As Clyde Reese begins his new tenure as commissioner of the state Department of Community Health, he has no time for a slow transition. He faces two big issues that many people had expected to be resolved by now.
The first is the hospital provider fee, a financing mechanism that’s designed to fill a nearly $500 million hole in the state Medicaid program. Legislation to facilitate the renewal of the current provider fee was fast-tracked through the General Assembly earlier this year with the backing of Gov. Nathan Deal.
Industry leaders had expected the federal Centers for Medicare and Medicaid Services (CMS) to approve the fee before the end of June — the end of the state’s fiscal year. That did not happen.
It is still expected to get federal approval, but the wait has become uncomfortable for some officials in the industry.
The second big issue that Reese and his staff face is the new contract for the State Health Benefit Plan (SHBP), which covers more than 650,000 state employees, teachers, school personnel, retirees and dependents.
Currently, UnitedHealthcare and Cigna hold the contract, with United covering more than 90 percent of members. Community Health had been expected to announce the winner of the new contract early in July. The winner would begin serving members Jan. 1.
Speculation on the winning bidder has centered on a single vendor — Blue Cross and Blue Shield of Georgia, the state’s largest health insurer.
But some industry officials say they fear that Blue Cross’ reimbursements for services will be lower than the current rates, and lead to a financial squeeze for some medical providers.