will certify their applications at the site.
Patients will be offered their choice of providers who are paid through
the Medicaid system
If patients are not eligible for any government programs, Unity is
required by its federal mandate to provide care on a sliding scale.
Hopefully, Unity will increase its federal grant to provide this care in
the upcoming years.
Qualified patients will receive an Alliance insurance card that will
entitle them to the same level of services that was provided by the PBC.
Social work and other wrap-around services
Patients will chose a pnmary care medical home, which will serve as a
gatekeeper to specialty and other care.
What isn't included?
During the start up phase: none-Alliance patients will not be able to
get medications, specialty visits and hospital visits. Specialty visits
and hospitalizations for non-Alliance members will be added in the future
Medicaid services will be limited to those provided by the PBC. For
example, the PBC did not do heart transplants, so therefore, the Alliance
is not required to do heart transplants.
Increasing the number of uninsured who are eligible. The PBC, while the
largest provider, did not spend the majority of the money on uninsured
care. Hospitals, free clinics, specialists, etc have long taken up some of
the slack between government funding and need. This will not change. This
is called "maintenance of effort" and providers will be required
to keep up their free/subsidized care.
The Alliance is only responsible for former PBC patients. If an
uninsured low-income patient has been using a free clinic or a sliding
scale clinic, and did not use the PBC for specialty care or hospital
services, they are NOT eligible currently. Once the Alliance has enrolled
previous PBC patients, and some cost projections are possible, there is
hope that the number of patients can be increased.
Future possible inclusions:
Snecialtv/Hospitalization Alliance Card Holders; As the Alliance
solidifies its administrative capacity; it will add a second category of
uninsured cardholders who did not use the PBC over the last two years.
These patients, many of whom rely on Unity's current clinics, the
Nonprofit Clinic Consortium sites, hospital-affiliated clinics like Perry
School and the Children's mobile van, will be able to see specialists and
get hospital care.
More patients: Clearly one of the problems with the District's system
of care for the uninsured: financing is arbitrary. Patients who are
"lucky" enough to get into the PBC system are going to have the
government guarantee payment. Those who don't must continue to rely on the
good will of the non-profit and provider sectors. This causes dramatic
imbalances in quality and quantity. This has been true for years; but only
with this transition did the issue crystallize in public discussions. It
is true in all but a handful of places in the United States.
More providers: The Alliance is interested in adding more providers to
its roster; but this will likely be determined by availability of finding.
The more finding, the more providers it can bring in. In other
communities, free care pools are used, similar to the Alliance contract,
with all providers being able to directly bill the pool for services.
Primarv Care In the Alliance:
Unity Healthcare will acquire management of the six PBC clinics. This
will allow Unity to combine five major finding sources for medically
vulnerable: federal 330 dollars, health care for the homeless dollars;
Medicaid; Medicare and DC appropriated funding. Plus, Unity does
charitable fund raising.
Unity, which was formally Healthcare for the Homeless, took over the
two troubled federally funded 330 clinics two years, stabilizing the
quality of care and finances. By acquiring the former PDC community
clinics, Unity's two main clinical sites, and its 13 bealthcare for the
homeless site, Unity's central role in the health care system is
The District plans to use some of the capital money which had been
allocated to the PBC to improve the PBC clinical sites, but there are no
final decisions on which ones or when. Unity has also applied for a $1
million federal grant to help improve its MIS capacity, and link it to
other uninsured primary care sites.
In addition, Unity owns a Medicaid health maintenance organization,
making it able to maximize managed care income. This gives Unity a strong
combination of funding options to pay for care for the medically
vulnerable -- Medicaid, Medicare, federal funding for primary care and
homeless services, and DC appropriated contract money. In addition, Unity
bills private insurance and raises charitable dollars. As a federal
community health center, Unity is also eligible for special federal
funding for capital and other improvements. For the medically vulnerable,
who often shift from one population to another, this might increase their
chances of achieving a stable medical home.
Over the long term, it is also likely Unity will attract increased
direct grant money for its care of the uninsured, bringing valuable cash
resources to the primary care safety net.
In addition to Unity, Greater SE will manage the DC General ambulatory
care site, and add an urgent care center at the campus. Chartered and
Children's will offer primary care at their community sites (?)
Chartered has one ambulatory health care clinic for its patients; and
former PBC patients will be able to go there as well. In addition,
Children's four neighborhood clinics will be included.
This expands the choice from six sites to XX sites.
There are discussions under way on how to increase the number of
primary care sites, but it is unclear how long that would take to work
$Cash and the Contract
|Annual amount base services:
||$66.3 million cap for services
||$54.25 million minimum
|Base services include:
||Outreach and application assistance
||no specific details available on
||Primary case, disease management and
||Diagnostic testing and evaluation,
||no specific details available on
||$7.01 million school health
||$3.7 million corrections
||$1.4 trauma capacity funding
||Year one capital:
||Start up support:
The Alliance must complete cultural competence training, and provide
translators, but it is not specified yet anywhere what they are planning
to do, nor how Alliance will report on this.
Shauna Spencer has been named the Director of the new Health Care
Safety Net Administration. This Administration is housed in the Medical
Assistance Administration, which will manage the money and oversee
contract compliance. In addition to the above allocations of money, the
Safety Net Administration will receive any monies owed to the PBC when it
is dissolved. The Safety Net Administration can adjust the volume of
services across categories -- savings in trauma could be shifted to
primary care and prevention for example.
Safety Net Administration funds will carry-over from year to year: they
will not revert to the general fund.
The contractor will submit monthly, quarterly and annual reports on
cost, quality, and access as specified by District. No report format is
An oversight committee, appointed by the Mayor, is set to begin its
work next week. It is unclear exactly what role they will play, which
agency or office will provide the committee with support, or if the
committee will have an authority over adjustments in the contract; fines
for non-performance etc.
Background, Politics, and Legislation on the Transition from PBC to
In the summer of 2000, The Post began reporting that the PBC was
illegally operating in the red, and had been doing so for seteral years.
It is illegal for any DC agency to operate in the red, because of a
Congressional law. Normally, when a DC agency finds itself in the red,
special budgetary supplement legislation is passed to cover the deficit.
However, the District had been making "loans" to cover the PBC
deficit and these loans were never repaid.
Immediately following the publicity of the "loan" prob1em,
serious management and financial problems were made public by the Cambio
Group, which was hired by the city to complete an assessment of the PBC.
In response to the "loans" and the Cambio report, the Mayor
overhauled the PBC Board of Directors. The new Board immediately let the
PBC Chief Executive Officer go.
This round of PBC/DC General controversy follows more than 20 years of
problems with DC General cost overruns and management problems. In 1995,
the PBC was created to try and improve integration and efficiency in the
District's trotibled public health system. Unfortunately, the PBC was
established with a budget deficit and with system problems in the set up.
Coupled with a CEO who was to later be fired for fiscal irregularities,
the PBC six-year history has been a difficult one.
DC General cost overruns were one of the management problems that
prompted Congress to establish the Control Board in 1997. Congressional
committee members were unsympathetic to the desires of PBC employees and
the Council to keep the PBC going.
From August, 2000 through April 30, 2001; the Council, the Mayor, the
Control Board and a wide host of providers, advocates, employees and
patients engaged in a long, noisy and public debate, replete with
meetings, policy papers, recommendations, hearings, public demonstrations,
angry exchanges, and creative thinking.
Some of the major debating points were: 1.) Keeping inpatient services
at DC General Hospital, which was loosely translated by proponents of the
services into "Save DC General"; 2.) Using money that funded a
quasi-public system to fund a private, for profit system; 3.) Loss of an
historical African-American institution; 4.) Fear that Greater SE and the
other hospitals couldn't handle DC General's trauma and emergency care.
On December 4, 2000, the Control Board directed the Council and the
Mayor to come up with a plan to establish a new system of care for the
uninsured, and gave them 90 days to do it.
In the Mayor's FY2002 District budget, the Mayor put forward a plan to
use $90 million in reserves to fund PBC shut down and transition costs,
and requested $70+ million in operating funding for the FY02 fiscal year.
Council voted down both transition funding and future contract money,
approving instead direct funding for the PBC This would have required
Congressional approval; since Congressional language in the FY2OO1 Budget
Act limited the PBC to receive it's $45 million in appropriated funding,
money, which was all, spent by the end of March.
In response to the Council's "no" vote to privatization, the
Control Board, on April 30, 2001, superceded the authority of the Mayor
and the Council, and voted to end the PBC and transition to a privatized
contract. A single court challenge remains: on June 8, 2001. Predictions
are that the challenge will lose, since the US Court of Appeals for DC
Circuit Court upheld the authority of Congress to grant the Control Board
the power to Eassume any or all of the [department or agency's]
powers" in January of 1998.
The "Health Care Privatization and Emergency Amendment Act of 2001
Emergency Declaration Resolution of 2001" was signed into law on
April 30, 2001. The Resolution was accompanied two Orders and three Acts.
The Resolution approves the expenditure of $90 million to maintain
continuity of care for the uninsured by implementing an alternative
publicly financed health care delivery system. Or, in non-resolution
language, the Resolution approved using the $90 million to fund a
The first order justifies the action of the Control Board, citing the
DC 2001 Budget Appropriations Act that limits PBC spending to $45 million
in FY01, the PBC reduction in force resolution passed by the PBC Board on
August 25, 2001, and the December 4, 2000 Control Board Resolution passed
on December 4, 2000 that instructed the Council and Mayor to come up with
It goes on to repeal the PBC legislation, and authorizes the handing of
a "publicly financed health-care delivery system. It authorizes the
Health Care Safety Net Administration. It creates an exemption from the
Certificate of Need process for developing services to meet the contract
obligations, and authorizes the Chief Financial Officer to transfer them
The second order uses roughly the same justification but also adds a
legal precedent to firmly declare the authority of the Control Board. In
1998, someone named Shook took the Control Board to court, questioning its
authority to govern, and the courts upheld the Control Board.
This Order transfers control of the PBC's operations to the Control
Board, names Dr. George Gilbert as the person to assume leadership in the
transition, and names the Department of Health as the regulatory agency
responsible. It allows MAA to transfer PBC's disproportionate share
allotment to Greater SE.
The ACT. DCFRMAA-1
This docunient outlines the role and responsibility of the Health Care
Safety Net Administration, which are to:
- Terminate and wind down existing PBC contracts
- Complete administrative and court activities that the PBC was
- Assess claims and pay the lawful ones
- Provide oversight to ongoing PBC services during the
- Funds owed to the PBC to go into the DOH budget.
- Keeps the collective bargaining agreements active until the PBC is
- Instructs DOH to transfer PBC employees to DOH
- Gives all PBC liabilities to the DC government
It establishes the Health Care Safety Net Fund and Appropriations,
- Be a revolving fund; that is, the money does not go back into the
general fund at the end of a fiscal year.
- The money in the fund can come from federal, state or charitable
It gives the Mayor authority to contract with a private contractor for
health care services for the uninsured, and exempts the Mayor from the
Further, it defines charity care and gives DOH the charge to measure
and monitor charity care.
It defines the role of the Health Care Safety Net Administration in
determining Certificate of Need exemptions.
It repeals: the PBC law of 1997, the Comprehenstve Merit Personnel Act
of 1978, the Confirmation Act of 1998, and the Procurement Practices Act
It is an emergency Act and can be in effect for 90 days, when new
legislation will be required. Acts two and three are the temporary and
permanent legislation, passed at the same time.
Need more info on this topic? Your best bet is to log on to the
Washington Post and do a search on the words, "DC General
Hospital". The Post has covered this issue extensively. Old issues of
the Health Justice Update are also available, just call Kelly Ferrell at
the DCPCA at 638-0252. City Paper also did several articles, but the only
ones available on line are the Loose Lips columns.
Meet the DC Healthcare Alliance! Tuesday mornings at DCPCA.
What will the future bring for the uninsured?
Help make the future a healthier one for the uninsured.
Let the Alliance inform you about these services:
- Greater Southeast Community Hospital
- Manage DC General Ambulatory and Urgent Care Services
- Hospital inpatient and trauma, specialty care
- Corrections patients
- George Washington University Hospital
- Hospital services, trauma care
- Children's National Medical Center
- Children's hospital care including trauma
- Children's specialty and primary care S
- chool health nurse program
- Chartered Healthcare
- Administration of plan
- Health education/wellness
- Data gathering and reporting
- Unity Healthcare
Meet the DC Healthcare Alliance Tuesday mornings at the
A new day, a new system for the uninsured.
How will it work? Who will be eligible?
What services will people receive?
Yes, I would like to join my colleagues in learning about the Alliance,
at the DCPCA, 1411 K Street, NW, Suite 400.
Tuesday mornings, 8:30 am to 10:30 am on: (circle YOUR date, please)
May 29, 2001
June 5, 2001
June 12, 2001
June 19, 2001
June 26, 2001
Number of people: _______________________
PLEASE RSVP -- 30 people each week!
FAX THIS FORM TO 638-4637
Brought to you by the DCPCA and Chartered Health Plan