The Richmond Register

Local News

April 5, 2013

Beshear vetoes Medicaid dispute resolution bill

FRANKFORT — Gov. Steve Beshear announced Friday he had vetoed a bill to expedite disputes between Medicaid managed care companies and providers over prompt payment of claims.

However, he will implement a plan to comply with the intent of the bill.

House Bill 5, sponsored by Speaker Greg Stumbo, D-Prestonsburg, would require such disputes to be resolved by the Department of Insurance rather than the Department of Medicaid Services.

Beshear said other language in the bill was “expanding the reviews by DOI beyond the prompt pay disputes” and might conflict with contracts signed by the managed care companies (MCOs) and providers.

But Beshear said he “understands and appreciate the intent behind the bill” and agreed complaints about prompt payment need to be addressed.

“While we must address the prompt-pay issue,” Beshear said, “we must also address the resistance by some providers and patients to the change in culture that is required” by managed care.

So, while he vetoed the bill, the governor said he will implement the main intent of House Bill 5 by giving the Department of Insurance the authority to resolve the prompt payment disputes. DOI already provides such a process for private insurers.

Other parts of Beshear’s five-point plan will convene meetings between the three MCOs and hospitals to go over disputed accounts, the results of which Beshear said will be made public, and DOI will conduct targeted audits of the MCOs by August.

On top of that, the state will conduct education forums for the MCOs and medical providers and physicians from the University of Kentucky and University of Louisville will consult with hospitals to improve emergency room use.

In November 2011, the state moved most of its Medicaid patients to managed care delivered by three MCOs: Kentucky Spirit, Coventry and WellCare (a fourth, Passport, was already serving the Jefferson County region with few complaints).

Prior to that, providers were paid on a fee-for-service basis for each individual medical procedure or test. That drove up costs. Under managed care, the MCOs are paid a per-capita amount to provide care for patient-clients and negotiate contracts with providers to provide medical care to those clients.

Almost immediately providers such as hospitals complained to lawmakers that the MCOs were delaying payments for services for months and threatening providers’ cash flow and in some cases even their solvency.

That produced an outcry from lawmakers and prompted Stumbo’s bill, which passed both chambers of the General Assembly without a dissenting vote.

Stumbo issued a statement after Beshear’s announcement saying the unanimity of lawmakers’ votes “shows that a real problem exists.”

He said he was pleased Beshear had directed DOI and the Cabinet for Health and Family Services, which houses Medicaid, to correct the problems, calling it “a great positive effect.”

But, said Stumbo, “We will continue to monitor the situation and every lawmaker will talk with their local providers to see if the new approach is working.”

Senate President Robert Stivers, R-Manchester, said the Senate is committed to helping Beshear solve the problems.

“It is well known that the state needs to get the kinks out of the implementation of managed care,” said Stivers in a statement released through his press office. “Payment for providers needs to be addressed because they offer the health care we need.”

Michael Rust, President of the Kentucky Hospital Association, said hospitals would have preferred Beshear sign the bill, but he called the alternative plan to move disputes to DOI a “positive step.”

He also said hospitals realize manage care is “here to stay.”

That was part of Beshear’s message. He began his press conference by saying managed care is necessary to provide better and preventive care for patients at a reasonable cost to the state.

“Kentucky is not now and not ever returning to the obsolete, costly and unfettered fee-for-service model,” he said.

Beshear showed reporters several charts showing managed care has reduced costs and provided better care. Since implementation of managed care, costly emergency room visits are down, far more preventive services have been delivered and immunizations and other preventive procedures are up while overall costs are down.

He also displayed charts indicating hospitals were showing millions more in unpaid claims than they ever expected to be paid. Beshear compared it to the amount on a hospital bill versus the amount the hospital had agreed to accept from a private insurer.

In one case, a hospital had billed more than $15 million — the amount it said hadn’t been addressed by the MCOs — but in fact never expected payment of more than just a little over $5 million. And of that, $2.1 million had actually been paid to the hospital and another $1.8 million in claims had never been filed.

Another example Beshear provided: under managed care, emergency rooms are paid a $50 “triage fee” for patients who come to the emergency room but do not require emergency care. But out of 643,839 emergency room claims by hospitals in the past year, only one was for the triage fee.

Rust said he didn’t have any specific data on that but said hospitals are required by federal law to screen such patients for serious medical problems. A patient may say he has a headache but hospitals must do expensive tests to ensure it’s not caused by serious conditions such as an aneurism.

“If (the tests indicate) the patient only has a headache and just needs a couple of Excedrin, the hospital gets $50,” Rust said. “But they are running up several thousand dollars’ worth of charges which we feel we should get paid for.”

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
  • May 30 last school day for students

    After 16 snows days and two weather delays this winter, the Madison County School Board decided Thursday to end the school year on Friday, May 30.

    April 19, 2014

  • 4-19 TechExtra1.jpg Students showcase projects in Technology Extravaganza

    Madison County School students showed off just how tech savvy they can be during the district’s sixth annual Technology Extravaganza on Thursday at Madison Central High School. After the showcase, more than 350 students were honored for their work.

    April 19, 2014 7 Photos

  • 4-19 SchoolBoardJesseWard.jpg Ward honored for service; tech center named after him

    Retired Madison County educator Jesse Ward was recognized Thursday for his many years of service. To honor him, Superintendent Elmer Thomas announced the board’s decision to rename the district’s technology training center on North Second Street in Richmond the Jesse P. Ward Technology and Training Center.

    April 19, 2014 1 Photo

  • 4-19 Brian Smith.jpg Berea man indicted on 24 child porn counts

    A Madison grand jury has indicted a Berea man on 24 counts related to child pornography.

    Brian J. Smith, 26, is charged with four counts of distribution and 20 counts of possession of matter portraying sexual performances by a minor.

    April 19, 2014 1 Photo

  • 4-19 Gregory Powell.jpg Police apprehend burglary suspect

    An observant witness was able to help Richmond police catch a burglary suspect shortly after a break-in Thursday afternoon on Savanna Drive off Berea Road.

    April 19, 2014 1 Photo

  • 4-18 PackTrack1a.jpg Walkers, runners of every age ‘Pack the Track’

    Waco Elementary and Model Laboratory schools students raised more than $8,000 (and counting) for the annual Pack the Track event at Eastern Kentucky University’s Tom Samuels Track Thursday, said Kim DeCoste of the Madison County Diabetes Coalition.

    April 18, 2014 14 Photos

  • 4-18 George WilliamsWEB.jpg Suicide attempt fatal for inmate

    A Todd County man died Tuesday at a Lexington hospital following a suicide attempt at the Madison County Detention Center, according to Madison and Fayette county officials.
    George Kenneth Williams, 50, of Allensville, was transported Monday afternoon by Madison County EMS to Baptist Health Richmond, according to EMS Director Jimmy Cornelison. He was then transferred to Baptist Health in Lexington where he died Tuesday, according to the Fayette County Coroner’s Office.

    April 17, 2014 1 Photo

  • CCDW instructor indicted on charges of failing to provide training

    A Madison County grand jury has indicted a carry-concealed weapons permit instructor on charges he falsely claimed to have provided instruction to one person for a CCDW permit and provided incomplete training to three others.
    Christopher D. Fins was indicted April 9 on one count of CCDW instructor not providing firearms training and three counts of providing incomplete firearms training.
    Fins faces up to 20 years in prison if convicted of all four felony charges.

    April 17, 2014

  • EKU dorm sprinklers may have been activated maliciously

    Fire-suppression sprinklers went off about 2:30 a.m. Thursday in Eastern Kentucky University’s Martin Hall dormitory, prompting its evacuation.
    Fluctuating pressure then caused a campus water main to break, according to EKU spokesperson Mark Whitt.
    The cause is uncertain, but university officials are investigating to determine if the sprinklers were activated maliciously, Whitt said.
    The residence hall houses 260 students who were placed in other university housing or stayed with friends. All were able to move back in later in the day, he said.

    April 17, 2014

  • Sixth person charged in motel meth bust

    A sixth person has been charged in connection with a methamphetamine-making operation discovered last week at the Bel Air Motel in Richmond.
    Roger M. Million, 24, Moberly Road, was charged Wednesday with manufacturing methamphetamine.

    April 17, 2014

AP Video
Captain of Sunken SKorean Ferry Arrested Raw: Fire Destroys 3 N.J. Beachfront Homes Raw: Pope Presides Over Good Friday Mass Raw: Space X Launches to Space Station Superheroes Descend on Capitol Mall Man Charged in Kansas City Highway Shootings Obama Awards Navy Football Trophy Anti-semitic Leaflets Posted in Eastern Ukraine Raw: Magnitude-7.2 Earthquake Shakes Mexico City Ceremony at MIT Remembers One of Boston's Finest Raw: Students Hurt in Colo. School Bus Crash Raw: Church Tries for Record With Chalk Jesus Raw: Faithful Celebrate Good Friday Worldwide Deadly Avalanche Sweeps Slopes of Mount Everest Police Arrest Suspect in Highway Shootings Drought Concerns May Hurt Lake Tourism Vermont Goat Meat Gives Refugees Taste of Home Calif. Investigators Re-construct Fatal Bus Cras Mayor Rob Ford Launches Re-election Campaign Appellate Court Hears Okla. Gay Marriage Case
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