medicaid reform overview of stakeholder meetings november 10, 2004 dch board meeting
TRANSCRIPT
MEDICAID REFORM Overview
of Stakeholder Meetings
November 10, 2004
DCH Board Meeting
Georgia Department of Community Health
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Stakeholder Meetings Began with a legislative leadership meeting on
August 23, 2004 Met with statewide professional organizations and
advocacy groups on August 24, 2004 at the Governor’s Mansion
A total of seventeen meetings were held from September through November, with over 275 healthcare leaders and advocates in attendance.
DCH has met with over 375 participants for the purpose of unveiling a plan to reform Medicaid and to collect input, suggestions and concerns.
Georgia Department of Community Health
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Who we met with… Legislative leadership Georgia Society for Managed Care VHA Managed Care Council Georgia Chapter of the American Academy
of Pediatrics Georgia Academy of Family Practice Hometown Health North Georgia Dental Society Georgia Dental Association Georgia Dental Society Georgia Alliance of Community Hospitals Georgia Optometric Association Georgia Association of Community
Services Board NAMI Georgia Metro Therapy Providers, Inc. March of Dimes Georgia Chapter National Kidney Foundation of Georgia
Georgia Hospital Association Georgia OB/GYN Society Medical Association of Georgia American College of Physicians Georgia Pharmacy Association Grady Health System Georgia Children's Hospitals Covering Kids and Families Coalition Georgia Association for Primary Health
Care Georgia Department of Human Resources Governor’s Advisory Council MH/MR/SA National Mental Health Association Georgia Mental Health Consumer Network Physical Therapy Association of Georgia Georgia Speech, Language and Hearing
Association Other Behavioral Health Associations
Georgia Department of Community Health
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Here’s what we heard…
Georgia Department of Community Health
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Plan Governance
Require liquidated damages
Provide access for providers to come directly to the State with plan issues
Limit or cap plans’ profits
Re-invest program savings into healthcare infrastructure
Georgia Department of Community Health
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Carve-outs
Most groups shared a desire to have the services they provide carved out by either:
Continue direct fee-for-service on a statewide basis
Regional approach
Pilot approach
Georgia Department of Community Health
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Member Issues
Access to healthcare services may be reduced Member outreach and education is vitally important Member responsibility for healthcare is a concern Inappropriate ER utilization Desire to see State create an ombudsman function
for mental health Concern that plans will deny needed healthcare
services to members DCH needs to more strictly enforce eligibility Plans should require cost-sharing by members
Georgia Department of Community Health
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Provider Payment Issues
Provider reimbursement (FFS vs. Capitation) Reimbursement levels for out-of-network providers Concern that plans will overuse administrative denials and
interfere with a provider’s cash flow Desire for the use of standardization across the plans Establish definition of a “clean claim” to comply with
Georgia Prompt Payment Laws Fear that plans will reduce reimbursement rates Fear that plans will sub-capitate to providers Desire to see State as a guarantor if a plan becomes
financially insolvent Loss of supplemental funding from UPL/IGT program Need for Tort Reform
Georgia Department of Community Health
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Provider Network Issues Concern that traditional community providers will be excluded
from networks Desire for DCH to mandate “Any Willing Provider” networks Appropriate number and mix of specialists and sub-specialists Assurance that, at least in rural areas, specialists can serve as
primary care physicians Plans should have a “real time” local physician advisory
committee Providers’ appeal process related to activities by CMOs Consistent Utilization Management strategies across all plans Concerns with administrative complexity DCH should not allow members to seek healthcare outside the
state
Georgia Department of Community Health
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Pharmacy
Fear of lowered dispensing fees The potential State loss of pharmacy rebates associated
with managed care Fear that independent pharmacists may lose market
share to larger chain pharmacies, under a plan Interest expressed in the provision of case management
and primary care services by pharmacists DCH should not allow mail-order pharmacy services
Georgia Department of Community Health
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DHR Issues
Future role of county health departments
Future role of Community Service Boards
Managed care program impact on eligibility staff (DFCS)
Georgia Department of Community Health
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Questions & Comments