Kentucky: Managed care plans switch terms

Sunday, October 30, 2011

FRANKFORT, Ky. - HME providers here are none-too-happy with the terms of new state managed care contracts, which they say pay as much as 30% less than what was originally agreed upon.

Kentucky planned to implement a managed care program for all Medicaid beneficiaries Nov. 1. Three managed care organizations (MCOs), WellCare, Kentucky Spirit and Coventry Care, will administer the plans. Cover letters were sent to providers this summer, stating that DME providers would be paid at 100% of the current Medicaid fee schedule. However, when the actual contracts arrived, only WellCare said it would pay 100%. Coventry Cares offered 85%; Kentucky Spirit offered 70%.

"Providers are enrolling in these networks because the cover letters said 100%," said Teresa Camfield, executive director of the Kentucky Medical Equipment Suppliers Association. "When the contract comes back, it has the lower rate."

The lower Medicaid rates mirror private-insurance contracts that the MCOs currently have with some HME providers, said Camfield.

Providers can absorb low payment rates when there's only a handful of patients affected, she said, but when you are talking about a larger patient population--like Medicaid--it's a different story.

"They can't accept 70% and provide 24/7 care," said Camfield.

Adding insult to injury: With three separate MCOs, providers will have triple the work when it comes to Medicaid patients, said provider Alan Grogan.

"All the contracts are different, each has a different fee schedule, and there may well be different processes for each," said Grogan, president of Grogan's Healthcare Supply in Lexington. "We've been in contact with the Medicaid liaison. There's still a lot of unanswered questions."