Frankfort Local News

Edelen Says He’ll Audit Private Medicaid Operators This Year

After months of mounting problems, State Auditor Adam Edelen says he will launch a full investigation intoKentucky’s statewide Medicaid Managed Care system.

Edelen created a Medicaid task force in February after taking a first look at the managed care system. He also gave recommendations to managed care companies, health care providers and the state on how to make the system run better in the future.

But with clashes between private Medicaid companies and healthcare providers ongoiong, Edelen wants to take a stronger look into the system.

“We will launch a full blown audit of the managed care companies based on the information that’s being gathered right now, we’re going to launch that investigation by the end of the year,” he says.

Frankfort Local News

Denton Says Lawmakers Will Remove CoventryCares From Medicaid System if Tough Bargaining Continues

Kentucky Senator Julie Denton says the state’s largest private Medicaid company is underpaying and threatening healthcare providers, and she says lawmakers may kick the company out of the state Medicaid system if the behavior persists.

CoventryCares is one of three new private Medicaid Managed Care Organizations (MCOs) that began business in the commonwealth last year. But problems with the privatized system popped up quickly. They began in Eastern Kentucky. Hospital chain Appalachian Regional Healthcare sued Coventry for making inadequate and late payments to hospitals for care that should be covered by Medicaid. Coventry officials say they’re operating within the new state rules for private Medicaid operators. The two sides are in contract talks now, but the problems have spread. This week Coventry told Baptist Health Systems in central and western Kentucky that it will stop payments immediately after their current contract expires in September unless a new deal is worked out in advance. 

Coventry and the other new MCOs, Kentucky Spirit and WellCare, are losing money. Denton, who is chairwoman of the Senate Health and Welfare committee, says that’s because they received bad information from the state Cabinet for Health and Family services when they signed contracts last year. That misdirection has led Coventry to hard bargaining in contract talks. But as talks continue, Denton says costs are being passed on to patients and providers.

“It is ridiculous for Coventry to think that they can go to Appalachian Regional Healthcare and Baptist Health Systems and basically hold them over a barrel saying you’re going to take what we give you or we’re not going to play in your sandbox,” she says.

Denton says Coventry took a risk by joining Kentucky’s rushed system and the company should find other ways to make profits or risk being kicked out of the system.

“Something’s got to be worked out and if Coventry can’t work it out, I would anticipate the legislature would move, if the Cabinet does not move, to eliminate Coventry from participating in Medicaid in Kentucky,” she says.

Lawmakers were hesitant to act to correct any problems during this year’s session because they wanted to give the system time to work. But Denton says things are not getting better.

Governor Steve Beshear proposed the managed care system as a way to shore up the Medicaid budget, which is normally one of the state’s heaviest financial burdens. Despite the problems, Beshear says the system will eventually work.

Local News

Healthcare Provider Sues Medicaid Care Operators

The main healthcare provider for eastern Kentucky, Appalachian Regional Healthcare, has filed suit against two of the state’s four Medicaid managed care operators.

In complaints filed this week, Appalachian Regional Healthcare alleges Coventry Health and Kentucky Spirit Health Plan owe the provider over $17 million in back payments.

Kentucky privatized Medicaid statewide last November to reduce costs and provide better patient care. Since then, the three new managed care operators have been criticized for not making timely or appropriate payments. Passport has operated in the Louisville region for a number of years and are not part of the criticism.

Frankfort Local News

Lawmakers Take Medicaid MCOs to Task for Not Solving Pharmacy, Mental Health Care Issues

Kentucky lawmakers continue to chastise three of the state’s Medicaid Managed Care organizations for mismanagement.

Representatives of Kentucky Spirit, Wellcare of Kentucky and Coventry Cares appeared before the program review committee today. Legislators wanted to know whether they had solved problems brought up by health care providers in a January committee meeting.

The MCOs all said the problems were mostly solved and that operations were improving every day. But independent pharmacists and mental health care providers disagreed.

The pharmacists say things have only regressed since that first committee meeting. That didn’t please committee co-chair Representative Fitz Steele.

Frankfort Local News

Managed Care Executives Say They’ve Fixed Problems With Payments

Officials with Kentucky’s Medicaid managed care organizations say they’re on track to resolve any problems with reimbursements to doctors and pharmacists.

CoventryCares, WellCare and Kentucky Spirit began administering Medicaid statewide last fall, and they’re off to a rocky start. Executives with the three organizations are in Frankfort this week for a series of committee hearings. Doctors, hospitals and other health care providers spent previous weeks telling lawmakers horror stories about working with the MCOs. One such story included a pre-authorization to deliver a baby that didn’t come through until weeks after the child was born.

CoventryCares Vice President Kevin Conlin told the committee his company’s payment backlog will be cleared by Friday, and the other issues are nearly resolved.

“We accept accountability for the fact that we contributed to some of the issues that providers are facing,” he said. “I trust you can see we’ve taken this seriously, we’re bringing significant resources to improve this and I’m encouraged we’re seeing some early success.”

Local News

Managed Care Operators Struggle Early, Kentucky Spirit Loses Members

With reporting from Kentucky Public Radio’s Capitol Reporter Kenny Colston.

Since taking over a portion of Kentucky’s Medicaid system, Managed Care Organization (MCO) Kentucky Spirit Health Plan has lost nearly 70,000 members while some healthcare professionals are questioning whether the three new private operators can handle the state’s Medicaid program.

Kentucky Spirit, CoventryCares and WellCare took over Medicaid management last year. Since then, all three have been criticized for delaying payments to doctors and pharmacists. But Coventry Cares and WellCare have slowly increased membership since Nov.1. Kentucky Spirit has dropped from 217,000 members to nearly 140,000.

Frankfort Local News

Beshear Confident Medicaid Managed Care Problems Will Be Resolved

Governor Steve Beshear says the problems with Kentucky’s new Medicaid Managed Care system will be resolved.

Beshear pushed for the managed care system last year to take some of the administrative burden of Medicaid off of the state. But earlier this week, doctors, pharmacists and hospital officials told lawmakers there were significant problems with the system. Specifically, care providers are owed millions of dollars in claim payments and have struggled to get pre-authorizations for procedures and medications.

But the governor isn’t surprised to hear about the problems.

“Look at when Passport first came online you’ll see all of the news reports and their the same problems and same kinds of problems we’re having today. Now that doesn’t mean we ought not to be addressing those problems. And we are being very aggressive from the Cabinet stand point and from my administration’s standpoint in looking at each one of those issues and resolving those issues,” he says. “I’m confident that we’re going to work through all of these issues,” Beshear says.

Frankfort Local News

Medicaid Providers Complain of Managed Care Mismanagement

Kentucky’s private Medicaid providers say they need immediate changes in the state Medicaid system. Kentucky turned the system over to managed care providers four months ago. And today doctors, pharmacists and hospital executives told a Senate committee how disastrous the change has been.

Kentucky currently contracts with four Managed Care Organizations, known as MCOs. Passport is based in Louisville, while Kentucky Spirit, WellCare and Coventry Cares operate statewide.

The providers say the three statewide MCOs are mismanaged and ineffective. They say their claims aren’t reimbursed on time, and the MCOs aren’t consistent about pre-authorizing treatments and medication.

Shawn Jones is a doctor in Paducah and the president of the Kentucky Medical Association. He says the pre-authorization system needs to be overhauled.

“This bureaucratic nightmare needs to change,” Jones said. “First the MCOs need to pare down the number of procedures and treatments that require pre-authorization. Second, they need more uniform and timely processes to review the pre-authorization requests, and thirdly some sort of appeals process should be established.”