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Modern Healthcare - - REGIONAL NEWS -

AL­BANY, N.Y.— Un­der a pro­posal to over­haul New York’s safety net fi­nanc­ing, the state would con­tract with ac­count­able care or­ga­ni­za­tions or health plans for se­niors who are el­i­gi­ble for both Medi­care and Med­i­caid. The pro­posal would af­fect roughly 700,000 New York se­niors and would re­quire a waiver from the CMS, said a work group that re­leased its pro­pos­als for the state’s on­go­ing task force to re­design Med­i­caid. Un­der the waiver, New York would as­sume fi­nanc­ing and health­care de­liv­ery risk for so­called dual-el­i­gi­bles and reach cap­i­ta­tion or sub-cap­i­ta­tion agree­ments with health plans and providers, the re­port said. Med­i­caid and Medi­care spend­ing for the state’s jointly en­rolled se­niors to­taled about $23.5 bil­lion and $11.3 bil­lion, re­spec­tively, in 2010. The waiver could pro­mote de­vel­op­ment of ACOS and pa­tient-cen­tered med­i­cal homes, but New York could also be left with losses should providers fail to curb spend­ing, the re­port said. The re­port also rec­om­mended ex­pan­sion of the state’s Med­i­caid qual­ity mea­sures from man­aged care to fee for ser­vice. The state would start qual­ity reporting for men­tal health and sub­stance abuse in 2012 and ex­pand it fur­ther in 2013-14. Home health would re­port qual­ity mea­sures in 2012-13, when long-term-care qual­ity mea­sures would also ex­pand, the re­port said. Un­der an­other pro­posal, the state would also of­fer lim­ited fi­nan­cial sup­port to hos­pi­tals, nurs­ing homes and home health providers deemed es­sen­tial to off­set costs of clo­sures, merg­ers or in­te­gra­tion or re­design of ser­vices. Such fi­nanc­ing could help with pro­pos­als made to the task force for the re­con­fig­u­ra­tion of Brook­lyn’s hos­pi­tal mar­ket (Dec. 5, p. 6). AU­GUSTA, Maine— Gov. Paul Lepage is propos­ing tougher Med­i­caid el­i­gi­bil­ity stan­dards and a new ben­e­fit struc­ture as part of his plan to bal­ance a yawn­ing short­fall in the pro­gram. In a news con­fer­ence Dec. 6, Lepage said an anal­y­sis of fis­cal 2012, which ends next June, shows a short­fall of $120 mil­lion. The short­fall for fis­cal 2013 is an additional $100 mil­lion. The gov­er­nor says Maine’s Med­i­caid pro­gram is one of the most gen­er­ous in the coun­try and has grown be­yond the state’s means. He says el­i­gi­bil­ity must be re­struc­tured, ben­e­fits re­designed and pay­ment re­forms put in place to re­store Med­i­caid to fi­nan­cial ac­count­abil­ity. The gov­er­nor pre­sented his Med­i­caid re­struc­tur­ing plan to key leg­isla­tive Democrats and Repub­li­cans on Dec. 6. His pro­posed changes must be ap­proved by the Leg­is­la­ture. FREE­HOLD, N.J.— Cen­trastate Health­care Sys­tem, based in Free­hold, be­came the lat­est in­vestor in Qual­care, a provider-owned man­aged care com­pany. News that Cen­trastate joined more than a dozen own­ers in the New Jersey health plan fol­lows the Novem­ber an­nounce­ment that At­lantic Health Sys­tem, Morristown, N.J., had in­vested in Qual­care. Cen­trastate’s stake in Qual­care brings the to­tal num­ber of hos­pi­tal and physi­cian or­ga­ni­za­tion own­ers in the man­aged-care com­pany to 15, ac­cord­ing to a news re­lease an­nounc­ing the deal. Qual­care in­cludes 750,000 mem­bers cov­ered by self-in­sured health and work­ers’ com­pen­sa­tion and li­a­bil­ity in­sur­ance, the re­lease said. MIL­FORD, Del.— Bay­health Med­i­cal Cen­ter, a 328-bed hos­pi­tal in Dover, Del., hired Michael Ash­ton as ad­min­is­tra­tor of Mil­ford Me­mo­rial Hos­pi­tal, a newly cre­ated po­si­tion in which Ash­ton is ex­pected to lead the plan­ning and con­struc­tion of a re­place­ment fa­cil­ity. Ash­ton, 36, most re­cently was ad­min­is­tra­tive di­rec­tor of the med­i­cal ser­vice line for Wellspan Health, a twohos­pi­tal sys­tem in York, Pa., ac­cord­ing to a Bay­health news re­lease. Mil­ford Me­mo­rial, a cam­pus of Bay­health, plans to be­gin con­struc­tion by 2014 on the re­place­ment hos­pi­tal at the same site in or­der to al­low phased con­struc­tion and take ad­van­tage of ex­ist­ing in­fra­struc­ture and park­ing. Of­fi­cials ex­pect con­struc­tion to take two years. Ash­ton also has re­spon­si­bil­ity for the 37-bed in­pa­tient re­ha­bil­i­ta­tion unit and home health ser­vices.

Ash­ton will lead plan­ning of hos­pi­tal’s re­place­ment fa­cil­ity.

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