Glasgow Daily Times, Glasgow, KY

February 16, 2012

Medicaid managed care groups reassure committee

By RONNIE ELLIS
CNHI

FRANKFORT — Medicaid managed care organizations went before a restive Senate committee whose members have been bombarded with complaints from providers about late payments for Medicaid services.

But, for the most part, representatives of WellCare, Coventry HealthCare and Kentucky Spirit seemed to calm the waters. They acknowledged a lot of problems in the early implementation of managed care but assure the committee they are on their way to resolving most of them.

Those three companies won contracts from the state to implement managed care services outside the Louisville region for Medicaid patients on a per-patient contracted fee basis rather than by payment for each individual procedure or service. But they now are responsible for making those payments to providers who say they aren’t receiving prompt reimbursement and complain they can’t get pre-authorization for some services.

Kevin Conlin, executive vice-president of Coventry HealthCare, acknowledged there have been problems but said they are being resolved. The company has brought in extra personnel to help get claims payments on schedule and has made advance payments in some cases to help providers manage their cash flow, he said.

The company should “be on track” with payments by the end of the week, Conlin said.

Conlin and Mike Minor of WellCare said, however, some of the problems were not of their making. Some providers use third-party administrators to submit claims and some claims were halted at that level before they were submitted to the managed care organizations, they said. Additionally, there have some problems with duplicate billing for the same procedures.

“Many providers think they’ve made claims and haven’t been paid,” Minor said, “when Kentucky Spirit has not actually received those claims.”

Other problems, Minor said, included duplicate claims and claims on behalf of patients who were not Medicaid eligible or enrolled on the date of the service.

Two areas which remain problematic are behavioral treatment services and hospice services. In the first case, cost savings measures result in rejection of claims for in-patient clients who no longer need those intensive services but aren’t ready to go home without some treatment. So called “step-down” services aren’t available in many parts of the state and providers are faced with the choice of keeping the patient without reimbursement or discharging him when the patient is likely to return without some services.

Acting Medicaid Commissioner Neville Wise said that before managed care implementation, the state simply paid to keep those patients in the hospital. He said this staff is working with the MCO’s to find “innovative” solutions but had no specifics to offer lawmakers.

Sen. David Givens, R-Greenville, and Committee Chair Sen. Julie Denton, R-Louisville, chastised Wise for what they see as an abundance of patience with the MCOs dealing with the problems.

“At what point are you going to say enough is enough?” Denton asked. Wise said the Department of Medicaid Services had “to some extent” already reached that point, having conducted on-site reviews during the past three weeks. But he also said the problem is difficult, the state is working with the MCOs to resolve it.

Sen. Tom Buford, R-Nicholasville, sized up the problem for the MCOs. He said lawmakers are hearing lots of complaints and “it takes a lot of time” to run down answers. He wants the MCOs to fix those problems before lawmakers hear about them.

“Please make it stop,” Buford asked.

Denton said much of the problem was caused by the quick implementation schedule, something she and other Republican lawmakers criticized when Gov. Steve Beshear’s administration announced plans for managed care of Medicaid.

“We all know it was a quick turnaround and really pushed the envelope,” Denton said. But she said it appears much of the dissatisfaction of providers “is settling down.” She said, however, concerns remain about payments to pharmacies and problems with pre-authorizations for some services.

Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at rellis@cnhi.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.