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Kaiser scores another annual top rating in Georgia

Kaiser Permanente is again Georgia’s top-rated health plan in commercial insurance, according to the National Committee for Quality Assurance.

photo.jpgIt’s the 11th straight year that Kaiser, a nonprofit, got NCQA’s No. 1 rating among commercial health plans in the state.

The NCQA rankings use a 1-to-5 scale, with 5 being the highest.

The 2015-2016 ratings also put Kaiser as the leader among Medicare insurers in Georgia – the only one operating in the state to achieve a 5 score. full story

Report criticizes state’s overdue patient transfers

Georgia continues to show a lack of progress in moving people with developmental disabilities out of state-run hospitals, an independent monitor says.

The report by independent reviewer Elizabeth Jones, filed in federal court, said just four individuals with developmental disabilities have moved to community settings in the past year. “This is especially troubling because 266 individuals are still confined to state hospitals,” Jones said in her report, dated Sept. 17.

iStock_000023217379LargeGeorgia, under a five-year settlement agreement with the U.S. Department of Justice, agreed to end all admissions of people with developmental disabilities to state psychiatric hospitals. It also promised in the 2010 pact that patients with developmental disabilities already in those hospitals would be moved to more appropriate settings by July of this year — the deadline for the agreement’s provisions to be met.

But problems in the care delivered in the community living situations led a state agency last year to stop transferring people with developmental disabilities from hospitals to community residences.

Media outlets reported that almost 10 percent of the Georgians with developmental disabilities who had moved out of state hospitals since July 2010 had died after being placed in community situations.

The settlement agreement with the Justice Department also sought to improve care for Georgians with mental illness. Georgia agreed to establish community services and housing for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization. full story

State sees decline in rate of uninsured people

Georgia’s uninsured rate in 2014 fell by three percentage points, to 15.8 percent, mirroring a national trend linked to new coverage from the Affordable Care Act, the U.S. Census Bureau reported Wednesday.

1439134419538But Georgia’s percentage of people without coverage last year was the fourth-highest in the nation, trailing only Texas, Alaska and Florida.

Nationally, the percentage of people without insurance for 2014 was 10.4 percent, or 33 million, a big drop from the year before, when 41.8 million, or 13.3 percent, had no coverage.

Between 2008 and 2013, the national uninsured rate remained fairly stable, the Census Bureau noted. The biggest changes last year came from those directly purchasing insurance and from an increase in Medicaid enrollment, according to the report, considered the most consistent and complete picture of the nation’s health coverage.

Georgia’s drop from 18.8 percent was expected, said Bill Custer, a health insurance expert at Georgia State University. He cited the coverage newly available through the ACA and an improved economy in the state. But he also added, “Georgia is clearly lagging behind other states.” full story

Four firms picked for Medicaid, PeachCare contracts

Three holdover companies and one new entrant have been selected as winners of a multibillion-dollar contract to serve more than 1 million Georgia children in lower-income families.

Healthcare CostCareSource, an Ohio-based nonprofit health plan, is set to join Amerigroup, Peach State and WellCare to serve low-income adults and children in Georgia’s Medicaid and PeachCare programs.

The deals are not yet final, state officials emphasized Thursday. Losing bidders have a 10-day period to appeal the decision to state contracting officials.

The contract for the “Care Management Organizations’’ is worth an estimated $4 billion over six years. The launch date for the new contract is July 1. Ten other bidders either did not earn scores as high as the four winners or were judged “non-responsive.”  full story

Big hospitals in Columbus take financial hits

Last week, the hospital business in Georgia’s second-largest city received a double dose of financial misery.

The first round of bad news centered on Columbus Regional Health.

LogoState Attorney General Sam Olens announced Friday that Columbus Regional and other related entities had agreed to pay Georgia and the United States up to $35 million to resolve allegations of false Medicaid claims.

Then the Columbus Ledger-Enquirer reported Saturday that the other hospital organization in town, St. Francis, has been told by the feds that it must repay $21.4 million and make major changes in the way it does business.

The federal audit report came 10 months after St. Francis said it could not account for about $30 million on its financial books.

The two situations are unrelated and very different, experts point out. But together they put a spotlight – and force large payouts – in Columbus. And what happens economically in the big city on the Chattahoochee River affects large areas of west Georgia and east Alabama. full story

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