MAG Meets with Proposed Medicaid Care Management Organizations
03.25.05 Companies' Responses to MAG's Questions
On Friday, March 25, 2005, MAG invited seven of the leading proposed Medicaid Care Management Organizations to speak to MAG’s Third Party Payer Committee and other MAG members about their proposals for the Medicaid Georgia Cares Managed Care Program. Representatives from Centene Corporation, WellCare Health Plan, Coventry Health Care Inc., AmeriGroup Corporation, Wellpoint/ Blue Cross Blue Shield of Georgia, Three Rivers Health Plan, and Americhoice Health Services made presentations and responded to physicians’ questions and concerns.
The Department of Community Health released its Request for Proposal (RFP) for the proposals from Care Management Organizations to provide health care services in the Georgia Cares Medicaid Program, a full-risk, capitated care management system, on January 8, 2005. The RFP seeks proposals to serve Medicaid children and families in six regions of the state. The specific patient categories include: Medicaid low-income families, transitional Medicaid, Pregnant Women (Presumptive), Pregnant Women (Right from the Start Medicaid), children (Right from the Start Medicaid), children (newborn), PeachCare for Kids, and women eligible for Medicaid due to breast and cervical cancer. There will be two awards made in each of the Central, East, North, Southeast, and Southwest Services Regions. In the Atlanta Service Region there will be between three and five awards made. In order to be considered for the Atlanta Service Region, the Offeror must be awarded a Contract in at least one other Service Region.
The proposals are due April 4, 2005 with operations scheduled to begin in the Atlanta and Central service regions by January 1, 2006; in the East and North service regions by July 1, 2006 and in the Southeast and Southwest service regions by December 1, 2006.
In response to concerns about the tight timeframe for implementation, most plans concurred that the timetable was ambitious, but thought they could meet the deadline since: 1) they had been conducting preliminary planning over the past year; 2) they have programs in other states which they can draw from; and/or 3) they had dealt with conversions in the past. Plans were commonly separated into those that are Medicaid-only plans (Centene Corp. & Coventry) versus those plans, which had added Medicaid populations to their private pay plan designs.
In respect to payment, most plans offered a choice of Fee-for-Service or Capitation payments to physicians with models of varying complexity. The majority of plans reported they would reimburse physicians at the most recent Georgia Medicaid reimbursement rate, or at a percentage above the Medicaid Fee Schedule. One plan stated that their rate could go as high as 110% for some physicians under their incentive payment plans (Amerigroup). Several plans reported that they offered “physician incentive payments” if certain criteria were met.
Many plans reported strong efficiencies in claims processing times from as low as 1–2 days for one plan (Coventry) to one which simply stated that they would fall within the full 15 days required by Georgia law (Three Rivers). Several questions were raised on retroactive payment denials, to which the standard answer was that if the preauthorization had been given for the procedure done, that there should be no retroactive denials. Most plans agreed they would have a local presence even when their central office is out of state. The plans varied in terms of those requiring referrals versus those who didn’t.
This information was particularly timely and useful as members decided whether to sign letters of intent and with which companies. MAG will continue to provide members with up-to-date, practical information on the Georgia Cares Program as it is implemented.