Purchase photos

Kansas hospitals complaining about KanCare delays

9/30/2013

TOPEKA (AP) -- Hospitals are complaining about delays since the state switched to a new managed care plan for Medicaid.

TOPEKA (AP) -- Hospitals are complaining about delays since the state switched to a new managed care plan for Medicaid.

When KanCare rolled out in January, most of the state's Medicaid recipients were moved into plans administered by three private companies, The Topeka Capital-Journal (http://is.gd/zjpLo6) reports. Since the switch, hospitals have reported problems getting reimbursed for services they perform and getting prior authorizations to provide certain types of treatment in a timely manner, said Cindy Samuelson, Kansas Hospital Association vice president for member services and public relations.

Hospitals estimate it is taking three to 10 days to authorize treatment, Samuelson said. She said the state has attempted to deal with the issues, but the insurers haven't been as cooperative so far.

The change to KanCare was promoted as a way to save money and improve care. Gov. Sam Brownback announced earlier this month that $37 million had been saved so far and said that would allow 650 more people with physical or developmental disabilities to get off the waiting list for in-home services.

But Carrie Saia, chief executive officer of Holton Community Hospital, said she was skeptical of the savings. She said some of the hospital's staff members still were working on getting paid correctly for services performed in March, though rural health clinics affiliated with the hospital haven't had the same difficulties.

"We expected there to be some bumps, but not 10 months into it, so many bumps," she said. "The reason they're saving so much money is we're not getting paid correctly."

Robert Moser, secretary of the Kansas Department of Health and Environment, said the managed care organizations have an incentive to meet quality standards because a percentage of their payments will be withheld if they don't meet goals set by the state.

Moser acknowledged there have been some issues with the change and that the three managed care companies have been meeting with his agency and several others to come up with solutions. The managed care organizations have pledged to hire more staff and improve training.

Moser said service has improved, and 97 percent of clean claims are being processed in 20 days.

"There has to be more customer service to the providers, as well as the consumers," he said. "I understand the frustration from the providers."

He said getting patients care that is within medical guidelines, can cause some difficulties if doctors aren't used to those standards. For example, an insurance company won't automatically approve an X-ray or MRI for a person complaining of lower back pain, because those tests often don't yield much useful information, and the insurers want to "make sure we're not jumping to the most expensive test first," he said.

Jerry Slaughter, executive director of the Kansas Medical Society, said members reported some issues with prior authorization and prompt payments, but difficulties are to be expected in any large-scale undertaking.

"It's never going to be as smooth as everyone might like," he said. "I would expect by year's end they will have some of those problems resolved."