A state health agency board gave initial approval Thursday to offering care coordination services to 450,000 Medicaid beneficiaries who have disabilities or are elderly.
The proposal for the “aged, blind and disabled’’ population comes as part of the state’s move to improve care and reduce spending. This beneficiary category represents roughly 28 percent of Medicaid enrollees in Georgia, but it accounts for 60 percent of the overall costs of the program.
Clyde Reese, the Department of Community Health commissioner, also announced that Georgia primary care physicians are scheduled to start receiving a pay hike for Medicaid services Nov. 1, as part of a provision in the Affordable Care Act.
For two years, it will pay family physicians, internists and pediatricians the same for Medicaid services as they receive under Medicare. The pay hike for eligible doctors is expected to be retroactive back to Jan. 1.
Georgia is among the last wave of states to implement the raise. The delay here had frustrated physician groups, which said there was already financial pressure on doctors serving largely Medicaid patients. This will be the first Medicaid pay raise for Georgia doctors in more than a decade. full story
A report on a troubled health services organization in Coastal Georgia says its operation has been riddled with financial irregularities and management problems.
Gateway Behavioral Health Services, which has an annual budget of more than $30 million, has a deficit of close to $4 million. It also had $1.4 million in accounts payable at the end of August, according to a report written by the organization’s newly appointed manager.
“Most alarming was the fact that the staffing company that employs almost all of Gateway’s direct service staff was owed $1.2 million, or three bi-weekly payrolls, placing them at risk for interruption in its ability to deliver services,’’ said the Sept. 17 report by David Crews
Next month, Gateway will close a St. Marys bottling plant that is losing money, said the report by Crews to the state Department of Behavioral Health and Developmental Disabilities (DBHDD). The plant employs people with behavioral health problems and developmental disabilities.
Crews, in an interview with GHN on Friday, said Gateway “has some real cash flow issues.’’
Crews was put in charge of Gateway in July, when DBHDD took control of the organization, firing its CEO and asking its chairman to resign.
Gateway had previously sued DBHDD, and the attorney who filed that lawsuit told Georgia Health News recently that the state seized control of Gateway and fired the CEO in retaliation for the suit. The lawsuit alleges the state owes Gateway more than $1 million in reduced payments. full story
Strong-arm tactics. Improper use of state funds. Retaliation over a lawsuit.
Those are some of the accusations flying around a sharp-edged conflict between a state agency and a Coastal Georgia health services organization.
But it’s not been just talk. The state Department of Behavioral Health and Developmental Disabilities (DBHDD) recently took control of Gateway Behavioral Health Services, firing its CEO and asking its chairman to resign.
“There are indications that Gateway no longer has the fiscal ability to continue to provide contracted services,’’ said a July 18 letter from Frank Berry, the DBHDD commissioner, to Gateway. The letter cited a Gateway deficit of $3.9 million in fiscal 2012.
“In addition, we have received numerous allegations of mismanagement that at this stage warrant the department’s intervention,’’ the letter added. “Furthermore, it would appear that Gateway has potentially misused state and federal funds.’’
Gateway’s lawyer, however, says the state’s seizure of control and firing of the CEO “without cause, reason or explanation” are retaliation for a lawsuit that Gateway has filed against DBHDD. The suit alleges the state owes Gateway more than $1 million in reduced payments. full story
The state is continuing its transformation in behavioral health services by creating “crisis centers” in Albany, Thomasville and Valdosta.
Georgia officials are also seeking to lease empty buildings on the historic Milledgeville hospital campus, which has been downsized as the state moves away from a hospital-based system of care for people with mental illness and developmental disabilities.
The three centers in South Georgia will serve individuals experiencing behavioral health crises by providing assessment, short-term crisis counseling, supportive services and referrals, with a goal of treatment closer to the patient’s home.
The new centers will replace some services provided at the psychiatric hospital in Thomasville, which is set to close Dec. 31.
“People will no longer have to travel long distances to get care in a state institution,’’ Frank Berry, commissioner of the Department of Behavioral Health and Developmental Disabilities, said at an agency board meeting Monday.
The agency also received good news about its budget. Still, this has been a rocky month for DBHDD, with a lawsuit filed against it and a controversial closing. full story
Shannon Allen recently received a disturbing letter from the occupational and speech therapy services provider that works with her three special-needs kids.
The organization, Walker Therapy of Gainesville, “told us they’re going to have to drop my children,’’ Allen says. The reason is that the organization won’t agree to sign a new contract with a care management organization (CMO) that serves Georgia Medicaid and PeachCare children.
“We’re kind of stuck for the moment,’’ Allen says. “All three of my kids have made tremendous progress’’ through Walker Therapy, she adds.
Dissatisfaction with the contract that the CMO, WellCare, and its subcontractor are offering is not confined to one organization. Occupational, speech and physical therapists say many are refusing to sign the contract. They say it would reduce their payments and jeopardize the care of children.
WellCare, in a statement to GHN, said there will be no change in benefits for children and no limits on access or services under the new arrangement. The Florida-based company said it’s employing a subcontractor firm to monitor use of therapy services.
But Kay Nelson, owner of a private practice, Therapy Works, in Lawrenceville, told GHN that payments would be less under the new contract being offered by WellCare and its subcontractor, which takes effect July 1. full story