CMOs stir up trouble in Georgia

Tuesday, October 31, 2006

ATLANTA - A recent change in the way Georgia runs its Medicaid program has spurred headaches for the state's healthcare providers--everyone from hospitals to therapists to rehab providers.
On June 1 and Sept. 1, Georgia hired three Care Management Organizations, which work much like HMOs, to run its Medicaid program. The result: Hospitals have had to turn away patients, therapists have had to limit their sessions and rehab providers have had to wait longer to get paid, industry sources report.
"It's such a hard situation right now that we're looking at everything from limiting our Medicaid business all the way up to eliminating it," said Mike Daniels, who owns Acute Rehab in Valdosta, Ga. Medicaid makes up 45% of the company's business.
The CMOs take as long as 30 days to pay for rehab equipment, especially high-end equipment, Daniels said. It's supposed to take 10 days. Additionally, CMOs pay less than the Medicaid allowable.
But the headaches don't stop there. Because therapists have had to limit their sessions, they often have to choose between conducting a physical therapy session or a wheelchair seating evaluation. That causes problems for rehab providers.
"It's delaying seating evaluations," said Weesie Walker, manager of National Seating & Mobility's Atlanta branch.
Things have gotten bad enough that the hospital and therapist communities, along with the parents of children on Medicaid, have staged numerous protests. That doesn't surprise Kay Koch, who heads up education, training and marketing for Mobility Designs in Atlanta.
"The CMOs were supposed to be for children who are more well," she said. "The children in wheelchairs were supposed to be exempt."