DCH Requests Proposals for HMO Structure

01.06.05 DCH Releases HMO RFP For Their “Georgia Cares Medicaid Managed Care Program”

On January 6, 2005, DCH released their Request for Proposals for their new Medicaid HMO structure. The Department of Community Health (DCH), will be soliciting care management organization vendors (CMOs) to assist with the following objectives, which they have outlined, for the Medicaid and PeachCare for Kids programs:

  • Improve health care status of member population
  • Establish contractual accountability for access to and quality of health care
  • Lower cost through more effective utilization management
  • Budget predictability and administrative simplicity

The potential vendors will be required to develop provider networks depending on the service region(s) for which they bid, and will need to present to the DCH evidence of provider contracts or non-binding letters of intent in order to demonstrate their network adequacy. Many current Medicaid providers have been contacted by one or more of these potential vendors and can certainly expect this to continue over the next several months.

DCH has made available information related to its activities related to the research and development of the Georgia Cares Program and the related RFP via its Web site. The entire RFP will be posted at the Georgia Department of Administrative Services Web site.

Potential vendors will be bidding to provide all current Medicaid services based on six Medicaid Managed Care Service Regions – Atlanta, Central, North, East, Southeast and Southwest. Contracts will be awarded to two vendors in each Service Region with the exception of the Atlanta Service Region, where the DCH anticipates awarding contracts to three to five vendors.

These contracts will be for all services currently covered under Medicaid and PeachCare for Kids, exclusive of Non-emergency Transportation. This program will impact the following mandatorily enrolled populations only: Low Income Families, Transitional Medicaid, Pregnant Women (Presumptive), Pregnant Women (Right from the Start Medicaid – RSM), Children (Right from the Start Medicaid – RSM), Children (newborn), PeachCare for Kids (pending legislative approval) and Women eligible for Medicaid due to Breast and Cervical Cancer. All other Medicaid populations will remain in the current Medicaid fee-for-service program.

MAG has put forth their strong concerns with the Department about this new structure, which would be following on the heels of the ACS debacle. We presented to the Commissioner a number of reasons why a Georgia HMO would not have the intended effects of stabilizing the budget or reducing costs. We pointed out that savings could better be achieved through modifications of the current system and/or through expansion of the current primary care case management program or through the consideration of alternative models. MAG will be carefully reviewing the RFP and offering further comments in the weeks ahead. DCH expects to begin operation of the first phase of their program by January 1, 2006.

In response to physician questions concerning the letters of intent from the potential CMOs, MAG General Counsel suggests that you review these letters very closely and be certain that signing them is not a binding commitment, until you have the opportunity to review the contract and all its conditions and terms. Should you have any questions, please feel free in calling Cam Grayson at the Public Payer Office 678.303.9277 or Donald Palmisano, MAG General Counsel at 678.303.9281.