Stumbo files bill to improve Medicaid managed care disputes
by Ralph B. Davis
FRANKFORT – In an effort to improve Kentucky’s ongoing transition to Medicaid managed care, Kentucky House Speaker Greg Stumbo is filing House Bill 5 today to streamline disputes between the Cabinet for Health and Family Services, the managed care companies and medical providers.
“Now that we are more than a year into Medicaid managed care, we’re seeing where things are going well and where improvement is needed, and one major roadblock is the backlog of complaints we’re hearing about payment,” said Speaker Stumbo, D-Prestonsburg. “My bill will give the Department of Insurance, which has an extensive history of resolving disputes in the private insurance market, the ability to do the same thing when it comes to Medicaid. It’s a clean resolution, and one already well understood by the managed care companies and medical providers alike.”
Under HB 5, complaints arising out of Medicaid managed care would be directed to the state’s Dept. of Insurance, which would have much more stringent enforcement and investigative powers. Under current law, the department can only accept cases referred to it by CHFS, and the department cannot enforce any penalties it might impose as it can with private insurers.
In other provisions, the bill would set a six-month maximum time limit in which managed care companies could deny payment, stopping the endless delays some healthcare providers have seen. If the department’s rulings are disputed, meanwhile, anyone could appeal the case to circuit court. This alone would cut delays down by months, Speaker Stumbo said, because it would get the Dept. of Insurance involved more quickly.
Speaker Stumbo added that the Dept. of Insurance is also pro-active in making sure private insurers are aware of the law and any changes. “While I understand the Cabinet is working to do something similar, there is no need to re-invent the wheel since we already have a system in place.”
He added that other states relying on Medicaid managed care have established a formal review process for disputed claims. This, he said, “removes any potential conflicts between those that provide the medical service and those that pay for it. To me, this is just a common-sense measure, and it would go a long way to addressing the thousands of complaints my legislative colleagues and I have been hearing,” he said. “If we want managed care to work, this is the only viable way forward, in my opinion.”
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