WASHINGTON — The Centers for Disease Control and Prevention should consider not renewing a lucrative contract with Managed Care Advisors/Sedgwick, which is supposed to provide health services to some 25,000 9/11 responders who live scattered around the country, an advocacy group says in a letter to the CDC.
The Daily News reported earlier this month that responders and survivors of the 2001 terrorist attacks and the aftermath have struggled to get care and medications after the CDC changed up two significant contracts this past summer to provide those services, with a third in legal limbo.
Now the group 9/11 Health Watch is calling on the CDC to take a hard look at yanking the contract to the firm Managed Care Advisors-Sedgwick, which was hired to run the World Trade Center Health Program’s national network.
“By any interpretation, the performance of Sedgwick since it took over responsibilities as the National Provider Network has not met their contract requirements to provide services and benefits promised to responders and survivors under the Act,” says the letter dated Nov. 10 to CDC Director Dr. Rochelle Walensky.
The letter identifies numerous instances where Sedgwick still needs to live up to the contract’s requirements, which called for a system of providers to be in place and ready to go in May, well before operations began in August.
In addition to a lengthy delay in helping ill responders get their existing doctors signed up, based on October numbers, Sedgwick forwarded just 22 claims from doctors to the Trade Center program for payment.
“A national provider network that fails to provide quick, timely payments is not going to be able to find providers willing to participate,” the letter says.
Precisely what action the CDC might take is unclear. Such contracts are written and executed by the CDC’s Office of Acquisition Services, which in this case, chose to replace the previous provider with Sedgwick. That office has not responded to questions since early October about how it went about its process and intended to enforce compliance.
Benjamin Chevat, the executive director of 9/11 Health Watch, said the agency has several options.
“The best outcome is that Sedgwick will put more resources into fulfilling their contract obligations immediately,” Chevat said, noting that the company has already doubled its call center staff to address the problems.
A spokeswoman for the CDC’s National Institute of Occupational Safety and Health, which oversees the World Trade Center Health Program, has acknowledged there are problems with the contract that the program is trying to resolve.
MCA-Sedgwick said it is making progress on the various issues. “We are committed to providing care and benefits to the thousands of responders and survivors served by the World Trade Center Health Program’s Nationwide Provider Network,” said a statement from Lisa Firestone, president of Managed Care Advisors-Sedgwick.
“Since we have taken over management of the Nationwide Provider Network, our team is focused on providing an optimal member experience,” she said. “We have made significant progress in member support, referrals and other areas. We will continue to work closely with the WTC Health Program to make improvements based on feedback from members and providers.”
But Chevat said that despite greater efforts, significant failings remain and suggested the CDC may have to take more decisive actions.
“The CDC contracting office can do their job and take public action against Sedgwick,” he said, or, “911 responders and survivors will continue not getting the care they need, and that is not an option.”