Tag: Medicaid Managed Care

MM Curator summary

[MM Curator Summary]: PA union organizers just got access to a $16B bargaining chip by tie-ing Medicaid provider payments to workers being union-ized.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

(The Center Square) – The Pennsylvania Department of Human Services is drafting Medicaid contracts that could compel health-care providers to unionize, making it more difficult for low-income patients to access health care and threatening more than a dozen hospital systems’ participation in Medicaid.

The HealthChoices Medicaid Managed Care agreements would take effect in July and would prevent a managed care plan from including in its network a provider that has had a work stoppage within five years – unless the provider has signed a collective bargaining agreement.

Effectively, health care providers would be compelled to unionize to be able to provide Medicaid services. If providers would not unionize after the provision takes effect, the threat of a work stoppage in the future could jeopardize their Medicaid participation.

The contracts concern the physical health portion of Pennsylvania’s Medicaid contracts, which were worth more than $16 billion in FY2021-22. Pennsylvania has almost 2.8 million Medicaid enrollees and the state’s Medicaid contracts have been worth $65 billion over the last 5 years, according to the Pittsburgh Post-Gazette. 

In testimony at a House Appropriations Committee hearing on March 9, Snead said the new provision’s language “was a collaboration between the administration and SEIU.” The language in the contracts is still in the process of negotiation and not finalized, though Snead noted the department wants to have a finalized version by April 1.

“My concern with all of this is that it could potentially limit health care options for low-income individuals,” said Sen. Kristin Phillips-Hill, R-Jacobus. 

“I think that the Wolf administration is taking us down a very dangerous path,” Phillips-Hill said. “It really comes down to putting patients at great risk to access their care.”

The provision had been little-noticed until it came up during committee hearings in the General Assembly.

“I think it was something the administration hoped would fly under the radar. They certainly did not want to bring this to the General Assembly,” Phillips-Hill said.

The Hospital and Healthsystem Association of Pennsylvania, which represents 240 hospitals and health systems, sent two letters to DHS in response to the provision. In the letters, HAP expressed concerns that the provision would “Improperly inject a subsidiary policy goal – mandating health care unionization – into a program that is designed to provide access to care to vulnerable and low-income Pennsylvanians.”

“From our perspective, the purpose of Medicaid programs should be to promote access to care and the state should be working to reduce hurdles for Medicaid patients to obtain care, not to cut off hospitals or other providers,” said Jeffrey Bechtel, senior vice president for health economics and policy at HAP.

 
 

Clipped from: https://www.theprogressnews.com/news/state/pennsylvania-health-systems-may-be-compelled-to-unionize-by-medicaid-contracts/article_a7a75d98-f1f2-5879-8747-c85259cc9755.html

MM Curator summary

[MM Curator Summary]: The Florida Medicaid managed care reform bill may stall in the upper chamber due to opposition from Dems.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

A bid to overhaul Florida’s Medicaid managed care process ahead of a mammoth multi-billion-dollar bidding process cleared the House on Tuesday and heads back to the Senate with an uncertain fate with just four days left in the Session.

The House voted 77-38 for the bill (SB 1950) as amended largely along party lines as Democrats said they were fearful the legislation would wind up harming public hospitals.

“It feels like the punishment isn’t worth the crime,” said Rep. Kelly Skidmore, a Democrat from Boca Raton.

More than 5 million Floridians are enrolled in Medicaid, with many of them receiving health care through managed care plans.

The House bill requires “essential providers” to enter into regional or statewide contracts with those Medicaid managed care plans. But it also includes a process where essential providers and managed care plans that can’t reach agreement will enter into mediation June 30. Mediators must submit a report to Agency for Health Care Administration (AHCA) by Oct. 1 showing the outcome of all mediation they presided over.

 
 

The state is required by Jan. 1 to withhold any supplemental payments from essential providers that do not have all the mandated contracts signed.

It was this “essential providers” language that drew the most criticism from those who lined up against the bill. But Rep. Sam Garrison, a Fleming Island Republican and the bill sponsor, defended the process.

“A mandate without an enforcement mechanism is really just a strong suggestion,” Garrison said.

Other Republicans also asserted changes included in the bill would result in better outcomes for Medicaid patients.

That essential provider mandate is a nonstarter for the Senate, according to top Republicans in the chamber. The House bill also would prevent Medicaid beneficiaries from being automatically assigned into any managed care plan that has a market share of 50% or more.

 
 

The Legislature in 2011 passed a rewrite of the state’s Medicaid statutes, requiring most beneficiaries to enroll in a managed care plan. In 2013, the Medicaid managed long-term care program was launched. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.

Current law requires the Medicaid contracts to be competitively bid in 11 regions in the state. Winning health plans are awarded multiyear contracts worth tens of billions of dollars.

Agency for Health Care Administration Secretary Simone Marstiller told lawmakers last fall her agency wanted the Legislature to make changes to the program during the 2022 Session before her agency starts working on new Medicaid procurement. Florida’s existing Medicaid managed care contracts expire Dec. 31, 2024.

Clipped from: https://floridapolitics.com/archives/505928-will-the-senate-take-up-the-house-medicaid-managed-care-rewrite/

 
 

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[MM Curator Summary]: The new MCO contracts go live this summer, and members can enroll now.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

COLUMBUS, Ohio (AP) — Medicaid enrollees in Ohio can begin selecting from among a new slate of managed care plans beginning Tuesday.

As part of the Ohio Medicaid Next Generation initiative, millions of enrollees in the government health care program for low-income Americans must choose from seven managed care plans or be assigned one.

The approved plans are: Buckeye Community Health Plan, CareSource, Molina Healthcare, UnitedHealthcare Community Plan, AmeriHealth Caritas, Humana and Anthem Blue Cross and Blue Shield.

Next Generation is scheduled to go live July 1.

Eligible participants have several ways to make their selection, including visiting the Ohio Medicaid Consumer Hotline portal, calling the hotline or contacting their county Department of Job and Family Services.

Those not yet ready to make their selection are encouraged to update their contact information, so they can receive notices regarding the rollout.

 
 

Clipped from: https://www.recordherald.com/news/72692/ohio-medicaid-managed-care-plan-enrollment-begins-tuesday

MM Curator summary

[MM Curator Summary]: As part of legislative efforts to overhaul the state’s Medicaid managed care system, the state would add the Core Set of BH measures and new demographic data reporting requirements to plan scope under a new proposal.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Medicaid managed care plans would be required to report more data to the state in the coming years under a bill that cleared the Senate Rules Committee Tuesday morning.

Sponsored by Sen. Shevrin Jones, SB 1258 would require Medicaid managed care plans to collect and annually report HEDIS measures, the federal Core Set of Children’s Health Care Quality measures, and the federal Core Set of Adult Health Care Quality performance measures. Those reports would go to the Agency for Health Care Administration (AHCA).

Beginning in 2025, the bill requires the plans to report the Adult Core Set Behavioral Health measures. And beginning with the 2026 calendar year, the Medicaid managed care plans must stratify the required reported measures by age, sex, race, ethnicity, primary language and whether there is a disability determination from the Social Security Administration.

The Rules Committee was the third Senate panel to consider the bill, which can now be heard by the full Senate. Its counterpart, HB 855, also has cleared all committees and is awaiting floor debate. Reps. Robin Bartleman and Nick Duran are sponsoring the House bill.

In addition to requiring plans to submit additional health care measures to the state, the bill also makes a technical correction to reflect that HEDIS is an acronym for “Healthcare Effectiveness Data and Information Set.” HEDIS once stood for “Health Plan Employer Data and Information Set,” and the statutes still reflect the old moniker.

 
 

Florida has a Medicaid managed care mandate that requires most enrollees, from cradle to the grave, to join a managed care plan.

To hold down costs, Florida competitively bids its Medicaid program, inking contracts with health plans that submit winning bids in 11 regions across the state. The current law requires contracted Medicaid managed care plans to be accredited by the National Committee for Quality Assurance, the Joint Commission, or another nationally recognized accrediting body, or have initiated the accreditation process, within one year of signing the contract.

AHCA, which houses the state’s Medicaid program, is charged with ensuring the plans meet contractual requirements, and the current law requires the health plans to report HEDIS measures to the state.

AHCA says it currently requires health plans to report 27 HEDIS measures related to medical care and nine measures related to Child and Adult Core Set measures in its contracts with those plans.

A staff analysis of the bill indicates the state will need one additional employee and $79,930 to implement the provisions in the bill.

 
 

This is one of two Medicaid managed care bills Florida lawmakers are considering this Session. The Senate Appropriations Subcommittee on Health and Human Services will consider the other Medicaid managed care bill, SB 1950 by Sen. Jason Brodeur, Wednesday morning. That measure updates the Medicaid managed care statutes.

Clipped from: https://floridapolitics.com/archives/498073-bills-would-require-medicaid-plans-to-provide-much-more-data/

MM Curator summary

[MM Curator Summary]: MS Medicaid officials are warning that a legislative removal of the MCO would have very disruptive consequences for members.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

In this file photo, Drew Snyder, executive director of the Mississippi Division of Medicaid, gives an agency update to members of the House Medicaid Committee at the Capitol in Jackson, Miss. in 2019.

Rogeio V. Solis | AP

JACKSON • The leader of the state’s Medicaid division on Thursday warned a group of senators that banning contracts between the state and health care companies that have settled lawsuits over fraud allegations would lead to chaos.

The House last week voted to functionally end the state’s contract with health care giant Centene, a company that has been investigated by two state agencies for overcharging Mississippi million of dollars, after a state lawmaker offered an amendment to a separate Medicaid bill.

Drew Snyder, director of the Mississippi Division of Medicaid, said the amendment authored by Republican Rep. Becky Currie of Brookhaven would be hazardous and potentially exclude other health care organizations from doing business in the state.

“If passed, the amendment would subject 162,328 Medicaid beneficiaries to a hurried reassignment process that would disrupt care services,” Synder said. “It likely would result in litigation against the Division of Medicaid.”

The amendment specifically prohibits the Medicaid division from contracting with any organizations that have settled with the state for more than $50 million over allegations of fraud and misspending. The amendment is clearly targeted toward Centene, though it does not name the company.

As first reported by the Daily Journal, the state attorney general and state auditor investigated Centene and its Mississippi subsidiary, Magnolia Health, for allegedly inflating its bills to the Medicaid division. Centene eventually settled with the state for $55.5 million. Under the agreement, they did not admit fault or wrongdoing.

A communications official from Magnolia Health gave the Daily Journal a list of talking points that its CEO, Aaron Sisk, was expected to deliver to the Senate committee. It’s unclear why representatives from Magnolia Health did not speak at the hearing.

“The final figure of $55 million was the proportion of the national settlement figure agreed upon with plaintiff lawyers and has absolutely no connection to taxpayer money in Mississippi,” the document reads.

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Centene has also settled with five other states after state agencies accused the company of ripping off taxpayers.

In Mississippi’s Medicaid system, Magnolia Health and two other contractors oversee health insurance benefits for about 485,000 of the state’s most vulnerable citizens. The Division of Medicaid pays the companies a set rate per patient.

Health care organizations can reap millions of dollars in tax dollars for managing benefit programs and often vie to secure a state contract.

Centene has injected thousands of dollars into the campaign coffers of some of Mississippi’s most powerful politicians and paid hundreds of thousands of dollars to prominent lobbyists, according to public documents on the Mississippi Secretary of State’s website.

Mississippi hospital leaders for years have accused managed care organizations of reaping too much money while hospitals in rural communities continue to suffer. Hospital leaders have suggested they could manage the state’s Medicaid benefits at a cheaper cost, offer better quality and keep more money in the state.

At the hearing, Sen. Hob Bryan, D-Amory, said he did not understand why the state had not explored the hospital’s plan and given them an opportunity to prove themselves.

“If the people who are complaining are willing to say we’ll take this on … and we can show you that all these complaints we’re making about (managed care) are right and we’ll do it better, why wouldn’t we want to call their bluff?” Bryan asked.

Clipped from: https://www.djournal.com/news/state-news/state-medicaid-director-banning-centene-contract-would-be-hazardous/article_c0b7fe77-3be3-5dbb-974a-b27aae652be0.html

MM Curator summary

[MM Curator Summary]: Legislators are working to pass a bill that would exclude vendors who settle lawsuits for more than $50M with the state.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(Photo: Pieter van de Sande/Unsplash)

The Mississippi House has voted to make the state’s Medicaid program end a contract with health care giant Centene, although that plan could change later as lawmakers continue to debate issues.

Centene settled a lawsuit last year that accused one of its subsidiaries of overcharging the Mississippi Division of Medicaid millions of dollars for pharmacy benefits management. Centene agreed to pay the state $55.5 million but did not admit fault.

It was reported that during discussion of a Medicaid bill Thursday, the House adopted an amendment that would prohibit the Medicaid program from contracting with a company that has paid over $50 million in a settlement agreement with the state.

The amendment to House Bill 658, offered by Republican Rep. Becky Currie of Brookhaven, was aimed at Centene.

“I am for doing away with our business to a company who took $55 million of our money that was supposed to be spent on the poor, the sick, the elderly, the mentally ill, the disabled,” said Currie, who is a nurse.

Currie’s amendment would require the state to contract with a nonprofit entity to manage Medicaid services.

Health plans hire pharmacy benefit managers to try to control costs in prescription programs. Among other duties, the management companies create lists of preferred drugs and negotiate rebates with pharmaceutical companies.

The bill was held for the possibility of more House debate, and it will move to the Senate for more work. A motion to reconsider was filled by principal author and District 35 Representative Joey Hood and District 12 Representative Clay Deweese on February 10.

 
 

Clipped from: https://www.oxfordeagle.com/2022/02/14/mississippi-could-rethink-a-medicaid-managed-care-contract/

MM Curator summary

[MM Curator Summary]: Humana is one of the MCO winners in LA.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Kentucky-based company will help people across the Bayou State achieve their best health

BATON ROUGE, La., February 14, 2022–(BUSINESS WIRE)–Leading health insurer and health care services company Humana Inc. (NYSE: HUM) has been notified by the Louisiana Department of Health (LDH) that the LDH intends to award a contract to Humana to deliver health care coverage to Medicaid beneficiaries across the state. Humana’s Medicaid division — Humana Healthy Horizons — expects to begin administering the coverage in Louisiana later this year, pending the state’s completion of its standard protest period.

Humana will serve adults and children across Louisiana with the goal of helping them improve their health and well-being through a whole-person, value-based approach that goes beyond traditional clinical care.

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“We are deeply committed to increasing access to care and improving health outcomes of Louisianans who have faced numerous public health crises, natural disasters, and other challenges over the course of the pandemic,” said Humana Medicaid President John Barger. “It is an honor and privilege to be chosen by The Louisiana Department of Health to serve people across Louisiana. We will provide those covered by Medicaid holistic care that prioritizes both their physical and mental well-being. And we are excited to bring our data-enabled population health model along with Humana’s rich history of innovation to the Louisiana Medicaid program.”

Humana is one of five health plans selected as part of a statewide Medicaid managed care procurement issued last year. The state contract will offer an initial three-year term of service and take effect later this year, with the option of renewal terms thereafter. The statewide program – administered by the five plans – will provide health care to approximately 1.6 Million Medicaid enrollees.

“This selection reinforces Humana’s decades-long commitment to not only delivering quality health care to Louisianans but also to playing a vital role in improving the health of the communities we serve,” said Tony Mollica, Humana Medicaid Regional President. “We take pride in the work we do here in Louisiana. Our team thoughtfully designed a health strategy – rooted in Humana’s unique approach to population health – to meet the specific urgent and long-term needs of Louisianans, which has been a rewarding experience. I’ve witnessed first-hand how Humana forms invaluable and lasting partnerships with local residents, health care providers and community organizations.”

Humana currently serves a total of approximately 450,000 Louisianans through Humana Medicare Advantage plans, Medicare prescription drug plans, commercial group health plans, and the TRICARE military health care program as administered by Humana. Humana’s participation in Louisiana’s new Medicaid program – pending the state’s completion of its protest period – will allow the company to bring its services to more Louisianans across the state.

Humana is working to address social determinants of health in the state — like lack of transportation and food insecurity — through its Bold Goal program. The Bold Goal is Humana’s population health strategy to improve the health of the communities it serves. New Orleans and Baton Rouge are among Humana’s official Bold Goal communities.

In addition, during the pandemic, Humana partnered with local organizations, like Healthy BR and Makin Groceries Mobile, who are facing unprecedented demand from Louisianans in need of critical services. The Humana Foundation, which is the philanthropic arm of Humana, donated $200,000 to the recovery and relocation efforts for those impacted by Hurricane Ida in Louisiana.

About Humana Healthy Horizons

In 2020, Humana launched its new Medicaid brand, Humana Healthy Horizons™. With this new brand, we are committed to continue demonstrating our strong ability to manage complex populations and create solutions that lead to a better quality of life for our members. Nationally, we serve Medicaid enrollees through Medicaid Managed Care (MMC), Managed Long Term Services and Supports (MLTSS) programs, Centers for Medicare and Medicaid Services (CMS) Financial Alignment Initiative Dual Demonstrations, MA, D-SNPs, and PDPs.

Humana has served Medicaid populations continuously for more than two decades and currently manages Medicaid benefits for more than 930,000 members nationally. We have developed expertise providing care management, care planning, and specialized clinical management for the complex needs of Temporary Assistance for Needy Families (TANF); Children’s Health Insurance Program (CHIP); Medicaid Expansion; aged, blind, or disabled (ABD); and dual eligible populations within a social supports‐based framework. Through these years of experience, we have also developed significant expertise in integrating physical health, behavioral health, pharmacy, and social services and supports for a whole-person centered approach to improve the health and well‐being of our members and the communities we serve.

Humana Healthy Horizons is a Medicaid Product of Humana Health Plan, Inc.

About Humana

Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

To accomplish that, we support physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Our range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at www.humana.com, including copies of:

• Annual reports to stockholders
  
• Securities and Exchange Commission filings
  
• Most recent investor conference presentations
  
• Quarterly earnings news releases and conference calls
  
• Calendar of events
  
• Corporate Governance information
  

View source version on businesswire.com: https://www.businesswire.com/news/home/20220214005840/en/

Contacts

Jim Turner
Humana Corporate Communications
jturner2@humana.com
502.608.2897

Clipped from: https://finance.yahoo.com/news/humana-selected-louisiana-health-department-213000762.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAEJk5Qw5z_OGBgARZtjaPsPdinvY3M44iBh-AJECeTvm7EzeZ3jL7GafCq52TnzA8H5gWf2MO8L8rWHVB6ikPD9HpsSOLWouRDOfC5aKBLMOeOV99JiIAQCtb3kJ-wqT0WzDpzc2MW5hBQuS4aoWjDASTBSsiBiGq1QOqs8Y3ROu

MM Curator summary

[MM Curator Summary]: Legislators want to give the next governor a say in the MCO contract renewals.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Skeptics worry about no-bid contract extensions, reform delays and federal scrutiny

 
 

Rep. Brenda Landwehr, R-Wichita, said the Kansas Legislature should approve a bill blocking until after the 2022 election for governor the rebidding of Medicaid contracts with managed care organizations serving about 400,000 people enrolled in KanCare. (Thad Allton for Kansas Reflector)

TOPEKA — A bipartisan cluster of House members, three Kelly administration agencies and a core group of advocates for the 440,000 Kansans in Medicaid shared unease with legislation blocking the rebidding of KanCare contracts with managed-care companies until after the governor’s race in November.

Officials working for Democratic Gov. Laura Kelly have been preparing to launch in October a competitive bidding process among for-profit companies and nonprofit organizations leading to selection in 2023 of three Medicaid contractors. Recipients of those contracts would share responsibility for delivering $3.9 billion in services to low-income children and adults as well as people with physical, intellectual or developmental disabilities.

The current contracts expire at the end of 2023, but legislation pending in the House would extend those deals to the end of 2025.

Rep. Brenda Landwehr, a Wichita Republican and chairwoman of the House Health and Human Services Committee, said the goal of the bill was to enable the Legislature to seize greater control of KanCare during a period covering the gubernatorial election and a portion of the next four-year term of a governor.

“The idea is to give whomever the next administration is the opportunity to go into long-term contracts with KanCare,” Landwehr said. “By extending it, then the next administration comes in and deals with it. That’s the intent.”

KanCare, the state’s privatized system of Medicaid, was launched in 2013 by Republican Gov. Sam Brownback. He extended the initial KanCare contracts by issuing an executive order, not by permission of the Legislature. Sunflower State Health Plan and United Healthcare have been KanCare contractors from the start. In 2018, GOP Gov. Jeff Colyer announced selection — seven months before his term as governor ended — Aetna Better Health of Kansas would replace the third original KanCare contractor Amerigroup Kansas.

Under House Bill 2463, the executive branch in Kansas would not have authority to make “substantive or material” changes to Medicaid until Jan. 1, 2026.

It would order the Kansas Department of Health and Environment to negotiate contract extensions with Sunflower, United Healthcare and Aetna. KDHE would be forced to seek federal approval to continue operating KanCare in the manner of an experimental program, but the state’s Medicaid director said any request for an extension of federal authorization beyond one year would be rejected by the U.S. Centers for Medicare and Medicaid Services.

Rep. Kathy Wolfe Moore, a Democrat from Kansas City, Kansas, said the bill deviated from a process established by Republican governors in which the executive branch took the lead in developing contracts with managed-care companies. So far, Kansas governors have guaranteed Medicaid recipients three options among MCOs.

She said the bill risked the state running afoul of federal regulators and jeopardized $2.9 billion in federal funding for Medicaid. A law requiring contracts with specific companies would soften the state’s leverage in management conflicts, she said.

“This would set up a no-bid process because these contracts would automatically stay. I’d love to be a contractor with the state if I knew I could do anything,” Wolfe Moore said.

 
 

Rep. Kathy Wolfe Moore, a Democrat from Kansas City, Kansas, expressed concern about a bill forbidding until 2026 a new round of competitive bidding on state contracts with Medicaid managed-care companies. A Republican legislator said the objective was to block progress until voters decided in November whether to give Democratic Gov. Laura Kelly a second term. (Sherman Smith/Kansas Reflector)

 
 

Political motivations?

Kelly, who is seeking re-election to a second term as governor, has supported proposals to expand Medicaid eligibility to include at least 100,000 more Kansans. So far, the House and Senate have not consented to expand access to Medicaid. Kelly’s likely Republican opponent in November would be Attorney General Derek Schmidt, who has opposed Medicaid expansion and authorized legal challenges of the Affordable Care Act.

None of the current KanCare contractors expressed support for the bill during the public hearing in Landwehr’s committee. Two Cabinet secretaries in the Kelly administration, the state’s Medicaid director and representatives of four health advocacy organizations opposed the legislation. Three organizations, including the Kansas Medical Society, raised objections but didn’t declare outright opposition.

Legislators were puzzled by absence of testimony from any organization or individual making arguments in support of the bill.

“It’s a little bit difficult when we don’t have a proponent,” said Rep. Doug Blex, a Republican from Independence. “The benefit of committee work is to hear all sides and make a somewhat intelligent decision.”

Democratic Rep. Susan Ruiz, of Kansas City, Kan., added: “I’m used to bills coming to us because we want to fix something or we want to enhance something. This is just out of that realm.”

GOP Rep. John Eplee, a physician from Atchison, said he was struggling to nail down purpose of the bill.

“I understand this is well-intentioned to provide more legislative engagement and oversight with this program,” Eplee said. “Without proponent testimony it’s a little hard for me to really embrace what the goal of this bill is.”

 
 

 
 

Sarah Fertig, Medicaid director at the Kansas Department of Health and Environment, said financial and legal problems would result from passage of a bill mandating extension of state Medicaid contracts with three companies until 2026. She said the bill jeopardized $2.9 billion annually in federal aid to Kansas. (Kansas Reflector screen capture from Kansas Legislature YouTube channel)

 
 

‘Uncertain, far-reaching’

Kansas Medicaid director Sarah Fertig, who is part of the Kansas Department of Health and Environment’s division of health care finance, said the federal government wouldn’t let Kansas secure more than a one-year extension of its current authority to operate KanCare.

KanCare functions under a so-called Section 1115 waiver of federal rules scheduled to expire Dec. 31, 2023. However, the bill would require the Medicaid program to remain frozen through Dec. 31, 2025, which would be two years after the state’s Section 1115 waiver expired.

She doubted federal officials would approve a “two-year, no-bid contract extension for our three MCOs in the absence of a clear operational need.”

Vague language of House Bill 2463 had “uncertain and far-reaching implications” on operation of Medicaid in Kansas, Fertig said.

If made into law, she said, it could interfere with adding new drugs, treatments and services to Medicaid coverage. It could block increases in medical provider reimbursements. It would interfere with extending coverage for postpartum women, behavioral health services and therapy for children with autism.

It would forbid the state from addressing workforce shortages for individuals working to care for people with disabilities. A prolonged hold on new contracts could jeopardize federal funding that made up two-thirds of the state’s Medicaid budget, she said.

“If even a portion of federal funding were lost as a result of the state’s compliance with HB 2463, the results would be devastating,” Fertig said.

DeAngela Burns-Wallace, secretary of the Kansas Department of Administration, said the House legislation could be problematic if it forced the state to extend contracts with a vender it no longer wanted to do business with.

“Language of the bill indicates that no substantive or material change can be made in the contracts. Vendors could argue that the state must retain the current vendor regardless of the vendor’s performance,” Burns-Wallace said.

 
 

 
 

Rachelle Columbo, executive director of the Kansas Medical Society, said legislation freezing Medicaid managed-care contracts until 2026 should include a provision allowing an increase in fees paid physicians caring for KanCare patients. Rates haven’t changed since 2006. (Sherman Smith/Kansas Reflector)

 
 

‘Harmful rigidity’

KanCare Advocates Network, a coalition of more than 50 organizations and individuals who advocate on behalf of participants in Medicaid, argued the House bill would unnecessary pump the brakes on broadly supported reforms of KanCare. Years of opportunity for progress could vanish, said Sean Gatewood of KanCare Advocates Network.

“The bidding process by the MCOs is needed to constantly adapt to the current environment as well as improve the overall system on a regular basis,” Gatewood said. “At the core of the KanCare program is the premise that competition will drive better outcomes. HB 2463 removes most of that competition.”

Denise Cyzman, chief executive officer of Community Care Network of Kansas, said 28% of patients at the network’s 34 clinics were covered by Medicaid. The network provides medical, dental, pharmacy, mental health, substance use disorder and case management services.

“The COVID-19 pandemic has demonstrated how important it is for our health care system to be nimble and adaptable. HB 2463 not only discourages adaptability, but imposes an unnecessary and harmful rigidity to the system,” she said.

 
 

Clipped from: https://kansasreflector.com/2022/02/04/house-bill-delays-rebidding-states-3-9-billion-medicaid-contracts-until-after-governors-race/