Medicaid reimbursement cuts haven’t driven away SD providersPIERRE — The fear that reductions ordered by the Legislature in reimbursement rates might backfire on availability of Medicaid services in South Dakota hasn’t borne true so far.
By: Bob Mercer, The Daily Republic
PIERRE — The fear that reductions ordered by the Legislature in reimbursement rates might backfire on availability of Medicaid services in South Dakota hasn’t borne true so far.
Meanwhile a state task force assigned to find ways to make the program more cost-efficient and effective in helping the needy has met dead ends in some cases and discovered opportunities in others.
Two of state government’s top officials in the Medicaid field met last week with the Legislature’s Joint Committee on Appropriations to review what’s happened in the six months since lawmakers wrapped up their budget-cutting 2011 session.
The Legislature’s directive that reimbursement rates for Medicaid providers be cut will reduce spending in the program by an estimated $58.9 million, including about $25 million in state general funding and about $33.7 million in federal aid.
State Social Services Secretary Kim Malsam-Rysdon said none of the health care professionals who provide Medicaid services have dropped their state contracts in the wake of the reductions.
She said the federal Department of Health and Human Services allowed South Dakota’s plan to proceed because her staff was able to document that patients wouldn’t lose access.
South Dakota is taking a tiered approach to the cuts, with the most critical services receiving the smallest reductions while some of the largest providers such as hospitals are taking larger cuts.
The unofficial panel that came up with that concept, rather than the flat 10 percent cut that Gov. Dennis Daugaard originally proposed, has been transformed by the governor into an ongoing task force called the Medicaid solutions workgroup.
The workgroup held its final meeting for this year on Oct. 3 and its report will be delivered in a few weeks, according to Deb Bowman, a senior adviser to the governor. She is the former secretary of social services.
She said no short-term answers were found to minimize the impacts of the reimbursement rate reductions.
“What we did find is our Medicaid program is extremely cost-effective,” Bowman told the legislators Friday.
She said some “small but significant” recommendations will be made, such as capping the annual amount of dental services that adults can receive; raising the co-pay on name-brand prescriptions from $3 to the maximum allowed $3.30; and imposing a co-pay for the first time on generic drugs at $1 on an experimental basis.
There will be an emphasis on improving community-based services for all types of patients including the developmentally disabled, senior citizens and people in rehabilitation.
A home-health care model will be developed, and there also will be invitations issued for health care providers to offer their approaches for managing chronic diseases.
Bowman said many of the highest-cost segments of Medicaid are the most unpredictable, such as neo-natal care for babies.
She said the workgroup found there is a misconception held by many people, including her, that Medicaid patients misuse emergency room services. She said the data proved the use is not significantly different whether the patient is covered by Medicaid or private insurance.
Sen. Deb Peters, R-Hartford, was one of the legislators who participated in the workgroup. She said she became frustrated many times because seemingly good ideas from other states were shown by South Dakota providers to be unworkable or impractical.
Sen. Corey Brown, R-Gettysburg, wasn’t an official member but attended parts or all of every one of the monthly meetings held by the workgroup.
He said the level of cooperation seemed to diminish as the effort began on a petition drive to place on the 2012 ballot a proposal for an additional 1 percent sales tax that would fund health care and K-12 education.