By KATHY WINGARD
MONTGOMERY, Ala. —
Committees of the Alabama House and Senate passed similar Medicaid financial reform bills Wednesday, clearing the way for debate on the floors of both houses.
Both bills carry expanded anti-trust language and more specific wording on how patients would be able to make complaints. The newer version of the original bill makes it easier for local groups to step into regional health care management by allowing performance bonds to be used to cover mandated reserves.
The crux of the reform effort, the replacement of the current method of “fee-for-service,” was described Wednesday as a major financial revision.
If passed, the bill would create about eight regions that would each have a professional health care management organization to hire and pay providers. The “regional care organization” would be responsible to the State Medicaid Agency for the quality of care and day-to-day management.
The RCO could be comprised of a local entity or, if no local group steps into the role, the State Medicaid Agency could allow commercial managed care corporations to be responsible for regional health care. The RCOs would be overseen locally by community boards that would be knowledgeable about each region’s unique needs.
During the House health committee hearing, Rep. Laura Hall, D-Huntsville, asked for further specifics on diversity on the community boards of the RCOs. She acknowledged that language exits in the bill for inclusion, but said frequently the intent in legislation had not matched the reality of the makeup of boards.
One of the major differences for the state would be that financial risk would be spread among the regional care agencies. Now, the state agency bears all risks. The changes would have the state Medicaid agency moving to a system that provides for a set monthly payment to a professional management company instead of paying a doctor each time he sees a patient.
If the RCO helps patients stay healthy and avoid ER visits, they could see a profit. Any losses would have to be absorbed as well. The state agency would become, in effect, a contract management agency.
The timeline for implementation was deliberately made aggressive, according to Dr. Donald Williamson, the state health officer and the chair of the commission that made the recommendation upon which the bills are based.
If passed, the next step would be for an actuary to propose regional boundaries. If a patient needs specialized care outside their region, they would be covered for that treatment.
Both committees asked Dr. Williamson if health care services would be limited under a new plan. He answered that not only would services not be cut, but “access to appropriate care though transportation and wraparound care” services would be expected to improve outcomes and lessen emergency room visits, thereby saving costs.
Long term care patients and facilities will not be among the early implementers of the capped payment model, so few changes would be seen for them over the four years.
The statewide roll out would become fully operational in 2017 if the new plan is adopted.