Health News
- State And Companies Were Unprepared For Quick Move To Managed Care, State Auditor Concludes
Kentucky officials and the companies in charge were unprepared for the switch to Medicaid managed care, State Auditor Adam Edelen said Wednesday. He sent the Cabinet for Health and Family Services 10 recommendations to improve the system, which provides...
- Managed-care Executives Acknowledge Problems, Say They're Trying To Fix Them
Executives of three managed-care companies who run most of the state's Medicaid program told a legislative committee yesterday that they are aware of "significant problems" with their management since they took over in November, and they are "committed...
- Legislators Hear From New Managed-care Firms; Lawmaker Rates Their Performance With A Show Of Hands From Pharmacists
Kentucky Health News The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One...
- More Complaints Lodged About Medicaid Managed Care; Lawmakers Demand Answers
Complaints continue to pile up about the state's new Medicaid managed care plans, which cover about 560,000 Kentuckians. Lawmakers are hearing gripes from providers who say they are not getting paid, and from patients and clinics who say the three...
- Home-health Industry Is The Latest To Complain About Late Payments Since State Switched To Managed-care Medicaid
Kentucky's new Medicaid managed-care system is three months late in making payments to home-health agencies, officials told the House Health and Welfare Committee Thursday. Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000,...
Health News
Responding to complaints about new managed-care companies, state auditor asks for claims data; lawmakers threaten subpoena
With complaints piling up about the three Medicaid managed-care companies that coordinate care for 560,000 poor and disabled Kentuckians, lawmakers and officials are taking action to get to the bottom of the situation.
After health providers complained reimbursements have been wrongly rejected, delayed or ignored, state Auditor Adam Edelen asked to see the companies' claims-processing data, reports Deborah Yetter of The Courier-Journal. Legislators are threatening to subpoena the companies "after the state's 550 small pharmacists complained that they're being pushed out of business by the companies' low Medicaid reimbursements," Yetter and Mike Wynn report for the C-J. (C-J photo: Pharmacist Mac Bray at Capital Pharmacy in Frankfort)
Some providers said they are having to borrow money to offset the shortage until the claims are reimbursed. Others are worried they will go out of business because they can't afford to wait for claims to be paid.
Audit: Edelen told CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky he wants the claims data by Feb. 17. He also asked for information from Passport Health Plan, which has long coordinated care for 170,000 Kentuckians in the Louisville area. No complaints have been voiced about Passport, but an Edelen spokeswoman said they want to get information to paint "a complete picture."
The move to managed care was the Beshear administration's answer to fill a hole in the Medicaid budget, but lawmakers have complained the transition has been bumpy. "They never know when they are going to get paid," said Sen. Joey Pendleton, D-Hopkinsville. "I can see why it saves money ? if you don't pay your bills, you have more money." (Read more)
Pharmacies: The House-Senate Program Review Committee has asked officials from the three companies to appear Feb. 13 to answer questions. If the committee doesn't get the information it seeks, it will issue subpoenas. "This is a drastic measure, but they are putting our independent pharmacists out of business," said Sen. Jimmy Higdon, a Lebanon Republican who co-chairs the committee. "You can't see things for less than they cost and stay in business."
With traditional Medicaid, "pharmacists were paid a dispensing fee of $4.50 to $5, plus the cost of medication, based on an industry formula called the maximum allowable cost," Yetter and Wynn report. "But two of the three companies under contract with the state have cut the dispensing fee to $1 to $3. And pharmacists say that under managed care, the maximum allowable payments don't cover their costs of buying the drugs from the wholesaler."
The committee has not used its power to issue subpoenas in more than 10 years, Higdon said. (Read more)
- State And Companies Were Unprepared For Quick Move To Managed Care, State Auditor Concludes
Kentucky officials and the companies in charge were unprepared for the switch to Medicaid managed care, State Auditor Adam Edelen said Wednesday. He sent the Cabinet for Health and Family Services 10 recommendations to improve the system, which provides...
- Managed-care Executives Acknowledge Problems, Say They're Trying To Fix Them
Executives of three managed-care companies who run most of the state's Medicaid program told a legislative committee yesterday that they are aware of "significant problems" with their management since they took over in November, and they are "committed...
- Legislators Hear From New Managed-care Firms; Lawmaker Rates Their Performance With A Show Of Hands From Pharmacists
Kentucky Health News The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One...
- More Complaints Lodged About Medicaid Managed Care; Lawmakers Demand Answers
Complaints continue to pile up about the state's new Medicaid managed care plans, which cover about 560,000 Kentuckians. Lawmakers are hearing gripes from providers who say they are not getting paid, and from patients and clinics who say the three...
- Home-health Industry Is The Latest To Complain About Late Payments Since State Switched To Managed-care Medicaid
Kentucky's new Medicaid managed-care system is three months late in making payments to home-health agencies, officials told the House Health and Welfare Committee Thursday. Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000,...