Time Is Running Short To Get Medicaid Reform Right

Legislators are still optimistic a Medicaid reform bill will be passed before this extra-long session ends. Two sticking points between the House and Senate seem to have been resolved. First, it is agreed the state will no longer assume the risk for Medicaid and will ‘outsource’ that risk to other entities. Second, both chambers now appear to agree to a hybrid model in which managed care corporations would be competing with provider-led entities, which we have favored, to take on the risk of the Medicaid program.

Now our work begins in earnest. We need to ensure adequate protections for doctors and their patients are in place to avoid the mistakes other states have made when inviting managed care to take on their Medicaid program. The North Carolina Medical Society (NCMS) has been working diligently to educate legislators on how to adequately protect the state, taxpayers and patients.

Several key areas where we have been advocating to amend the legislation include:

  • A rate floor for professional services.
  • Patient choice of their primary care physician.
  • Contracts with providers to include value-based payments supporting performance, quality and outcome measures – and these measures must be clearly defined, risk adjusted and monitored and measured continually.
  • The state would maintain a system to ensure oversight, efficiency and provider participation including network adequacy standards and patients’ timely access to services. The state could impose penalties on the managed care organization or provider led entity if those standards are not met.

The federal government currently is considering rules for Medicaid managed care organizations that would address these same issues and more, and we have been urging legislators to be proactive and incorporate protections like these into any North Carolina Medicaid legislation in advance of a federal mandate.

For more details on what the NCMS is asking the legislature to do to protect your practice and your patients’ access to care read Medicaid Reform: NCMS Principles for Reform. To hear the NCMS Director of Legislative Relations Chip Baggett explain what is happening on Medicaid reform at the General Assembly watch his Bowtie Briefing legislative update.

Most importantly, legislators want to hear from you. Tell them North Carolina needs to avoid other states’ mistakes when it comes to privatizing Medicaid by codifying the protections described above. To make it easier, we have composed an email message detailing each area of importance for you to send. Please take action NOW. As a provider on the front lines treating Medicaid patients and a constituent, you offer the most credible and valuable input for legislators.

 
 

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