Health initiative sign-up delayed

Managed-care firms given more time to grow networks

An open-enrollment period that had been set to begin today for Medicaid recipients whose health benefits are provided by managed-care companies will be delayed five months to give the companies "more time to stabilize and grow their networks of providers," the state Department of Human Services announced Tuesday.

The sign-up period, when recipients can change from one company's plan to another, will now be held in October instead of this month. A second sign-up period that had been set for November has been canceled, the department said in a news release.

The department said the companies have agreed to pay the same rates through Sept. 1 to all health care providers who are enrolled in Medicaid, regardless of whether a provider is in the company's network. Until that date, the companies also will delay placing restrictions on patients' care through changes to their care plans and authorizations for services.

The announcement followed complaints aired at legislative hearings last month about disruptions in care and delayed payments to providers stemming from the shift on March 1 to managed care for almost 45,000 Medicaid recipients with significant mental illness or developmental disabilities.

The companies are known as Provider-led Arkansas Shared Savings Entities, or PASSEs.

Physicians' experiences with the program so far have been "horrible, just to put it bluntly," David Wroten, executive vice president of the Arkansas Medical Society, said Tuesday.

"I'd say the program was ready to kick off and a lot of physicians around the state still had no idea what a PASSE was," he said.

Sen. Ron Caldwell, R-Wynne and chairman of the Senate Committee on State Agencies and Governmental Affairs, said the changes announced Tuesday don't address delayed payments to providers -- the key issue he said he's been focused on during joint meetings of the committee and its House counterpart. The next meeting on the issue is set for May 13.

"The way the system's set up right now, it doesn't work," he said.

Human Services Department spokesman Amy Webb said in an email that the department "identified complications around billing identifiers for a small group of specialty providers."

"We've set up daily calls with those providers and put a short-term fix in place that has resulted in those providers now being paid," she said.

She added that she "can't say at this time that all their claims have been paid" and didn't have any additional information.

The managed-care initiative is designed to save the state money while reducing the number of adults and children with developmental disabilities who are on a waiting list for home- and community-based services, including help with daily living tasks.

As of February, about 4,600 Arkansans were receiving such services and more than 3,100 others were on the waiting list.

Under the initiative's first phase, four companies began coordinating the care of patients with significant mental illness or developmental disabilities last year in exchange for monthly payments of $173.33 per recipient.

Under the second phase, three of the companies in March began receiving larger payments, ranging from $998.86 to $12,671.62 per patient, in exchange for paying for all of the patients' care.

The fourth firm, Forevercare, dropped out after the Human Services Department rejected its request to delay the start of the second phase until July 1.

Stephanie Smith, chief operating officer for Easterseals Arkansas, which serves people with developmental disabilities, told lawmakers last week that some difficulties that providers have encountered in submitting bills to the managed-care companies stem from differences in the systems used by the companies and the Medicaid program.

Melissa Stone, director of the Human Services Department's Division of Developmental Disabilities, added after the state agencies committees' meeting April 24 that some parents of children assigned to a PASSE had been concerned that none of the companies had signed a contract with Arkansas Children's Hospital and its affiliated clinics.

She said the hospital had signed on with one of the companies, Arkansas Total Care, that morning.

Nicole May, interim director of Empower Healthcare Solutions, said Tuesday that her company's negotiations with the hospital's network were "almost concluded, and should be within the next day."

She said her company has been meeting with the Human Services Department, legislators and providers to address providers' complaints about reimbursement.

"We have meetings ongoing with DHS -- three, four, five a day -- and with providers, and so we are working with providers and DHS to resolve any issues that may have occurred," May said.

Jason Miller, president of the third company, Summit Community Care, didn't return a call seeking comment Tuesday. Representatives of Arkansas Total Care and Arkansas Children's Hospital also didn't respond to messages seeking comment.

In the news release, Paula Stone, deputy director of the Human Services Department's Division of Medical Services, said the delay in open enrollment will give the companies time to expand their networks and "help clients make the best choice for themselves and their families."

The department said in the release that the changes were made "in response to feedback from providers, families and legislators."

Recipients who want to change plans before October can do so "for cause," such as to move all household members to the same plan or if a recipient's plan lacks providers who can address the person's health care needs.

Wroten, the Medical Society's executive vice president, said physicians "had strong support for Medicaid," even though its reimbursement rates were low, because it paid claims within about a week and was easier to work with than private insurance. Now, they're waiting "30, 60, 90 days" for reimbursement from the companies and are having to "jump through hoops," he said.

He said physicians also aren't happy that they no longer receive up-front payments from Medicaid to coordinate the care of patients who have been assigned to a company.

For patients who are on traditional Medicaid, doctors since the 1990s have received a $3-a-month fee for serving as a patient's primary-care physician. Those participating in the state's patient-centered medical home program receive additional payments of about $4 a month for providing additional care-coordination services.

"There's a lot of unhappiness out there among physicians," Wroten said.

Diane Skaggs, director of the Mental Health Council of Arkansas, said a survey of the state's 12 community mental health centers a few weeks ago found that they had been paid for about 20 percent of what they had billed since March 1.

"My opinion is it's a good thing to delay [open enrollment] for now," she said. "There's so much that's going on and so much that needs to be fixed."

Loretta Cochran of Pottsville said she hopes the delay will give the companies time to build better networks and educate providers.

Both her 17-year-old son and a 28-year-old man for whom she is a guardian have autism and were assigned to Arkansas Total Care.

The clinic where the 28-year-old's doctor works wanted to drop him as a patient because of the shift to managed care, but she said she persuaded the clinic to keep him by giving up her own slot as a patient.

"A healthy person may be able to travel 50 miles to a doctor," Cochran said. "Our folks can't."

Metro on 05/01/2019

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