FRANKFORT, Ky. (AP) — Two bills gained traction in the Legislature Wednesday that would address millions of dollars in Medicaid disputes between hospitals and the organizations that provide reimbursements.
Each proposal takes a different approach to an issue that hospitals say has compromised care for some of Kentucky's low-income residents. But one organization that provides Medicaid reimbursements to hospitals has concerns about the proposals' cost and workability.
The Senate Committee on Health and Welfare approved a bill that would force the organizations to reimburse hospitals for emergency care required by federal law.
Hospitals say the organizations won't pay for procedures, such as a CT scan, if they fail to reveal a serious condition, such as a brain hemorrhage. But federal law requires hospitals to perform these precautionary measures, which hospitals say are financially unsustainable without proper Medicaid reimbursement.
The bill will proceed to the full Senate for consideration.
The House passed a bill that would take a broader approach. It would allow hospitals to file payment complaints regarding all types of treatment with the Department of Insurance. Currently, complaints are filed with the Cabinet for Health and Family Services, which has less authority to enforce Medicaid payment laws. The cabinet also has a backlog of grievances.
The House bill now moves to the Senate.
Medicaid is a federal-state program that helps pay for health care for some people who are poor or disabled. States, which share the cost, administer the program. It has more than 800,000 enrollees in Kentucky.
In 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 provided to one that pays private managed care organizations to coordinate the program.
Michael Rust, Kentucky Hospital Association president, told the Senate Committee on Health and Welfare that the payment disputes with managed care organizations have hurt patient care in Kentucky. He said fewer hospitals and fewer doctors contract with managed care organizations, leaving Medicaid patients without "ready access" to treatment.
But WellCare, which serves about 220,000 of Kentucky's Medicaid enrollees, said managed care is working in the state.
Mike Minor, president of WellCare of Kentucky, told The Associated Press in a statement that the Senate bill addressing emergency care reimbursements would be "extremely costly" to taxpayers. He said the bill would eliminate the requirement that managed care organizations reduce unnecessary use of emergency room care.
"We have a responsibility to make sure we pay only for medical services that are appropriate," he said.
Minor said WellCare has concerns about the workability of the House bill that would allow hospitals to file complaints with the Department of Insurance. But he said the organization is reviewing amendments that were recently attached to the bill.
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The legislation is House Bill 5 and Senate Bill 178.
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Associated Press reporter Roger Alford contributed to this report.
