Medicaid Regulations No Match for Rural Roads

 

The dispute between an Eastern Kentucky hospital chain and private Medicaid operators has lawyers arguing distance versus drive time. Under state regulations, a private Medicaid operator cannot sign up a patient unless it has a doctor or hospital within 60 miles of that patient’s home. But that distance is measured as the crow flies and the state doesn’t take into account narrow and winding Appalachian roads. For many patients, it may be faster to visit a doctor that’s 70 miles away than it is to visit one that’s 50 miles away.That’s prompted the Appalachian Regional Healthcare hospital chain to argue against the 60-mile rule.

ARH says it has hospitals that are easier to get to for Eastern Kentucky patients, therefore no private operator could have a proper healthcare network without a contract with ARH. The state and private operators disagree.

“I think they do realize there is an issue there it’s just a question of how’s that’s been interpreted,” says Anne Hadreas with the Kentucky Equal Justice Center.

State regulations also say providers within a one-hour drive are in a patient’s network, but Hardreas says that isn’t often enforced.

“It definitely puts more of a burden on the consumer and we’re talking about Medicaid patients here who are by definition are low income and it means that they will have to travel farther to get the same amount of care,” she says.

Denton Has Concerns About More Private Medicaid Operators in Louisville

by Kenny Colston on May 10, 2012

The problems with privatized Medicaid in Eastern and Western Kentucky could be coming to Louisville.

Passport Health Plan has run Medicaid in Louisville and the surrounding area for more than a decade. The system was the model for last year’s Medicaid privatization, which brought three new Medicaid management companies into the state.

The federal government has ordered the state to open the Passport region to competition by next year. But Medicaid privatization isn’t working too well in the rest of the state. Hospital officials claim two of the private companies aren’t paying enough to reimburse Medicaid-covered care. The private operators say they are only adhering to their contracts with the state.

“Let’s make sure we have a plan,” says Senate Health and Welfare Committee Chairwoman Julie Denton. “If we are going to be bidding out with the Passport region for next year, starting January 1st, the Cabinet sure as heck better be working on an RFP and putting it together in a more thoughtful and steady fashion than they did the Medicaid managed care RFP for last year.”

The state has until July 1 to tell the federal government its plan to open Louisville to competition. But the Cabinet for Health and Family Services hasn’t yet begun work on the plan.

The current three statewide operators all have offices in Louisville, making them obviously competition partners for the region. But Denton says she’s not sure bringing those three in is a good idea.

“I don’t think they can just take three bids from the three MCOs and open those up and let those three MCOs in. And frankly with the way Coventry has been working thus far, I have no interest in letting them into the Passport region,” she says.

Currently, many healthcare systems are having contract issues with CoventryCares, one of the three new statewide MCOs. Coventry officials say they need more operating money and the company is looking to providers and patients to recoup profits.  That has led to lawsuits and threats from lawmakers that Coventry could be barred from operating in the commonwealth.

Medicaid Fraud Bill Introduced

Medicaid Fraud Doesn’t Pay, Yet

A bill that would allow Kentucky to collect money from Medicaid fraud busts has again been introduced in Frankfort. House Speaker Greg Stumbo filed the bill, which would also protect and possibly reward whistle blowers who report fraud in Medicaid or any other areas of state government. Stumbo says the bill is needed to help Kentucky get money that usually ends up in federal coffers.

“It’s a choice of revenues, state or federal, the states that don’t have a state law don’t have the option to get any of that forfeiture money or penalty money,” Stumbo says.

The bill passed the House last year. The Senate passed a similar bill that only dealt with Medicaid fraud, but the two sides couldn’t come together for a compromise.

Stumbo says he thinks some form of legislation that deals with fraud revenues will pass both chambers this year.