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OAFP Communications and Advocacy Efforts on Medicaid Payment Parity
Randy Wexler, MD, Advocacy ChairAnn Spicer, EVP
In Ohio, Medicaid PCP reimbursement is 59% of Medicare rates
Real $$ on that tableFPs lacked information on:
enhanced payment attestation process
Medicaid outreach insufficient
Medicaid Payment Parity in Ohio
OAFP Goals
Make OAFP members aware of enhanced payment and attestation process
Advocate for workable attestation process
Help OAFP members with attestation and payment problems
Unfavorable Environment
Early comments of Medicaid personnel:What’s the big deal?Mortgaging my children’s future – feds can’t
afford this“You people” are always complaining
Identified Gaps; Sought to Fill
Outreach Process uncertaintyTechnology issuesProcess issues
OAFP Maintained Problem List
Ask OAFP members to let us know if they attested and weren’t on approved list
Gave us the ammunition to use to convince Medicaid director of problems
Medicaid pledged to work with us on problem resolution
Slow, difficult process
Touched Members in Positive Way
Generated more calls and emails than any issue in recent memory
Touched members we have not had any contact with before
Made some loyal friends for lifeEnded every conversation with, “thank
you for being an OAFP member.”
Member Response
Thank you for working so hard on this and keeping me updated!
Thanks for your assistance, patience, and hard work. I really appreciate.
We appreciate the value of OAFP membership.
Member Response
Thanks for dogging this on my/our behalf.
Thank you for your persistence and assistance with this!
If you are ever in NW Ohio I would be delighted to buy you an adult beverage. Thanks for all your help.
Status
Have eliminated most of our problem list
PaymentMost have still not received paymentFFS Medicaid paid at enhanced rateManaged care to receive $ in late Oct. to
begin paymentsFiguring out retroactive payments scheme
Delay is Harmful
Purpose of enhanced payment was to increase numbers of PCPs seeing Medicaid patients
Still haven’t been paid so it is likely that increase hasn’t happened
Will be used against us when we argue for continuation of enhanced payment beyond Dec. 31, 2014
Lessons Learned
Having input into the implementation of legislation is just as important as having input into the legislative process itself.
Advocacy journey doesn’t end when a bill is signed into law.
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