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Budget focus: Medicaid growth, hep C drugs, SHBP

The state’s Department of Community Health is asking for additional state funds to cover projected Georgia enrollment for Medicaid and PeachCare, which for the first time will exceed 2 million.

Clyde Reese

Clyde Reese

The budget proposal also requests $23 million to cover the high cost of drugs to treat hepatitis C patients in both the midyear fiscal 2016 budget and in the 2017 plan.

The budget plans, approved by Community Health’s board Thursday, now go to Gov. Nathan Deal and then to the Georgia General Assembly for approval.

It would be the second straight year that the agency will not have to cut its base budget, said Community Health Commissioner Clyde Reese. The agency’s current budget is roughly $3 billion in state funds.

Hepatitis C drugs have an astronomical cost, averaging more than $30,000 per patient per month in retail price. But states, including Georgia, can get a discount on that price for their Medicaid programs that could reach 40 percent. full story

State outlines arguments against Medicaid ‘waiver’

The state’s Medicaid agency has all but ruled out Grady Health System’s “waiver’’ proposal to cover more uninsured Georgians.

Photo of the Georgia Capitol Building“We’re not going to move forward on this at this time,’’ Clyde Reese, commissioner of the Department of Community Health, said at an agency board meeting Thursday.

He cited “significant costs to the state” to implement the proposal.

Reese added that federal officials indicated they would consider the waiver proposal only if Georgia was willing also to expand its Medicaid program. That is something Georgia political leaders have emphatically declined to do.   full story

State agency: Medicaid ‘waiver’ plan too expensive

Grady Health System’s proposal to cover more uninsured through a “waiver’’ has run into a major snag at the state’s Medicaid agency.

The big problem is concern about the cost.

Photo of the Georgia Capitol BuildingThe current waiver proposal “is cost-prohibitive to the state,’’ Jeremy Arieh, a spokesman for the Georgia Department of Community Health, told GHN on Tuesday.

The Grady plan contains several factors “that present a challenge and a significant cost to the state,’’ he added.

DCH and Grady officials met recently to discuss the waiver proposal, which would use federal matching Medicaid dollars to help set up pilot sites that would give coverage to the uninsured. Participating medical providers would then manage these patients’ care and potentially improve their health. full story

Most Georgia hospitals face readmission fines

Two-thirds of Georgia hospitals will receive Medicare fines for having too many discharged patients return within a month for additional care, federal data show.

The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.

Piedmont Henry Hospital

Piedmont Henry Hospital

The readmission penalties, launched as part of the Affordable Care Act, seek to encourage hospitals to pay closer attention to what happens to patients after discharge.

Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News’ Jordan Rau reported this week.

The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.

The maximum possible fine is 3 percent. Piedmont Henry Hospital in Stockbridge will get the highest fine in Georgia, at 2.59 percent.  full story

Deal may save faltering Clayton hospital

Last month, a consulting firm was hired to find a financial partner to rescue the ailing Southern Regional Medical Center.

img-stock-IMG_2483It looks like a match has been made.

Prime Healthcare Foundation, a nonprofit based in California, has signed a letter of intent to acquire the Riverdale hospital. The Clayton County commissioners approved that letter Tuesday.

The parties will move toward negotiating and executing the terms of an acquisition of Southern Regional. The health system’s board and the local hospital authority must sign off on the deal.

Southern Regional, saddled with a heavy burden of uncompensated care, has been in danger of closing its doors.  full story

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