MEDICAID REFORM Overview of Stakeholder Meetings

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MEDICAID REFORM Overview of Stakeholder
Meetings
November 10, 2004 DCH Board Meeting
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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
  Governors 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.

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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
• Governors 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

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Heres what we heard
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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

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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

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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

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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 providers 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

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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

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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

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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)

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• Questions Comments