Home-health industry is the latest to complain about late payments since state switched to managed-care Medicaid

Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000, Jeannie Lemaster, chief compliance officer, told lawmakers. “Kip Bowmar, executive director of the Kentucky Home Health Association, said only 8 percent of the claims from the approximately 150 home-health agencies have been paid since the switch to managed care Nov. 1,” reports Beth Musgrave of the Lexington Herald-Leader.

“If these problems don’t get corrected, there is a likelihood that some agencies could go out of business,” Bowmar said.

Therapists who work with abused, neglected and at-risk children have likewise told lawmakers of back payments. Independent pharmacists have said “reimbursement rates are much lower than they were under traditional Medicaid, which means they are having to lay off employees,” Musgrave reports.

In November, Kentucky made the switch to managed care for its 500,000 Medicaid recipients outside the Louisville region. The move is expected to save the state more than $1 billion in the next three years. Three companies, Coventry Cares, Wellcare of Kentucky and Kentucky Spirit, broker the care and are paid on a per-patient, per-month rate.

Lemaster said most of her agency’s problems are with Coventry, which has denied 82 percent of their claims. “Lemaster said that because there are differences in the managed care companies and what is being approved for payments, there are inequities in the Medicaid system,” Musgrave reports. “Some people are receiving services and others aren’t.”

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, said problems related to the changeover are being ironed out. “The primary focus of the Medicaid program staff is and continues to be the prompt resolution of any issues that arise as we ease the transition of providers to managed care,” she said. (Read more)