ATLANTA — Georgia lawmakers will take into account a invoice that would power the state’s Medicaid managed-care insurers to repay tens of millions of {dollars} if their spending on medical care doesn’t attain a sure threshold.

The bipartisan bill, launched Jan. 26 by the highly effective Georgia Home Speaker David Ralston, a Republican, is targeted on bettering the state’s psychological well being care system.

Tucked contained in the laws is a provision that will require the Medicaid managed-care firms to refund funds to the state in the event that they don’t spend sufficient on medical care and high quality enhancements for sufferers.

Georgia Well being Information and KHN reported in September that Georgia was one of only some states that doesn’t mandate a minimal degree of medical spending for its Medicaid insurers.

Annually, Georgia pays three insurance coverage firms — CareSource, Peach State Well being Plan, and Amerigroup — a complete of greater than $4 billion to run the federal-state medical health insurance program for low-income residents and other people with disabilities. For 2019 and 2020, the businesses’ mixed income averaged $189 million per yr, in accordance to insurer filings reported by the Nationwide Affiliation of Insurance coverage Commissioners.

“As an alternative of making certain enough well being care networks for Georgia’s kids, Georgians with disabilities, and Georgians in nursing amenities, tons of of tens of millions of {dollars} go as an alternative to the Georgia [insurers’] backside strains,” mentioned Roland Behm, a board member for the Georgia chapter of the American Foundation for Suicide Prevention.

Behm, who suggested lawmakers on the invoice, mentioned the KHN and Georgia Well being Information article helped carry the difficulty to the eye of legislators crafting the invoice.

Georgia is amongst greater than 40 states which have turned to managed-care firms to run their Medicaid packages — and ostensibly management prices. In accordance to an August report from the U.S. Division of Well being and Human Companies’ Workplace of Inspector Normal, 36 of these states and the District of Columbia set a benchmark “medical loss ratio” for the minimal spending by insurers on medical care. In addition to Georgia, the report mentioned, the 5 states not requiring a managed-care spending threshold have been Kansas, Rhode Island, Tennessee, Texas, and Wisconsin.

Republican state Rep. Todd Jones, a co-sponsor of the brand new invoice, advised KHN that Georgia lawmakers ought to set up a powerful benchmark for insurers to meet. “We should always take a look at what different states are doing,” he mentioned.

Most states with a spending requirement set that ratio at a minimal of 85% of premium {dollars} that insurers are paid. So when a Medicaid insurer spends lower than that on medical care and high quality enhancements, it should return cash to the federal government.

The Georgia invoice additionally requires setting the edge at 85%. If the invoice is permitted, the Medicaid insurers would face the medical spending requirement in 2023.

If the benchmark had been in place in recent times, it might have pressured a recoupment from the Peach State firm, which has the biggest Georgia Medicaid enrollment of the three insurers. State paperwork present it failed to attain the 85% mark from 2018 to 2020, KHN beforehand reported.

Andy Schneider, a analysis professor at Georgetown College’s Middle for Kids and Households, known as the 85% mark “a win for taxpayers, for Medicaid suppliers, and for Medicaid beneficiaries.” He additionally mentioned it could be greater than honest to the Medicaid insurers, which might maintain 15% of what the state pays them for administrative prices and revenue.

As a result of Ralston is the lead sponsor of the invoice within the Home, it’s anticipated to move that chamber.

However the insurance coverage business seemingly will work to take away the medical spending provision.

An business official, Jesse Weathington, govt director of the Georgia High quality Healthcare Affiliation commerce group, declined to touch upon the laws.

Fiona Roberts, a spokesperson for the state Division of Group Well being, which oversees the Medicaid program, mentioned the company wants time to overview the measure earlier than commenting on it.

The primary provisions of the invoice require insurers to present protection for psychological well being care or substance use remedy on the identical degree as different bodily well being wants.

The laws would offer schooling mortgage help for individuals coaching within the fields of psychological well being and substance use problems and search to increase behavioral well being companies for kids. It could additionally facilitate “assisted outpatient remedy” — when a choose might order an individual with a severe psychological sickness to comply with a court-ordered remedy plan locally.

Andy Miller: [email protected], @gahealthnews