Doctors, hospitals left out of Medicaid budget

Thursday, May 19, 2005 | 8:56 a.m.

CARSON CITY -- Many health care providers will be getting rate increases to make up for inflation, but doctors and hospitals have been left out of a Medicaid budget approved Wednesday.

A legislative budget subcommittee Wednesday approved a two-year budget for Medicaid of an estimated $2.4 billion to cover an expected 184,024 clients next year and 193,339 in the following year.

The budget provides for a 11.6 percent increase next fiscal year to cover the rising cost of drugs and a 10.7 percent increase in the following year. The subcommittee also approved inflationary rate increases of 7.3 percent next fiscal year and 7.4 percent in fiscal 2007 for HMOs.

Also included in the approved budget was $4 million for the coming to years to provide rate increases for air ambulance services, providers of mental health rehabilitation and for home infusion therapy.

The rates paid physicians and hospitals were overhauled in 2003 and it resulted in a drop in reimbursement for some specialists and surgeons.

Chuck Duarte of the Health Care Financing & Policy Administration, said he had to send patients out of state for medical care after pediatric specialists refused to treat children either in the hospitals or in their offices. Duarte decided to raise the rates by 20 percent for doctors to resume treating the patients.

After the subcommittee's approval, Larry Matheis, executive director of the Nevada State Medical Association that represents doctors, said he understood the shortage of money but called it a "significant issue in the next fiscal year."

He said the rates for physicians have been frozen based on 2002 calculations. He said the rates resulted in a "significant reduction" in reimbursement for speciality physicians and surgeons.

"Now they are freezing them again," Matheis said. "Many physicians will find it hard to see Medicaid patients."

But he said the subcommittee "left the door open" for Duarte to address any problem that might arise, such as boosting rates that were not approved by the Legislature.

Assemblywoman Sheila Leslie, D-Reno, chairwoman of the subcommittee, said Duarte last year raised the rates without legislative approval.

"The physicians balked and perhaps rightfully so. But we want to be informed."

Senate Majority Leader Bill Raggio, R-Reno, said he was "not as concerned" as others by Duarte's decision.

"They had to act," Raggio said. "Physicians were not available. He (Duarte) had to do some adjustments.

"We should not micro manage in the interim."

After the session, Duarte said the budget approved would retain existing services, but he would have to "keep close track" of the money to make it through the next two years.

One new program calling for the state to spend $3.3 million in the next biennium will allow earlier intervention for individuals to avoid escalation of untreated mental illnesses. He said this would allow "master specialists" to treat these people in a clinic under supervision. The division estimates it will pay $22.50 per hour per patient for the services.