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With Dartmouth On Board, Managed Medicaid Transition A Step Closer

Posted: July 1, 2013

Here is an article from NH Public Radio, which informs the reader that the largest health care provider in the state of NH, Dartmouth-Hitchcock, has signed contracts with the 3 Medicaid managed care organizations (MCO’s).

This is certainly a significant leap forward for what appears to be the eventual management or coordination of medical (acute care) services for all of NH’s Medicaid populations by commercial MCO’s.

The state budget recently signed by Governor Hassan contains a large increase in the amount of funding larger hospitals will receive in payments from the state’s uncompensated care fund. However, in order to access these funds, hospitals must have agreements with the MCO’s by today, July 1st. This was seen as a carrot and stick approach response to the main road block to Medicaid managed care moving forward, which was the lack of providers signed up to participate with the state selected MCO’s.

Dartmouth-Hitchcock is not just a large state of the art hospital in the Upper Valley, it is a vast healthcare network throughout the state with a strategic presence in areas such as Keene, Concord, Greater Manchester and Greater Nashua. It is very logically to assume that other healthcare providers including those on the Seacoast and in Rockingham County will be joining the MCO’s networks quickly (if they haven’t already). A realistic start date for Step 1, continues to be early 2014 although there will likely be scrambling to get it in place before January 1st because Medicaid expansion could begin at that point.

It is also interesting to note that based on CMS status reports written by the Commissioner, CMS has yet to approve the state proposed Medicaid rates (paid to the MCO’s) or the Medicaid managed care contract itself. However, if the major healthcare providers are accepting MCO’s offered rates and terms, it seems likely CMS will approve the rates at some point soon. Again, logic dictates that if medical providers and MCO’s can come to terms on contracts, CMS will eventually approve the state’s contract with the MCO’s.

The contracts mentioned here do not address long term Medicaid funded services such as those provided by an Area Agency, or a nursing home. The only practical effect this development has on so called Step 2 is the time frame. Once Step 1 services “go live” DHHS’s goal is to have Step 2 services in the same model or in some way connected to Step 1 one year later. Obviously, the details of what that will mean are far from clear at this point in time.

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