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Alaska to expand Medicaid management program

'Pilot program' would more closely monitor care for 'super utilizers'

Posted: January 1, 2014 - 1:02am

The Department of Health and Social Services is looking at a Medicaid care coordination program in 2014. The pilot project would supplement the department’s Care Management Program that, according to a department brochure on the state’s Medicaid program, oversees Medicaid recipients “who have used services in an amount or at a frequency that is not medically necessary.”

In a request for proposals (RFP) issued Dec. 24, the department says it seeks to implement a coordinated care program “to combat harmful and costly inappropriate use of Medicaid-covered services.”

Those who would participate in a state coordinated care program are those who have visited the emergency room more than five times in a year and are not already in the state’s Care Management Program. Those individuals are called “super utilizers” by the department.

Twelve months of medical and pharmacy records for the participating Medicaid beneficiary would be reviewed before they’re put into the program. The patient would only be allowed to utilize a single health care provider and a single pharmacy while in the program. Participation in the program would last one year.

The department’s current Care Management Program receives more than 100 referrals a year and manages about “300 top utilizers but lacks sufficient resources and expertise to address the complex and layered problems of this super utilizer group,” the RFP states. “Additionally, these recipients may not require the severe limits applied to participants in the Care Management Program.”

The department says that the current contractor for the Care Management Program “does not have the capacity to service this larger number of recipients.”

The RFP says that the referrals “affirm that the Alaska medical community views the Care Management Program as a valuable tool in reducing fraud, waste and abuse of Medicaid services.” The department expects the coordinated care program to bring “increased prescription oversight, a reduction in unnecessary health care encounters, increased coordination of care, better health outcomes and cost savings to the Medicaid program.”

The Department of Health and Social Services was unable to answer questions about the expected cost of the program by press time.

The RFP says that the State of Alaska will issue a contract for the program by Feb. 21, 2014. The contract will last until Feb. 28, 2015 with an option to continue with a second and possibly third phase of the program. The state has the option of canceling the program after six months if cost savings are not realized. The RFP does not specify how much the state seeks to save by implementing the program.

Gov. Sean Parnell announced in November that the State of Alaska would not accept federal money to expand Medicaid under the Affordable Care Act.

“Instead of expanding Medicaid at this time, we will work to address the issues within our control,” Parnell said at the time.

Parnell said he wanted to create an Alaska Medicaid reform strategy and an advisory group to address Medicaid need and spending.

A report commissioned by the state examining a Medicaid expansion in Alaska estimated that the state’s share of Medicaid costs will increase by $11.1 million to $39.9 million from 2014 to 2020.

• Contact reporter Jennifer Canfield at 523-2279 or at jennifer.n.canfield@juneauempire.com. Follow her on Twitter at https://twitter.com/canfieldjenn.

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