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State studying design for Medicaid waiver plan

The state’s main health agency says it’s analyzing a new plan to cover more uninsured Georgians through a special Medicaid “waiver’’ program.

Clyde Reese

Clyde Reese

Gov. Nathan Deal “has asked us to work on it,’’ Clyde Reese, commissioner of the state Department of Community Health, said Thursday.

The plan for a Medicaid waiver was generated by Grady Health System as an alternative to Medicaid expansion under the Affordable Care Act, a step that has been firmly rejected by Deal and state legislative leaders.

The Grady plan focuses on using federal matching Medicaid dollars to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage plan, which has generated much interest and speculation within the state’s health care industry.

Meanwhile, a safety-net health system in Cleveland, Ohio, told GHN that a similar program there –- cited as a model for the Grady plan -– helped improve many patients’ health and was carried out at costs below budget estimates. full story

Grady outlines plan to transform care for uninsured

Grady Health System realized it couldn’t count on Medicaid expansion anytime soon, so it went looking for a different path.

Expansion, already implemented in a number of other states, would have extended coverage to hundreds of thousands of low-income Georgians – turning them into paying patients. By doing that, it would have helped Atlanta’s Grady Memorial and other hospitals offset deep federal cuts looming from the Affordable Care Act.

But Gov. Nathan Deal and the Republican-led Georgia General Assembly stood firmly opposed to expanding Medicaid because of the cost.

Grady Memorial Hospital

Grady Memorial Hospital

So Grady officials began to envision a smaller-scale insurance program that could avoid the political and financial pitfalls that accompany a Medicaid initiative.

What they and state officials are proposing is a plan where federal matching Medicaid dollars would be used to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial players in the coverage plan. full story

Nursing home exec says feds’ decision stunning

A health care company CEO says he was “speechless and stunned” when the feds asked Georgia to return more than $100 million in payments made to his firm’s nursing homes.

Ronnie Rollins

Ronnie Rollins

Ronnie Rollins, CEO of Macon-based Community Health Services of Georgia, said in an interview Monday that company nursing homes had received the extra Medicaid funding in question for more than a decade without a problem. Then, this past December, a federal ruling declared the funding to be inappropriate.

A Dec. 8 letter and report from the federal Centers for Medicare and Medicaid Services said the “unallowable’’ payments to more than 30 nursing homes were made in fiscal years 2010 and 2011.

But CMS also asked Georgia to return any similarly inappropriate payments for more recent fiscal years as well, pushing the total sought, according to state officials, to an estimated $248 million.

Rollins said Monday that the extra funding under “upper payment limit’’ (UPL) regulations had been approved by state and federal agencies for his nursing homes since 2001.

Still, he said, he was not surprised at the overall federal intention to cut off these funds.  full story

Grady settles with state in overbilling case

Grady Health System has agreed to pay $2.95 million to settle charges that it improperly billed Medicaid for treatment to neonatal intensive care (NICU) patients, the Georgia attorney general announced Thursday.

Sam Olens

Sam Olens

The state of Georgia alleged that Grady inflated billings for certain services provided to these NICU patients, resulting in either unjustified or inflated payments from Medicaid.

“This settlement demonstrates our office’s continued commitment to protecting crucial Medicaid dollars from fraud and abuse,” said Attorney General Sam Olens in a statement. “The health of NICU patients is fragile, and we must ensure that every Medicaid dollar is properly spent on their care.”

A spokeswoman for Olens said the Grady billing problem occurred from March 2008 to November 2012. Lauren Kane, the spokeswoman, told GHN in an email that “no single individual’’ at Grady was responsible for the overbilling. full story

A historic goodbye at Good News Clinics

Hall County in northeast Georgia, traditionally known as the gateway to the Blue Ridge Mountains, has a high uninsured rate. One of every four Hall residents has no health insurance, slightly higher than the state average.

dental-clinic-photoBut for many years now, a free health clinic has been giving thousands of these people primary care and medicines, as well as linking them to medical specialists when necessary.

The Good News Clinics in Gainesville is the biggest free clinic in Georgia. Its executive director, Cheryl Christian, who guided its growth spurt, recently announced her retirement.

When Christian took over as Good News leader in 2004, the clinics had 6,476 patient visits serving 2,400 patients. By last year, the numbers had increased to 21,427 patient visits serving 4,562 patients. (The name Good News Clinics refers to medical and dental clinics operated by the one organization.)

The people treated are Hall County’s uninsured, with incomes within 150 percent of the federal poverty level, which is $17,655 for an individual. “Most of our patients are working part-time jobs,’’ Christian says. full story

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