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Grady, Blue Cross at impasse as contract expires

Contract standoffs between hospital systems and health insurers typically have a way of being resolved — often right before a deadline.

But high-stakes negotiations between Grady Health System and Georgia’s biggest insurer failed to produce a new contract before the midnight deadline Sunday.

Grady Memorial Hospital

Grady Memorial Hospital

That means Grady Memorial Hospital is now “out of network” for Blue Cross and Blue Shield of Georgia members. Patients with Blue Cross insurance will face higher out-of-pocket costs at the Atlanta hospital and its clinics.

Both Grady and Blue Cross expressed disappointment that a deal was not reached. Contract negotiations had been under way for a year.

Grady recently had launched a publicity campaign to call attention to low reimbursements from Blue Cross, saying those payments were lower than the insurer’s rates for other comparable hospitals in Atlanta and throughout the state. full story

Georgia health centers get funding to expand care

A federal agency has awarded $6.9 million in Affordable Care Act funding to 30 community health centers in Georgia that will help expand their primary care services.

Sylvia Burwell

Sylvia Burwell

That funding was part of $295 million awarded nationally to 1,195 health centers by the Department of Health and Human Services (HHS).

“Health centers are a key part of how the Affordable Care Act is working to improve access to care for millions of Americans,” said HHS Secretary Sylvia Burwell in announcing the grants Friday. “These funds will enable health centers to provide high-quality primary health care to more people including the newly insured, many of whom may be accessing primary care for the first time in Georgia.”

The money will go to hiring new staff, including new health care providers; staying open for longer hours; and expanding services,  including oral health, behavioral health, pharmacy and vision services.  full story

2 nonprofits share $3.3 million in ‘navigator’ grants

Two nonprofit organizations will divide $3.3 million in federal money to provide “navigators” to help consumers enroll in the Georgia health insurance exchange this fall, the federal government announced Monday.

Sylvia Burwell

Sylvia Burwell

Navigators provide face-to-face, in-person help for consumers seeking information about the exchanges.

SEEDCO (Structured Employment Economic Development Corporation) will receive nearly $2.2 million, roughly the same as it received last year as a navigator grantee.

The second grantee will be an alliance led by Macon-based Community Health Works and consisting of cancer coalitions and other organizations. It will get $1.1 million.

Nationally, U.S. Health and Human Services Secretary Sylvia M. Burwell announced $60 million in navigator grant awards to 90 organizations in states with federally facilitated and state partnership exchanges. Also known as marketplaces, the exchanges were created under the Affordable Care Act, sometimes known as Obamacare. full story

Nightmare for vulnerable: Unlicensed care homes

The investigation of a South Georgia unlicensed personal care home began with the report of a resident of the facility breaking into a nearby home to get food.

Law enforcement officials later raided the care facility, called Uplift, which housed people with mental illness and disabilities.

Sen. Renee Unterman

Sen. Renee Unterman

Conditions were horrifying.

“All these people were hungry,’’ said Morven Police Lt. Terry Griffin, according to a Valdosta Daily Times article. The facility was infested with insects, and there was no air conditioning.

State and local agencies helped transfer Uplift residents to other facilities. “People started clapping in the breezeway, even crying. They were so happy to leave,” Griffin said.

These relocations are becoming commonplace in Georgia. Since June, law enforcement and state officials have transferred a total of 55 people from 10 unlicensed personal care homes, including Uplift, members of a legislative committee were told Tuesday.

The state has seen an increase in complaints about alleged abuse of adults at such unlicensed facilities, state officials told the legislative Joint Study Committee on Emergency Relocation of Abused Adults, meeting in Lawrenceville.

“This issue we have to address,’’ said state Sen. Renee Unterman (R-Buford), chair of the Senate Health and Human Services Committee, citing “unbelievable conditions’’ in some of the residences. full story

State health agency outlines spending increases

A state health agency is budgeting an extra $24 million this fiscal year, and a similar amount next year, to pay for costly hepatitis C drugs in Georgia’s Medicaid program.

clipboardThe state is also expected to pay $14.1 million more this year, and $37.9 million in fiscal 2016, for lengthening the time between eligibility reviews for Medicaid and PeachCare beneficiaries, as required by the Affordable Care Act.

Those were among the financial projections made in a budget presentation Thursday for the board of the Georgia Department of Community Health, which runs the Medicaid and PeachCare programs in the state, as well as the state employee health plan. The presentation is the beginning of a long budgeting process for the agency.

The Community Health board approved the budget requests.

The hepatitis C drugs are considered breakthrough medications for patients. One drug, Sovaldi, has a 90 percent cure rate for newly infected patients — much better than previously available treatments for hepatitis C. full story

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