The Richmond Register

Local News

December 11, 2012

State lawmakers grill Medicaid commissioner over late payments

FRANKFORT — It was almost a tale with two versions.

Kentucky’s Commissioner of Medicaid Services, Lawrence Kissner, seemed pleased to tell the Interim Joint Committee on Health and Welfare how well the state’s move to managed care for most Medicaid patients is progressing.

But Committee Chair Sen. Julie Denton, R-Louisville, and some other lawmakers wanted Kissner to explain why the managed care organizations are so slow in paying providers, especially hospitals who the lawmakers say suffer from long overdue bills to the MCOs.

“The reality is the providers aren’t getting paid,” Sen. Joe Bowen, R-Owensboro, told Kissner. “Their accounts payable are mounting and it’s creating a hardship for all of them, large and small.”

Hospitals and other providers, including local health departments, have complained for months that Kentucky Spirit, Coventry Cares and Wellcare, the three companies serving Medicaid patients outside the Louisville area, are slow to reimburse for services or frequently disallow services.

(Kentucky Spirit has said it will leave Kentucky because it has found serving its members is more expensive than data provided by the state indicated when it contracted to perform services. Kissner said Tuesday the MCO has not yet left, and he anticipates litigation involving the company.)

Kissner told the committee that the state Department of Insurance has found two of the three – Kentucky Spirit and Wellcare – have indeed been slow to make payments and ordered the two to adopt corrective action plans.

Kissner said the cabinet is “actively facilitating meetings (between MCOs and providers) and we have mediated on their behalf.”

Rep. John Will Stacy, D-West Liberty, who owns two pharmacies and who has been critical of the MCOs, said he believes “a correction action plan would be to send (providers) a check.”

“They can’t go for months without being paid or you’re not going to have any providers,” Stacy told Kissner.

The commissioner said the cabinet evaluates the adequacy of coverage for Medicaid patients in each region on a monthly basis.

Denton then asked Kissner what the cabinet intends to do to ensure MCO’s pay reimbursements promptly and to address hospitals’ cost problems when federal law requires them to treat anyone who shows at emergency rooms but whose health problems the MCOs frequently deny as non-emergency.

“Is there a particular reason that you are letting them get away with murder?” Denton asked.

Kissner said the cabinet is following the procedures set forth in statute, that it follows the timelines established by law. He conceded that timeline can take months.

Before the grilling began over late payments, Kissner painted a generally favorable picture of the implementation of managed care which is supposed to save the state about $1.3 billion in Medicaid costs.

“We are on track and under budget,” through five months of the fiscal year, Kissner said. He said he cannot predict the impact the potential departure of Kentucky Spirit on that budget and hinting the state may attempt to hold the company to its contract.

“I think it’s going to become a significant legal issue,” Kissner explained. “They haven’t left yet.”

Kissner showed the committee charts showing the costs for prescription drugs and the number of emergency room admissions have declined since managed care was implemented. The number of patients who show up at emergency rooms multiple times during one month has also declined.

He said he sees no significant problems with implementation of competitive managed care for the Region 3 Louisville area.

That 15-county region was previously served exclusively by Passport for years, but the federal government last year required other MCOs be allowed to compete for contracts in the region.

In addition to Passport three other MCOs – Coventry, Wellcare and Humana – successfully bid to serve the region. Kissner said Coventry, Wellcare and Humana each will get just less than 19 percent of the clients while Passport will serve about 44 percent.

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.

1
Text Only
Local News
  • 4-17 Melissa Lear.jpg BPD charge two in Richmond heroin-trafficking case

    Berea police arrested two women April 10 in a Richmond home in connection with heroin possession and trafficking.

    April 16, 2014 1 Photo

  • 4-17 MuseVisit4.jpg Theater students hear actor, Berea alum Muse Watson

    “I killed about eight or nine kids, about your age,” actor Muse Watson joked as a room full of high schoolers erupted in laughter Wednesday at Madison Southern High School.

    April 16, 2014 2 Photos

  • Legislature passes road-spending plan

    Kentucky House and Senate lawmakers agreed Tuesday to a $4.1 billion road-spending plan on the legislature’s final day, avoiding an expensive special session.
    The plan includes $5.2 billion worth of projects throughout the state. But as much as 25 percent of that money will not be spent. Lawmakers said they would like to include a cushion in case some projects are delayed because of environmental concerns or problems acquiring land.

    April 16, 2014

  • 4-16 CMMShealthfair5.jpg Health fairs cover contemporary teenage topics

    Berea Community High School health students coordinated their first all-day health fair in November that was catered to elementary students.

    But their spring fair Monday handled more mature issues that targeted the middle and high school crowd, said health teacher Cathy Jones.

    April 16, 2014 13 Photos

  • 4-16 Lisa Begley.jpg Police: Woman drove through storage business gate

    Richmond police arrested a Lexington woman Monday night after the property manager at Main Street Storage said she repeatedly drove her vehicle into a gate and fence at the 455 E. Main St. business.

    April 16, 2014 1 Photo

  • Local jobless rate for 2013 same as 2012

    Madison was one of 12 Kentucky counties with a 2013 jobless rate unchanged from the previous year, according to statistics released Tuesday.

    Still, only four counties – Woodford, 6.1; Fayette and Oldham, 6.5; and Scott, 6.7 – had jobless rates better than Madison’s 6.8 percent.

    April 16, 2014

  • Danville officials table fairness ordinance

    City officials in Danville have tabled an anti-discrimination proposal.
    The Advocate-Messenger reports that the move on Monday came after questions were raised about its legality and suggestions were made for changes.

    April 15, 2014

  • Grimes outpaces McConnell in first quarter

    Democratic U.S. Senate candidate Alison Lundergan Grimes has again outpaced her likely Republican general election opponent, incumbent Mitch McConnell, in fundraising during the first quarter — but she remains well behind McConnell in total fundraising and cash on hand.

    April 15, 2014

  • $250,000 wrecker stolen

    A representative of Barger’s Wrecking Service, North Porter Drive, reported to Richmond police Sunday that a black, 1996 Peterbilt wrecker with company logos on it was stolen from the business’ parking lot. The wrecker is valued at $250,000, according to the police report.

    April 15, 2014

  • Owner requests business zoning for corner of West Main and Tates Creek

    The owner of three lots at the corner of West Main Street and Tates Creek Avenue wants the property rezoned from R-1B (Single-family Residential) to B-1 (Neighborhood Business).

    April 14, 2014

AP Video
Hyperlocal Search
Premier Guide
Find a business

Walking Fingers
Maps, Menus, Store hours, Coupons, and more...
Premier Guide
Poll

Should the Richmond City Commission stop rezoning property to allow construction of apartments?

Yes.
No
     View Results