Georgia Selects PCG for Community-Based Rates Study

Austin, TX, January, 2012 – The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) has awarded PCG Health a contract to complete a rate study for community-based rates for mental health and substance abuse services. This project is mandated as a result of a federal settlement agreement filed by advocates that questioned the adequacy of community-based service delivery options. As part of the settlement agreement, DBHDD is required to hire an outside contractor to develop rates that will adequately reimburse providers their cost for the provision of services and sufficiently recognizes the resource and acuity differences depending upon the service setting, practitioner rendering the services, and geographic differences across the state, among other pertinent factors. For more information, contact pcghealth@publicconsultinggroup.com

New York Launches Medicaid Redesign Campaign

New York State's new Medicaid redesign team has begun outlining its plans to control costs and improve quality in the state's $58.3 billion Medicaid program.   The Medicaid redesign team was created by Governor Andrew Cuomo through an Executive Order that he announced in his State of the State address on January 5.   The Medicaid redesign team, a distinguished public and private group led by the State's new Medicaid director (who recently led successful Medicaid reforms in Wisconsin), includes chief executives of the State Department of Health, Office of Mental Health, Developmental Disabilities, Alcohol and Substance Abuse Services, and Budget Division; New York City's Deputy Mayor for Health and Human Services; and the State association of counties.    Specific recommendations will be formulated and voted on by the team by March 1, an initial report will be submitted to the Governor for his use in the budget process for state fiscal year 2011-2012, and a more comprehensive report on Medicaid reforms will be developed by November 2011.   The team's mission encompasses payment reform, implementation of the federal health care reform law, and opportunities to improve coordination between Medicare and Medicaid, as well as systemic issues unique to New York, such as that New York is highest among all states in avoidable hospital use across all public and private payers in the aggregate.    The team also is analyzing Medicaid program issues such as New York's high per capita expenditures across nearly all Medicaid categories of services other than physician services, and differences between Medicaid managed care and fee for service program results.   New York Medicaid has used pay-for-performance for Medicaid managed care since 2001 and exceeds national averages on most Healthcare Effectiveness Data and Information Set (HEDIS) measures applicable to the managed care population, but makes almost no use of performance measures and payment incentives for care delivered to the fee for service population.   Other issues being examined include opportunities for long term care rebalancing (nursing facilities account for 51 percent of New York Medicaid's LTC expenditures), improved management of behavioral health services, and care coordination for individuals with chronic and complex medical needs.   The Medicaid redesign team held its first executive session in Albany on January 13 and will meet next in New York City on February 7.

 

About Tom Entrikin

A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.

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