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Managed care effort for New Hampshire taking shape

CONCORD — The last major piece fell into place on Tuesday for the state to move to a managed care system for the state and federal health insurance program for the poor, young, disabled and elderly.

The nine Community Mental Health Centers signed agreements with the three managed care companies the state hired to administer the program for Medicaid recipients, although the two sides will work together to develop a new payment system.

The state’s health care providers have to join the new managed care system if they want to receive the state’s help with uncompensated care costs for health service they provide to patients who cannot afford to pay their bills.

For the past several years Department of Health and Human Services officials have sought to change from the current point-of-service system to managed care after lawmakers approved the change in 2011.

Until recently, health care providers balked at accepting the rates offered by the managed care companies.

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.

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.

The Senate used general fund money for the state’s share, but said hospitals would have to join the managed care networks by July 1 to receive the money.

The hospitals and community health centers agreed to join the managed care networks in July and on Tuesday the mental health centers did as well.

“As part of the move toward converting New Hampshire’s Medicaid program to a managed care system, the Community Mental Health Centers have reached agreements with the three MCOs (managed care organizations) who have contracted with the State to manage the Medicaid system.” said Roland Lamy, NH Community Behavioral Health Association executive director.

The managed care companies and the centers agree to seek a new payment system based on quality of care but still allow those seeking services to access the system.

Until the new system is developed, the centers will continue to operate under the terms they currently have with the state, Lamy said.

“By reaching this level of agreement, we believe that the State can move this process into the next phase with the federal regulators and demonstrate that adequate networks will be in place when the managed care system goes live in the coming months,” Lamy said.

State budget writers believe moving to a managed care system will save the state millions of dollars a year. Lawmakers have counted on the savings in the past, but without the system in place, they never materialized.

Lawmakers also want the managed care system in place if the state decides to expand Medicaid eligibility under the Affordable Care Act which could add about 44,000 people to the program.

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