New regulations unveiled for Medicaid-HMO shift Everything 'on target' for 1997 changeover

September 18, 1996|By M. William Salganik | M. William Salganik,SUN STAFF

State Health Secretary Martin P. Wasserman yesterday unveiled the latest draft of regulations for the complicated task of moving 220,000 Medicaid recipients into managed care plans to somewhat skeptical members of the Senate Health Subcommittee.

Wasserman said the revised draft was based on testimony by nearly 50 people and written comments from about 100 more in reaction to a draft released last month.

The health department is "still on target" to begin the program Jan. 1 and to get all Medicaid recipients assigned to HMOs or similar managed care plans by the end of June.

Once fully operational, the program will save the state $8 million a month, he said, and it is necessary to start Jan. 1 in order to meet budget projections.

Sen. Larry Young, the Baltimore Democrat who is subcommittee chairman, said he believes that a number of concerns remain over the proposed regulations. He said his committee will meet again next week to review the health department's response to questions from the committee and from health providers and advocacy groups who commented at yesterday's session.

The health department hopes to get final approval on the regulations by the end of the month from the legislature's Joint Committee on Administrative Executive and Legislative Review.

Remaining issues, Young said, include:

Timing. "That Jan. 1 date is magic to you," the chairman told Wasserman, but "many feel that is too short a time to develop and implement this program," and the health department might need to "leave the window open" to a short delay.

Reimbursement rates. The health department wants to give participating HMOs a flat fee per Medicaid recipient equal to 90 percent of the average fee-for-service cost for Medicaid patients. HMOs question the overall rate, and the method for adjusting for patients with unusual health problems. Wasserman says managing care will reduce costs, by reducing the need for emergency room visits and by reducing the need for expensive hospitalization.

Providers. The state is calling for doctors, clinics and hospitals that have treated Medicaid patients in the past to be included in the HMOs, but there is still debate over the specific rules for doing so.

Mental health services. There is still concern, Young said, over rules spelling out what mental health services need to be provided by the HMOs and which by specialized providers.

Qualification as a participant. Young said he wants assurance that the rules are flexible enough to allow churches, labor unions, clinics and others to group together and provide the functions of an HMO.

Pub Date: 9/18/96

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