Medical providers tell legislators about the challenges they face with Medicaid MCOs

06/18/2015 06:27 PM

ERLANGER — Members of the Budget Review Subcommittee on Human Resources heard from health care providers on Thursday in northern Kentucky about the impact of Medicaid managed care on their abilities to run their businesses successfully.

Some of the issues include non-payment, late payment and the complicated and lengthy process to get approvals to treat many Medicaid patients.

Josh Greeman, director of the Ephraim McDowell Regional Medical Center, told the committee that one factor crippling health care providers is the fact that the approval processes differ with each of the managed-care organizations.

“With the five MCOs, we basically have five different programs to administer across our different clinical settings,” Greeman said. “Admission criteria is not standardized across the MCOs.”

Martha Mather, chief operating officer of Our Lady of Peace Hospital in Louisville, had a number of suggestions as to how to make the process smoother between the providers and the managed care organizations.

“Number one, require MCOs to use a nationally recognized criteria such as InterQual Millennium, and, this is the big one, assure that they are consistently following this criteria,” Mather said.

One thing all providers agree on is that the Medicaid expansion has caused a crunch in the increased amount of patients being seen by medical providers.

Dr. Ron Waldridge, a physician from Shelbyville, noted that the increased number of patients presents challenges.

“This year alone, we have seen managed-care patient visits go up about 43 percent at Kentucky One Health physician offices,” Waldridge said. “Medicaid managed care visits have increased by 77,000 visits compared to fiscal year ’14 already this year.”


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