April 17, 2013 —
We’re trying to understand why Gov. Steve Beshear believes he is smarter than all 138 members of the General Assembly when it comes to Medicaid.
That must be how he feels because two weeks ago he vetoed House Bill 5, the “prompt pay” bill that had been unanimously approved by all members of the House and Senate.
The bill was aimed a forcing the state’s three managed care organizations (MCOs) to make timely payments to health care providers who treat Medicaid patients.
Beshear patronized the lawmakers for their good intentions but claimed the bill could have unintended legal consequences.
That is state government doublespeak for his administration does want to take any chances on disrupting the new MCO bureaucracy created a few years ago to save millions of dollars in a budget-balancing scenario.
It likely means that officials of the MCOs – Wellcare, Coventry, and Kentucky Spirit – are threatening either to sue or walk away from the Medicaid program.
Instead of signing the bill, our governor outlined what he calls an “aggressive, sharply focused” plan for clearing up billing disputes that have plagued the MCO operation from the first day and other issues involving managed care.
First, Beshear is directing the Kentucky Department of Insurance (DOI) to review and investigate MCO payment complaints, something DOI already does for private health insurance.
Next, the three MCOs must meet with each hospital in the state to resolve existing accounts receivable.
That will be especially interesting in the areas where local hospitals already have sued MCOs for not paying their bills.
Also, the Department of Insurance will conduct “targeted audits” of each MCO to determine if the company’s procedures are OK for handling complaints, prior authorization for treatment and emergency medical service payments.
The final piece of the Beshear plan is to have the Cabinet for Health and Family Services (CHFS) conduct public “educational forums on best practices” in each of the eight Medicaid regions.
MCOs and health care providers will be invited to share their views and DOI will be there to serve as referee, apparently.
One main objective of the forums will be to decide how best to keep emergency rooms from becoming primary care clinics.
Kentucky is among 47 states using managed care for Medicaid clients. CHFS claims patients are getting healthier and that the change has saved “hundreds of millions” of dollars.
Hopefully, all of that is true. Now all the MCOs have to do is to figure out is how to pay their bills on time.