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Legislature Holds Public Hearing on Future of Medicaid

Brandon Moseley

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By Brandon Moseley
Alabama Political Reporter

On Tuesday the Alabama Legislature held a public hearing to explain the Medicaid reform package introduced by Sen. Greg Reed (R) from Jasper.  The Chairman of the Alabama House Health Committee, Rep. Jim McClendon (R) from Springville presided over the meeting to explain the legislation drafted by he and Sen. Reed and endorsed by Governor Robert Bentley (R).
The new legislation is based on recommendations by the Alabama Medicaid Advisory Commission which was chaired by Alabama Health Officer and interim Alabama Medicaid Director Dr. Donald E. Williamson Dr. Williamson explained that the new law would divide Alabama into between six to eight Regional Care Organizations (RCOs).  The RCOs would be given the responsibility for administering the Medicaid program in their areas.  They would not be state agencies, but rather would be for profit or non-profit corporations which would administer the Medicaid program and would bear the risk for the program.
Currently Medicaid is set up on a Provider Fee For Service (PFFS) model where Medicaid beneficiaries purchase care from healthcare providers (doctors, hospitals, pharmacies, nursing homes, etc.) and they then bill the state.  With a PFFS model the state is at risk for whatever services the clients charge and there is very little coordination of care between providers for a Medicaid beneficiary.  The state can allocate money for Medicaid; but it has little real control on costs.
Dr. Williamson said, “We envision these being risk bearing entities. So must have capital.”  The capital providers would control 60% of the board of the RCO.  Dr. Williamson said, “We chose 60% because the people putting up the money should have control of the board.”  The Citizens advisory board has to be at least 20% Medicaid enrollees.
Much of the language comes from the Oregon Medicaid reform statute.  Medicaid spends about $2.5 billion in health care benefits.  That translates into about $300 to $500 million of business in each RCO.  The legislation protect the legislature from an RCO failing and the state having no way to pay providers.  Dr. Williamson said that the state has to be prepared in case an RCO fails.  The state will have to commit to implementing this by October 2016.  Dr. Williamson said the state will only proceed if this is cheaper than what we are doing now.  Alabama Medicaid is projecting that the RCOs would save the state $20 to $70 million a year and have better outcomes.
Williamson said that the RCOs may bleed into more than one region.  “What we envision is probationary licenses.”  The RCOs will have just over three years to go from probationary to full capitation.  The state must audit the RCOs to make sure they have solvency.   The proposed contract length is three years with two one year renewable options.
Medicaid providers must be willing to accept the payment and services set by the RCO.  Dr. Williamson said the state’s timeline is aggressive because it needed to be aggressive.  “By sept 30th we will have divided Medicaid into no more than 8 regions.”  The RCOs will be in place in one year.  By 2016 the RCOs must meet solvency standards must achieve capitation (i.e. the RCO has to have enough money in the bank to meet all the potential obligations.)  Not meeting the timeline is grounds for termination.
Williamson said that everyone acknowledges that we have to do something about long term care; but this plan does not specifically address the details of long term care reform.  The RCOs would handle the other Medicaid programs including, Medicaid services to poor families, Medicaid for poor children, and Medicaid benefits for poor seniors and the disabled.
Dr. Williamson said that the Alabama Attorney General’s office is involved in crafting the legislation to make sure that the state doesn’t violate any federal anti-trust statutes.
Sen. Greg Reed is the sponsor of SB 340. Sen. Reed said, “The goal of this meeting is to learn what issues that you have with my bill.  None of us feel that we have a Medicaid system that can’t be improved.”  Reed said that the goal is to wind up with a better system.
Rep. McClendon said that in order for an RCO to assume the risk they have to have money in the bank.  “Right now the taxpayers are at risk.” We need to move that risk for those claims to the RCOs.
One hospital administrator for a chain of three hospitals in northwest Alabama employing 1500 people thought that 180 miles is too large a diameter for some regions of Alabama.  Specifically he felt that Northwest Alabama deserves its own RCO.  He commended Gov. Bentley, the Alabama legislature and the Medicaid commission for the work that they did.
The Executive Director of the Alabama Dental association, Dr. Zack Studstill said that RCOs was not the ideal way to handle Medicaid dentistry and said that Florida had attempted the same thing and it did not work real well.  Utilization decreased, quality decreased, and the cost was the same.  He said that Dentistry is unlike medicine.  The possible unintended consequence is less Dentists participating in the Medicaid program.
This plan calls for a study of long term care services.  The spokesman for the Alabama Nursing Home association said, “We look forward to working with you.”
The Commissioner of the Alabama Department of Senior Services Neal Morrison said that he was supportive of the effort.  “We are here to help you.”
The Director of Business Development and State Relations with Centene Corporation (a managed Medicaid Corporation) Ryan Sadler said that this was a positive step forward but that the legislature should address the risk timeline.  “The focus must remain on the patient, but if we do not achieve budget savings what have we accomplished?”  Sadler said that the state should require that entities operate at full risk since day one instead of starting the RCOs with probationary licenses.  He also felt that the state should move much quicker and that are “very sophisticated players” who are eager to come run managed Medicaid services in Alabama. He also favored allowing competition.
The spokesman for Alabama Appleseed said that they have been working on making Alabama Medicaid stronger for several years.  He said they favored longer license renewal times and greater consumer involvement on the boards of the Regional Care Organizations.
Dr. Hammock with the University of South Alabama said that the Alabama Hospital Association is in support of this bill.  “We can’t do it (Medicaid) the way we have been doing it.
Kimble Forester with Alabama Arise said that they support the intent of the legislation but still have some concerns.  Their chief concerns is if one person on the board can properly represent consumers interests.
Lynn Williams with Melina Healthcare said that her company has successfully implemented Managed Medicaid in other states.  The traditional HMO model was not the best model in their experience.  “We believe that Alabama is not ready at this point for a full capitation model.”   She said that the Governor’s committee produced a very balanced study that took advantage of the lessons learned in other states and that this legislation meets Alabama’s needs.   “Melina strongly supports this legislation.  We believe this is a major first step.”
Dr. Jack Bradford representing the AARP said that his group represents a half a million Alabamians.  He said, “This is a wonderful first step.”
Rep. Laura Hall (D) from Huntsville and a House Health Committee member said that she didn’t see any African Americans or Hispanics testifying before the committee.  Hall said that the RCOs needs to have inclusive and diverse venders and boards.
Rep. Joe Hubbard (D) from Montgomery and a member of the House Health Committee said, “This piece of legislation appears to be an important first step to address the Medicaid crisis in this state.”  “I am proud of this body for bringing this forward.”
Senator Reed said that he was appreciative of everybody who spoke and who contributed to the debate.  Areas that they needed to look at going forward are the positives of the current Medicaid dental providers, incorporating Patient Care Networks (PCNs), and how to reform long term care.  “We are interested in this process.  Reed said they are still working on how the states can we offload that risk so that the state has budget clarity.  “How or are RCOs going to compete?”   Reed said that the legislature and the Governor have been working on this issue for 14 months.
Chairman McClendon said that the health committees will be meeting the week after Spring Break.  He encouraged that everyone with an interest in this to submit their comments and ideas in writing to the House and Senate Health Committees.

Brandon Moseley is a senior reporter with eight and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.

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Health

Three mental health crisis centers coming to Mobile, Montgomery and Huntsville

“Today marks a culture change in Alabama for treatment of individuals with mental illness and substance use disorders,” Mental Health Commissioner Lynn Beshear said.

Eddie Burkhalter

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Gov. Kay Ivey Press held a press conference with Alabama Dept. of Mental Health Commissioner Lynn Beshear for the announcement of Crisis Center Awards Wednesday, October 28, 2020 in Montgomery, Ala. (Governor's Office/Hal Yeager)

Gov. Kay Ivey on Wednesday announced an $18 million project to create three new mental health crisis centers to be located in Mobile, Montgomery and Huntsville. 

These centers, once in operation, will reduce the number of people suffering from mental health crises who are hospitalized or jailed, Ivey said during a press briefing in front of the Capitol Building in Montgomery. 

“When these facilities are open and fully staffed, these centers will become a safe haven for people facing mental health challenges,” Ivey said. 

Lynn Beshear, commissioner of the Alabama Department of Mental Health, said during the briefing that the centers will provide “recovery based” care with “short term stays of a few hours, or up to a few days, to provide treatment, support, and connection to care in the community.” 

“Today marks a culture change in Alabama for treatment of individuals with mental illness and substance use disorders,” Beshear said. 

Beshear said AltaPointe Health in Mobile will operate one of the three facilities, and once built it is to serve Mobile, Baldwin, Clarke, Conecuh, Escambia, Monroe and Washington counties with 21 new beds, including 15 temporary observation beds. Altapointe will begin with a temporary space while constructing the new facilities, she said. 

Beshear said the Montgomery Area Mental Health Authority is partnering with the East Alabama Mental Health Authority and the Central Alabama Mental Health Authority to serve the 11 counties in Region 3 with 21 new beds, including 10 temporary observation and respite beds. 

“The regional crisis center will be located in Montgomery, and will be open to walk-ins and for drop off by law enforcement, first responders and referrals from emergency rooms,” Beshear said. 

Wellstone Behavioral Health in Huntsville was selected to open the third center, and will do so at a temporary site while a new facility is being built, with the help of an additional $2.1 million from local governments, Beshear said. That facility will eventually have 39 beds, including 15 for temporary observation and 24 for extended observation.

“There’s not a day that goes by that after-hours care is not an issue in our state,” said Jeremy Blair, CEO of Wellstone Behavioral Health, speaking at the press conference. “And so I applaud the Department of Mental Health and the leaders for their efforts in recognizing that and taking it a step further and funding our efforts here.” 

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Asked by a reporter why a center wasn’t located in Jefferson County, one of the most populous counties with a great need for such a center, Ivey said those residents will be served in one of the other regions. 

“Plans are underway to continue this effort. Today’s beginning, with these three crisis centers, is just the beginning,” Ivey said. 

Ivey added that request for proposals were sent out for these three centers and “it was a strong competition for the location of these three crisis centers.” 

Alabama House Majority Leader Nathaniel Ledbetter, R-Rainsville, said during the briefing that more than a year ago, Ivey asked him what the state should be looking at, and that he replied “we’re failing miserably in mental health.”

Gov. Kay Ivey Press held a press conference with Alabama Dept. of Mental Health Commissioner Lynn Beshear and House Majority Leader Nathaniel Ledbetter for the announcement of Crisis Center Awards Wednesday, October 28, 2020 in Montgomery, Ala. (Governor’s Office/Hal Yeager)

Ledbetter said Ivey asked him to take on the challenge of correcting the state’s response to mental health, and a team was created to do just that. 

“Working together, today’s announcement will not only change Alabamians lives, but will help to save lives,” Ledbetter said.

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Health

Ainsworth returns to work after testing positive for COVID

Ainsworth’s office on Sept. 21 announced he had tested positive earlier that week, having been tested after someone in his Sunday school class tested positive for the disease. 

Eddie Burkhalter

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Lt. Gov. Will Ainsworth speaks during a video message. (LT. GOVERNOR'S OFFICE)

Alabama Lt. Gov. Will Ainsworth on Wednesday announced that he was returning to work that day and had met public health requirements for quarantining after testing positive for COVID-19 some time last week.

Ainsworth’s office on Sept. 21 announced he had tested positive earlier that week, having been tested after someone in his Sunday school class tested positive for the disease. 

“While many have battled with coronavirus, my symptoms never progressed beyond some mild congestion that I usually experience with seasonal allergies,” Ainsworth said in a statement. “During the quarantine period, I participated in several Zoom calls, caught up on some office work, spent some quality time with my family, and completed a number of overdue projects on my farm.”

Members of Ainsworth’s staff who were in close contact with him haven’t tested positive for COVID-19 but will remain in quarantine for a full 14-day period as a precaution, according to a press release from Ainsworth’s office Wednesday. 

“Ainsworth once again urges all Alabamians to practice personal responsibility, which may include wearing masks, maintaining social distancing whenever possible, and taking other precautions to lessen chances of exposure to COVID-19,” the press release states.

Ainsworth still disagrees with Gov. Kay Ivey’s statewide mask mandate, he said. According to the release, he considers such orders “a one-size-fits-all governmental overreach that erodes basic freedoms and liberties while removing an individual’s right to make their own health-related choices.” 

The wearing of cloth or medical masks has been proven to inhibit the spread of COVID-19 and the more people who wear masks, the better. While not perfect, masks limit the spread of respiratory droplets that may contain infectious virus shed from the nose and mouth of the mask wearer.

It is possible — even likely — for symptomatic, pre-symptomatic and mildly symptomatic people to spread the virus. That’s why it’s important to wear a mask even when you’re not sick.

Cloth masks offer only minimal protection from others who are not masked, meaning that masks are not simply a matter of personal safety but safety of others. Masks are also only effective when worn over both the mouth and the nose. [Here’s a guide on how to wear masks properly.]

VIA UAB

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Dr. Deborah Birx, coordinator of the White House’s coronavirus task force, told Ivey after she announced the statewide mask order that it was a “brilliant” idea. The order has been credited by Alabama infectious disease experts as having dramatically reduced the number of cases, hospitalizations and deaths in the weeks after the order went into effect. 

Dr. Don Williamson, president of the Alabama Hospital Association, told APR on Tuesday that from personal observation he is seeing more people not wearing masks, or wearing them improperly, and said the state could dramatically reduce the risk of COVID-19 if the public regularly wore masks and wore them properly.

Hospitalizations of COVID-19 patients in Alabama on Monday crossed the 1,000 mark for the first time since Aug. 31 — a sign that Alabama may be headed for another peak in hospitalizations as the state prepares for winter and flu season.

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Elections

Faith in Action Alabama calls on law enforcement to protect voters from harassment

“In these harrowing days it is incumbent upon all of us as citizens and you and your colleagues as law enforcement professionals to do all we can to maintain this right secured by so much courage and sacrifice.”

Micah Danney

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(STOCK PHOTO)

Nine clergy members from across the state have signed an open letter calling on local and state law enforcement to protect voters against intimidation and harassment at the polls.

The clergy are leaders in Faith in Action Alabama, a regional association of Christian congregations affiliated with the national group Faith in Action, the largest grassroots, faith-based organizing network in the country. It seeks to address a range of issues like gun violence, health care, immigration and voting rights.

This is their letter:

Across our country and here in Alabama, it is being seen that citizens are turning out in record numbers to vote early and by absentee ballots. It is very heartening to see so many of our fellow citizens energized and committed to exercising that most fundamental and critical duty of citizenship, the use of their franchise.  As servant leaders of an ecumenical association of nearly 2,000 faith communities across our state we are certainly encouraging our congregants to fulfill this duty either through early, absentee or day of election voting. For us this is not only part of our civic duty, but as people of faith obligation as well.

Unfortunately, it it also largely known that there are forces in our country that are actively, publicly and fervently at work to suppress the votes of some of our fellow citizens. We write to implore you to use the full authority of your office and department to ensure that those who seek to vote, especially on November 3, 2020 are not assailed or intimidated by illegal harassment in their polling places. We believe these threats are pervasive enough and real enough that proactive measures should be in place as citizens come to vote throughout that day. The strong, visible presence of uniformed legitimate law officers will hopefully prevent any attempts at confrontation or intimidation and violence.

The history of our state is marked by the efforts of tens of thousands of Alabamians who marched, protested, brought legal actions, shed their blood and some even gave their lives that every citizen of this state might have full and free access to the ballot box. In these harrowing days it is incumbent upon all of us as citizens and you and your colleagues as law enforcement professionals to do all we can to maintain this right secured by so much courage and sacrifice.

Please be assured of our prayers for you and the men and women of your department who have the awesome responsibility of providing public safety and equal protection under the law for every Alabamian. If we, the members of Faith in Action Alabama’s Clergy Leadership Team, can be of assistance please do not hesitate to call upon us.

Sincerely,

Rev. Jeremiah Chester, St. Mark Baptist Church, Huntsville

Rev. David Frazier, Sr., Revelation Missionary Baptist Church, Mobile, and Moderator, Mobile Baptist Sunlight Association

Bishop Teresa Jefferson-Snorton, Fifth Episcopal District of the Christian Methodist Episcopal Church

Bishop Russell Kendrick, Episcopal Diocese of the Central Gulf Coast

Bishop Seth O. Lartey, Alabama-Florida Episcopal District of the African Methodist Episcopal Zion Church

President Melvin Owens, Alabama State Missionary Baptist Convention

Bishop Harry L. Seawright, Ninth Episcopal District of the African Methodist Episcopal Church

Dr. A.B. Sutton, Jr., Living Stones Temple, Fultondale

Father Manuel Williams, C.R., Resurrection Catholic Missions of the South, Montgomery

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National

Report: Alabama’s Black Belt lags behind state in economic prospects

Black Belt counties lag behind others in economic prospects and investments in businesses.

Eddie Burkhalter

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(APR GRAPHIC)

It took Marquis Forge five years and 18 banks before he and his partner were able to open their company, Eleven86 Water, in Autauga County, just north of the Black Belt, and a report released Tuesday shows how Black Belt counties lag behind others in economic prospects and investments in businesses. 

Forge, a former University of Alabama football player, told reporters during a briefing Monday that he considers Autauga County, which borders the Black Belt’s Lowndes County, part of the Black Belt, and said it shouldn’t have been so difficult to access the capital needed to start a business. 

The report released Tuesday by the University of Alabama’s Education Policy Center titled “Black Belt manufacturing and Economic Prospects” is the last in the center’s Black Belt 2020 series, and found that only four of the state’s 24 Black Belt counties, as defined by the center, are above the statewide average of 22.4 businesses per 1,000 residents, and just one, Montgomery County, was above the 2018 statewide average of personal income of $43,229. 

Researchers also found that just three Black Belt counties are above the state’s average in gross domestic product being produced by counties of $45,348. 

“To achieve Governor Ivey’s ambitious goal of 500,000 a million more Alabama workers with skills by 2025, all hands have to be ‘on deck.’ It will require higher labor force participation rates, particularly in the Black Belt, where the average is 20 points below the statewide average,” said Stephen Katsinas, director of the university’s Education Policy Center and one of the authors of the report. 

“Due to smaller economies of scale, our approaches to  education, workforce development, and community building will have to be different to reach Alabama’s Black Belt,” Katsinas continued. “In the longer term, we first must define the Black Belt, because you can’t measure what you can’t define. Then we must do what West Alabama Works is doing–go where the people are to bring hope by connecting them to a well-aligned lifelong learning system that makes work pay.”   

Donny Jones, COO of Chamber of Commerce West Alabama and Executive Director of West AlabamaWorks, told reporters Monday that one of the keys to helping the Black Belt will  be helping state and Congressional legislators understand the nuances of rural Alabama. 

Jones said the state should look at how colleges are graded, and that many smaller colleges don’t get credit for putting students through programs that get them short-term certificates that lead to jobs. 

“Those are some of the things on the statewide level that we can really start to work on,” Jones said, adding that they’ve already begun teaching modern manufacturing in Black Belt high schools that gives students college credits toward an associates degree while still in high school. 

“I think that’s very important for individuals to understand the impact that we can have in our higher ed and our K-12 system, really works hand in glove to move the needle for workforce development,” Jones said. 

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Jim Purcell, State Higher Education executive officer of the Alabama Commission on Higher Education, told reporters that it’s also important to look at one’s own community and identifying what is “unique and special,” and said he was recently in Autauga County, where he is from, and bought two cases of Eleven86 Water because he remembered how good the water there was. 

“I think that’s what you’ve done, is you’ve taken the gift that Autauga’s environment has and enhanced it, so that the people can benefit from it,” Purcell said to Forge. “I think that’s the key.” 

Asked what he’d tell state legislators to spur them to make changes so that other entrepreneurs wouldn’t have to struggle as hard as he did to open a business, Forge said he would ask for a clearer path for assistance. 

“Instead of digging down through a tunnel with a spoon I would have someone outline the tracks on getting funds and assistance from local, state and the national level, because there are funds out there,” Forge said. 

After going to 18 banks to get the financing he needed, he still had to liquify all his assets to make it happen, Forge said. 

“How many people are going to do that?” he asked. “We shouldn’t have to do that.”

To read all of the Education Policy Center’s reports on Alabama’s Black Belt, visit here.

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