Kentucky advertises for Medicaid insurance proposals in Passport area

Kentucky advertises for Medicaid insurance proposals in Passport area

4:03 PM, Jun 20, 2012   |  
Tom Loftus
The Courier-Journal
FRANKFORT, KY. — Kentucky began the process this week of contracting with multiple companies to provide Medicaid services in the region that for the past 15 years has been served exclusively by Passport Health Plan.

On Tuesday the state began advertising for proposals from insurance companies to provide “managed care” services for Medicaid in Jefferson and 15 surrounding counties.

Bidders have until July 24 to respond.

Jill Midkiff, spokeswoman for the Kentucky Cabinet for Health and Family Services, said the state intends to select at least two companies that will begin providing Medicaid services in the region beginning Jan. 1.

Last year federal officials decided Medicaid beneficiaries in the region must be given a choice of managed care organizations. They did not extend beyond this year a waiver that has allowed Passport to be the exclusive Medicaid provider in the region.

That action came amid Kentucky’s decision last year to contract with three companies that now compete to manage health care for Medicaid recipients in Kentucky’s other 104 counties.

Mark Carter, chief executive of Passport, said it will bid to continue serving the region.

“With the track record we have, we think we’ll be able to make a very competitive proposal,” Carter said.

Because the transition to managed care in the rest of the state has been marked with complaints by providers and patients alike, some are concerned about what the pending change will mean for the 171,000 Medicaid beneficiaries in the region.

“We don’t feel that having multiple managed care contracts really supports the efforts of quality improvement and member satisfaction over time,” said Jodi Mitchell, of Kentucky Voices for Health, a health-care advocacy coalition.

Mitchell said that the federal government’s requirement of choice of managed care organizations may result in less choice of providers for Medicaid beneficiaries.

Currently a Medicaid beneficiary in the region can go to any provider because all work with Passport. “I’m not so sure that will be the same situation when you bring these for-profit companies in,” Mitchell said.

Passport was sharply criticized in late 2010 in a report by then-Auditor Crit Luallen that revealed wasteful spending and improper transfers of profits to the provider groups represented on its board. Passport responded by instituting reforms, restructuring its board and replacing all of its executives with a new team headed by Carter.

Reporter Tom Loftus can be reached at (502) 875-5136.

ARH Seeks Action Against Coventry Cares

LEXINGTON, KY. — Appalachian Regional Healthcare argued for a federal injunction against Medicaid contractor Coventry Cares on Tuesday as negotiations for a new agreement between the two have stalled.

The existing contract between ARH and Coventry, one of Kentucky’s three new Medicaid managed-care organizations, is set to expire on June 30, and weeks of negotiations have proven fruitless.

ARH is asking the U.S. District Court to allow thousands of patients in southeastern Kentucky to switch Medicaid contractors en mass or provide an open enrollment period for patients to change companies one at a time.

“We are just trying to make sure we can continue to provide services to Medicaid beneficiaries in that region as we have for 50 years,” said ARH attorney Steve Price.

Eastern District Judge J. Owen Forrester heard five hours of testimony Tuesday.

Witnesses for ARH testified that Coventry will no longer provide an adequate network of hospitals and doctors if a contract is not renewed with ARH, which operates eight hospitals and additional clinics in the area.

But Coventry and the state Cabinet for Health and Family Services dispute those claims and called witnesses to defend Coventry’s network of health care providers.

“Coventry remains committed to doing what is right by its members,” said Stephen Amato, an attorney for the firm. “Coventry is going to keep a strong, robust set of providers in that region, with or without ARH.”

Much of Tuesday’s hearing focused on the distance that Medicaid patients will have to drive if Coventry stops paying for services at ARH facilities.

The state requires that Medicaid networks maintain hospital services within a one-hour drive for patients in rural areas.

ARH witnesses argued that Coventry used faulty measurements to gauge drive time and thousands across the region will face a longer commute, particularly for obstetrician care. Price said 10 areas will not have a sufficient number of providers.

“That’s a hole in the region that’s as big as the hole that sank the Titanic,” Price said. “You ought to let passengers off before the boat sinks.”

But attorneys and witnesses for Coventry countered that ARH is undercounting hospitals in the network. According to testimony, 550 providers operate at 600 locations in the region, and Coventry says it will still pay for patient care at ARH at a lower, out-of-network rate.

Forrester asked the attorneys to submit additional briefs by Thursday, but did not indicate when he might make a decision.