Oh Caresource - part 1

If you haven't received your certified letter yet, Caresource is reducing everyone's rate starting in May to 80% of the Medicaid rate. I started getting calls on Friday about it, and unless someone else has a solution, there's not much we can do except leave the network. I had seen a lot of new contracts coming being offered at 80% but I thought they would only go forward with new contacts at that rate. 

I've heard rumors that it's because they can't continue to keep up with the ABA rates that were just raised last summer by DCH, or that they expect to take over the Peachstate caseload who's rate is lower for most newer contracts, but no confirmations on any rumors so far. With the new CMOs eventually coming into the picture, I thought they would understand the competition isn't offering a lower rate. So much for being a non-profit...

If you haven't received the letter it looks like this: 

Notice it says 45 days yet most are receiving them this week. 

So as your patients to change to another CMO when they can or email them stating you disagree and leave the network. You can find the redetermination date for each patient on GAMMIS on the eligibility page when you search right under the name, or the parents can call GA Families  (1-888-423-6765) to ask when they can switch.