health care providers&parent blast medicaid

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Fri, 25 Aug 2006 10:03:30 -0400

>

>

> *Health care providers, parents blast Medicaid overhaul *

>

> *Parents of special needs children sound off in public forum*

> 08/25/06,

>http://news.mywebpal.com/news_tool_v2.cfm?

show=localnews & pnpID=730 & NewsID=742602 & CategoryID=3511 & onfiltered=1

>*/ Brown _/*

>

>RINGGOLD & mdash; Georgia children covered by Medicaid may see cuts

or

>elimination of certain services on Sept. 1 and health-care providers

>say the changes could cause them to close their doors.

>

> About 60 people attended a meeting hosted by North Georgia

Pediatric

>Therapies at the Courthouse Annex in Ringgold Thursday night to

>discuss the changes and ask lawmakers to postpone them until Oct. 1

>to allow more time to adjust and better understand the overhaul.

>

> Fort Oglethorpe resident Shirley Wills said she & rsquo;s concerned

>about a reduction in the amount of physical therapy Medicaid will

>fund under the new program. Her 7-year-old son, Hunter, was born

>prematurely and relies on therapy both in school and outside school

>to help him develop motor skills.

>

> Getting outside therapy will be difficult under the new program,

>which will reduce the amount of therapy units per month from 20 to

8.

>A unit is 15 minutes.

>

> & ldquo;(The changes are) going to interfere with his

therapy, & rdquo;

>Wills said. & ldquo;Why stop now when he & rsquo;s come so far? & rdquo;

>

> Also at issue is the fact that local health care providers still

>have no way of collecting payments from Medicaid patients after the

>last day of August.

>

> Under the current system, Medicaid directly pays the provider.

Under

>the new system, private health insurance companies will take over

>billing. Medicaid will reimburse the companies, referred to as CMOs

>or care management organizations, and the companies in turn will

>reimburse the doctors. Lawmakers have touted the change as a way to

>cut costs.

>

> Medicaid assigns provider numbers so companies can collect

payments,

>but Amy of North Georgia Pediatric Therapies said the

office

>is among many that have still not received one.

>

> & ldquo;Starting Sept. 1, I can & rsquo;t bill, & rdquo; she said.

> & ldquo;This has essentially shut down 60 percent of my

>business. & rdquo;

>

> *Legislative response*

>

> State Sen. Jeff Mullis of Chickamauga and Rep. Ron Forster of

>Ringgold, both Republicans, said they would support postponing

>implementation of the new plans until Oct. 1 to allow time for a

>smoother transition. However, Forster said that wasn & rsquo;t the

only

>answer.

>

> & ldquo;I & rsquo;d much rather be in favor of getting all the

>providers credentialed within the next week and a half, & rdquo; he

>said.

>

> Forster said he and Mullis worked together to collect names of

>families and doctors attending the meeting. He said he plans to give

>them to the state Health and Human Services Committee in the Georgia

>House.

>

> Mullis said representatives from AmeriCorp, one of two CMOs

assigned

>to handle Medicaid claims in North Georgia, believed the program was

>off to a good start. It was implemented in Atlanta and southern

>Georgia on June 1, receiving mixed reactions in the public.

>

> & ldquo;What & rsquo;s so funny, & rdquo; Mullis said of those

>complaining about the changes, & ldquo;these people have never called

>us. Unless they call us, we do not know their personal

>struggles. & rdquo;

>

> Bruce Coker, Mullis & rsquo; Democratic opponent for the District 53

>Senate seat in the November election, said Medicaid should be

>available to those who need it most.

>

> & ldquo;I don & rsquo;t buy what they & rsquo;re selling, that

>there & rsquo;s that big of a problem with the system, & rdquo; he said.

> & ldquo;It & rsquo;s not going to be such that it will break the

>state. & rdquo;

>

> Coker predicted that the local legislative delegation would act

> & ldquo;in lightning speed & rdquo; to resolve the issue since

>it & rsquo;s an election year.

>

> *Patients and doctors*

>

> Dr. Rusty Baughman of Promise Pediatrics in Ringgold said he

harbors

>a & ldquo;cautious optimism & rdquo; about the lawmakers & rsquo;

>intentions. More than 75 percent of his income is from Medicaid

>payments. & ldquo;If we & rsquo;re not getting paid, that & rsquo;s going

>to be devastating, & rdquo; he said.

>

> Several parents expressed concern and outrage over

Baughman & rsquo;s

>statement that several children are being referred to Atlanta

>hospitals and doctors because those in nearby Chattanooga, as well

as

>Hutcheson Medical Center, haven & rsquo;t received the provider

numbers

>used to collect payments.

>

> Additional paperwork is also required under the new program,

making

>many services impossible to obtain without prior authorization from

a

>doctor. Proponents of the change said it is designed to crack down

on

>those who abuse the system. Some parents at the meeting said they

>were angry that unwed mothers who practice irresponsible sex can get

>Medicaid, while they have trouble getting services for their

disabled

>and special needs children.

>

> Abbott of LaFayette said her daughter, Savannah, has been

on

>Medicaid since she was 2. Now 8, Savannah was born with a spine

>deformity that has caused complications and numerous medical

>procedures that eventually put her in a wheelchair.

>

> Abbott said she found out recently, when she went to pick up $290

in

>prescription drugs, that she is no longer covered by Medicaid.

Abbott

>said one of her daughter & rsquo;s medical procedures costs about

>$200,000.

>

> & ldquo;I have been talking with Jeff Mullis, & rdquo; she said

before

>the meeting. & ldquo;I guess my next step is a lawyer. & rdquo;

>

> said she hopes the meeting at the Catoosa County

Courthouse

>Annex will help bring about change.

>

> & ldquo;If we can & rsquo;t make a difference, at least we can make

>some noise, & rdquo; she said.

>

> She provided lists of contact information for state

representatives

>and health officials, local media and the governor to all the

>attendees.