Blue Cross and Blue Shield of Georgia will remain the dominant insurer for the state’s high-profile employee health plan. More than 80 percent of...

Blue Cross and Blue Shield of Georgia will remain the dominant insurer for the state’s high-profile employee health plan.

More than 80 percent of State Health Benefit Plan members selected insurance plans from Blue Cross during its recent open enrollment, a state agency said Thursday.

Clyde Reese

Clyde Reese

Blue Cross was the sole insurer offering plans for the 2014 coverage year.  Through public criticism, rallies and a Facebook campaign, many state employees and teachers in the SHBP sought more choices of health insurers for their 2015 coverage.

The state then added two insurers, Kaiser Permanente and UnitedHealthcare,  to the offerings of health plans for next year.  They will share the remaining state health plan members.

The SHBP covers more than 650,000 state employees, teachers, other school personnel, retirees and dependents.

The Department of Community Health’s commissioner, Clyde Reese, announced the enrollment numbers at the agency’s board meeting Thursday.

The chairman of the agency’s board, Norm Boyd, also said that  Community Health, which manages $13 billion in federal and state funds, recently was determined to have a “clean’’ financial audit.

One problem area found in the audit, Boyd said, was in the timeliness of nursing home inspections. “This is really a head count issue, a manpower issue” related to the number of state inspectors of nursing homes, he said.

Community Health spokeswoman Lisa Marie Shekell said after the meeting that the agency is hiring 37 nurses to fill those surveyor jobs, and has requested funding for eight more.

The federal Centers for Medicare and Medicaid Services requires that nursing homes be inspected once every 15 months, Shekell said. The audit found in a sampling of Georgia nursing homes that 70 percent were not inspected during that required time frame.

“We had a number of retirements’’ of inspectors, she said, adding that the state did not fill these positions as quickly as needed.

Jerry Dubberly

Jerry Dubberly

Reese also announced that he himself would serve as interim Medicaid director after the departure of Jerry Dubberly, Georgia’s current Medicaid chief, in January. Reese said the agency would conduct a national search for Dubberly’s replacement.

Dubberly, who is leaving for a private sector job, served as Medicaid chief for the past six years.

Reese commended Dubberly for his “tremendous service’’ to the state.

In other action, the Community Health board approved a federally mandated change to the Georgia hospital provider fee, called Tier 2, that involves private hospitals in the state. One board member, Clay Cox, voted no on that proposal.

Private hospitals will receive payments of $31.3 million, pending federal approval, down from $39 million in fiscal 2014.

Reese also said that an RFP for the Georgia Medicaid managed care contract will be released by the end of the month.

Three companies currently share the multibillion-dollar contract that serves most of the roughly 1.9 million Georgians who are on Medicaid or PeachCare.  The new contract will begin in 2016.

 

 


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Andy Miller

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