Health CMO transition cause for concern in North Georgia - | Chattanooga News, Weather & Sports

Health CMO transition cause for concern in North Georgia

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WellCare is one of the largest CMOs utilized by Georgia Medicaid.

It's in the process of negotiating a new contract with the Therapy Network of Georgia, which has patients and providers who work with developmental and behavioral therapy concerned.

Three-year-old Skyler visits an occupational therapist at least once a week. He's diagnosed with Aspergers, ADHD, and PANDIS. His therapy sessions are vital. His younger brother, 10-month-old Ethan may also soon need therapy.

"He's already showing sensory issues," mother Jessica Gutshall says.

Gutshall worries her son's WellCare will not provide him with the care he needs after July 1, the proposed transition date.

Her son's therapist, Amy Williams, is just one of a group of therapists who refuse to sign the new contract between WellCare and the Therapy Network of Georgia. She says one big reason is a limit of 10 visits per lifetime.

"Its very hard to find quality services when I'm going to be limited to a minimal amount of visits and then the reimbursement rates have been cut from the Medicaid rate, which is not great but its doable, to a 60 percent cut," explains Williams. "As a small business owner I can't survive on what they are going to be offering."

Finding a provider who will take WellCare has proven difficult.

"We can't require private individuals that provide these services to accept the contract," State Rep Tom Weldon says.

Channel 3 sat down with Weldon who says negotiations are ongoing but the State will step in if it has to.

"We require that Wellcare or the CMO's provide access to the services," Weldon says.

A spokesperson for WellCare tells Channel 3 they're transitioning to the Therapy Network of Georgia to balance good treatment for less money. However, it would not confirm which providers will take WellCare after the transition.

Williams knows it won't be her.

"At this point my hands are tied. I can't maintain a business nor can I provide services," says Williams.

State officials and healthcare providers believe the transition will happen on July 1, however WellCare says that date is not set in stone and negotiations will continue.

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