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September 20. 2013 8:03PM

Officials approve contracts and rates for new Managed Care Medicaid

CONCORD — The state's new Managed Care Medicaid system received final approval from federal officials this week with approval for the program's contracts and rates.

The Department of Health and Human Services has been working on the new managed care system that lawmakers hope will save the state between 1 and 3 percent of program costs for more than two years.

"We are extremely pleased CMS has approved our contract and rates," said DHHS Commissioner Nicholas Toumpas. "Our staff has been diligently working on this project for over two years and this represents a significant milestone and progress toward our program start date, Dec. 1, 2013."

The department began enrolling recipients into the care management program last week. Clients have 60 days to select the health plan that best suits their needs before the program begins in December.

Medicaid clients will receive enrollment information in the mail. Recipients can choose one of three companies by returning the enrollment in the mail, by calling the Enrollment Center at (888) 901-4999 or by going online to www.nheasy.nh.gov.

"We have been working to provide our clients with as much information as possible about the Care Management Program throughout this transition time," said Toumpas. "We are now eager for the next step in the process: Having our clients select a health plan and a primary care provider."

State lawmakers first approved moving to a managed care system for the Medicaid program from a fee-for-service model in 2011, but the program failed to get off the ground when hospitals, mental health centers and community health centers balked at the low rates the three companies offered.

The state's largest hospitals sued the state two years ago, claiming the reimbursement rates under the Medicaid program were too low to sustain the health care system for the poor and were set illegally. That case is still pending in federal court.

To entice the hospitals to join the managed care networks, Gov. Maggie Hassan, the House and the Senate put additional money into the uncompensated care program and increased some provider rates.

The budget passed by lawmakers uses general fund money for some of the state's uncompensated care share, but providers had to join the managed care networks by July 1 to receive the money.

The nine Community Mental Health Centers signed agreements with the three companies last month and that was the final piece of the puzzle to complete the needed provider networks.

The hospitals and community health centers agreed to join the managed care networks in July.

Lawmakers want the managed care system in place if the state decides to expand Medicaid eligibility under the Affordable Care Act, which could add about 48,000 people to the program.

For additional information about NH's Medicaid Care Management Program, visit www.dhhs.nh.gov and look for the MCM logo.

grayno@unionleader.com


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