May 172013
 

reflector

By Michael Abramowitz

Friday, May 17, 2013

North Carolina’s health care providers soon will have a new state system for Medicaid reimbursement claims, but they have no idea yet who their Medicaid management partners will be.

N.C. Secretary of Health and Human Services secretary Aldona Wos on Thursday presented local health professionals with Gov. Pat McCrory’s vision for the future of Medicaid and gathered suggestions, questions and concerns about how to achieve a system that “makes people healthier in a predictable and sustainable way.”

McCrory already has opened the bidding process to private-for-profit entities to compete with the state’s award-winning not-for-profit community care (CCNC) management entity, a move that has concerned many health care providers. Wos said that having multiple management entities would make it easier for care providers to contract for management services and receive reimbursements more efficiently, “but how many is the right number… to keep the system successful and sustainable?”

She said the state has whittled the number to about 10 from which to choose, but said it will probably golower.

Wos did not present a new Medicaid plan, but outlined the administration’s general views and goals of providing the most effective care while reducing administrative costs through an efficient management system for services and cost reimbursements that will reduce the taxpayers’ burden. The DHHS operates under $20 billion budget, from which $13 billion goes to Medicaid, she said.

“The governor asked me to look at this carefully and make sure that North Carolina citizens’ needs are being met and the $13 billion is being efficiently spent,” Wos said.

After analyzing feedback already received, Wos cited common themes around which the department has started to build a framework for reform: simplifying the complex information management system for health care providers and patients, reducing administrative complexities and finding a way to treat patients as a whole by combining management of mental and behavioral health care with physical health care under one statewide umbrella, Wos said.

Even without a replacement Medicaid management system in place, the state will begin using an electronic one-stop provider billing system on July 1 and will require use of a one-stop electronic eligibility processing system on Oct. 1, Wos said.

Wos did not say, when asked, why the State Legislature turned down the federal government’s offer to fund 100 percent of its Medicaid program until 2017, then 90 percent thereafter. She and Medicaid director Carol Steckler were not allowed by their press secretary to answer questions about the 500,000 state residents not presently covered by Medicaid or any other insurance plan.

McCrory has said the new plan will not include eligibility for that portion of the population.

“The governor has said we are focusing on making our current Medicaid system more efficient and effective,” spokesman Ricky Diaz said. “His plan does not provide for any change in eligibility.”

When asked whether McCrory has factored the financial effect to his plan of leaving 500,000- 600,000 people out of the health care coverage equation, Diaz repeated that those people will not be eligible.

Health care providers in the east, like Dr. David Herman, CEO of Vidant Health System, which provides care under state law to 70,000 uncovered, non-paying people each year, were well aware of the challenges they face to continue providing quality care without reimbursement while keeping the system financially viable.

“Secretary Wos and I acknowledge there need to be changes in the health care system,” Herman said. “Our organization, however has particular challenges because of the demographics of eastern North Carolina. Dr. Wos has expressed that she understands that perhaps one size doesn’t fit all.”

Herman said his biggest concern about even small Medicaid funding changes is the effect they can have on Vidant’s ability to deliver on its mission, due to the wide variations in the payer mix.

“We can’t shift the cost of care to other payers the way providers in other parts of the state perhaps can,” he said.

Contact Michael Abramowitz at mabramowitz@reflector.com or (252) 329-9571.

via The Daily Reflector.

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