FRANKFORT, Ky. (AP) — Kentucky hospitals would have a quicker way to file grievances over Medicaid payments under a bill approved Thursday by a House panel.
The bill would allow health care providers, such as hospitals, to file complaints with the Department of Insurance to dispute the amount of Medicaid payments they receive from managed care organizations on behalf of patients. Currently, complaints are filed with the Cabinet for Health and Family Services, where there is a backlog of grievances.
Recommended Stories
The Department of Insurance, which has more authority to enforce the state’s Medicaid payment laws, would create an independent review process for complaints. The new process would not affect current contracts between a health care provider and one of the state’s three managed care organizations, which coordinate Medicaid coverage.
House Speaker Greg Stumbo, D-Prestonburg, sponsored the bill.
“It’s difficult to understand who really is correct in what they’re saying,” Stumbo said before the committee vote. “I’m not pointing the finger at anybody because I don’t know whether the providers are being as forthright as they should be. I don’t know if the (managed care organizations) are. I don’t know if the cabinet is doing its job. … My guess is the middle ground is where we’ll find the truth.”
Medicaid is a federal program that covers certain groups of low-income people, such as pregnant women and people with disabilities. States, which share Medicaid’s cost, administer the program. It has more than 800,000 enrollees in Kentucky.
In late 2011, Kentucky changed the payment system it uses to administer Medicaid to all of its beneficiaries in an effort to save money. The state switched from a system that bases payments on services to one that pays private managed care organizations to coordinate the program based on the number of beneficiaries they have.
Hospitals and other health care providers have complained about the Medicaid payments they have received — or not received. Providers also take issue with the amount of time it takes to resolve their disputes.
“Our rural hospitals are really in distress,” said Rep. Ben Waide, R-Madisonville, a bill co-sponsor who voted yes. “(There are) millions and millions of dollars that providers are not being paid right now because of these issues.”
The measure will now proceed to the full House for consideration.
___
The legislation is House Bill 5.
