CEO shares info on Medicaid changes

Published 3:00 am Thursday, November 6, 2014

The Pike County Chamber of Commerce Health and Human Services Committee hosted a luncheon Wednesday at Troy Regional Medical Center with Ron Owens, CEO, South Alabama Medical Center in Dothan as guest speaker.
Attending were health care providers and business and community leaders. Owens gave the group an overview of Regional Care Organizations.
“In May 2013, the Alabama Legislature passed legislation outlining a reform plan for Alabama Medicaid, which Gov. Robert Bentley signed into law,” Owens said. “The law authorizes Regional Care Organizations (RCOs) to provide benefits to Medicaid beneficiaries through a capitated financing model that establishes a set amount per patient that Alabama Medicaid will pay to the RCO.”
In April 2014, the Alabama Legislature amended the RCO legislation that included governance, risk and reserve requirements, beneficiary eligibility and enrollment and provider contracting and network adequacy.
Owens said the reason for establishing RCOs is they will provide better care, improve efficiency and are less costly.
The requirements for RCOs are that they serve only Medicaid beneficiaries and will not be deemed an insurance company under state law. RCOs must have a governing board of directors and a citizen’s advisory committee that meets specified requirements and must be incorporated as an Alabama non-profit.
The state will be divided into five regions. Pike County will be in region D, which has a RCO population of 156,750.
Those covered include aged, blind and disabled; breast and cervical cancer treatment programs, Medicaid for low income families and SOBRA children and mothers. The RCOs do not cover dual eligibles, foster children, Hospice patients, ICF-MR recipients, nursing home/institutional recipients, Plan 1st recipients and home/community-based waiver patients.
Teresa Grimes, Troy Regional Medical Center CEO, said the RCOs will manage Medicaid patient care and payments and, therefore, better manage the dollars from Medicaid budget.
“As Medicaid continues to change, the RCOs will manage the dollars within the five regions of the state where the needs are best known as well as the services necessary to meet those needs,” Grimes said.
Kathy Sauer, Pike County Chamber of Commerce president, said Wednesday’s luncheon provided an opportunity for health care providers and professionals to learn more about the RCOs and the role they will play in health care in the immediate future.
“If things go as planned, in 2016, the state will be under the regional concept and we need to be aware of what will take place,” Sauer said.
“It’s rather complicated and the more we learn the better prepared we will be when the changes come.”
Sauer said the quarterly luncheons hosted by the Chamber’s Health and Human Services Committee are planned to keep the community better informed on health related issues and to provide a time of fellowship for those in the healthcare field.

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