Friday, June 13, 2003 | 11:08 a.m.
CARSON CITY -- As long as the Legislature doesn't cut the budget, children in the Medicaid program in Clark County should have doctors to take care of them, officials said today.
Medicaid reimbursement rates for pediatric specialists had been cut recently and that caused a wave of the physicians to quit participating in the program. The state now is set to restore Medicaid payments to pediatric specialists.
But State Human Resources Director Mike Willden said today a final decision won't be made until the Legislature passes a tax plan and the department knows that its two-year budget is safe and will not be reduced.
If the Medicaid payments are restored, Willden thinks most of the 25 doctors who resigned from Medicaid on May 8 would return to the program. But he added there would probably be some holdouts.
Willden said that pediatric surgeons would be paid at 170 percent of the Medicare rate and radiologists would be reimbursed at 120 percent of the Medicaid rate for treating Medicaid patients under 21-years old. The reimbursement rate had been cut by the state to 85 percent of the Medicaid rate for thousands of medical procedures.
After the resignations, three Clark County children were airlifted to California or Arizona for treatment.
But Charles Duarte, administrator of the state Division of Health Care and Policy, said that in one case the transfer of the child had nothing to do with resignations. He said no additional children have had to be shipped out of state for treatment.
Durate said there has been a concern of parents with children with special needs about receiving treatment in Southern Nevada. He said these were "very fragile" cases. If the rates were not reinstated, Durate, who heads the Medicaid program, said there was a fear these children would not have access to medical care.
For those physicians who stayed in the program, the new higher rates will be retroactive to May 8. For those who left the program and who return, the rates will take effect when they re-enroll.
These physicians would be paid 100 percent of the Medicare rate for treatment of those over 21-years old. That rate had been cut from to 80 percent from 170 percent of Medicare.
The state reduced physician reimbursement in May hoping to save $11 million over the next two years. Willden said that savings will be reduced to $5 million to $6 million because of the restoration of some rates.
There are no reductions planned in other programs to offset the increased payments to physicians, Willden said.
Willden said the department will monitor other programs to see if there can be savings. For instance, the agency will start a preferred drug provider program for Medicaid recipients next year. And that could save money, he said.
The Legislature passed the state's budget. But Assembly Republicans are calling for it to be re-opened so there can be reductions in order to offset a proposed tax increase of about $860 million.
Gov. Kenny Guinn said he won't allow the budget to be re-opened. But the department is not making a final decision until the tax plan is approved.
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