The state Medicaid contractor Aetna’s recent problems were front and center last Tuesday at the KanCare Oversight Joint Committee meeting in Topeka. There, Aetna Medicaid professionals presented ways they are planning to fix the recent issues they have had and how they are planning to work with healthcare providers across Kansas, including Lawrence Memorial Hospital.
Aetna became a Kansas Medicaid provider in the KanCare program at the beginning of the year and has since been under fire for many issues, including delayed payments to healthcare providers.
“We haven’t met the expectations I have for our plan, and we certainly haven’t met your expectations either,” Aetna Medicaid CEO Randy Hyun said Tuesday. “I do want to acknowledge that and apologize because that’s happened under my watch, and I’m accountable for it. I’m also accountable, more importantly, for fixing it.”
When Aetna became one of the Medicaid providers for Kansas, it did not load the Lawrence Memorial Health contract with the correct rates according to the hospital’s contract, said Stephanie Swan, patient accounts manager of LMH.
This impacted both inpatient and outpatient services.
Lawrence Memorial Hospital has since been in constant contact with an Aetna Medicaid representative, even when there's "nothing to report."
Aetna Medicaid is changing the management team for Kansas as well as bringing in new resources from Aetna branches nationwide in hopes to resolve these problems, according to Hyun. Health officials in the state are also hoping the problems they’re seeing will start to decline with time.
“We are cautiously optimistic. We’ve had a lot of conversations with their new leadership team, and they’ve reaffirmed their commitment to Kansas in making sure that they get themselves back to where they need to be,” said Adam Proffitt, Kansas State Medicaid director.
The Kansas Department of Health and Environment is currently reviewing a new plan from Aetna that is aimed at correcting problems they have seen, according to Proffitt.
“We’re going to make sure that we feel confident that they’ll be able to work themselves back into compliance and deliver the quality care that we expect them to,” Proffitt said.
The KanCare Oversight Joint Committee meeting lasted two days last week and discussed multiple issues regarding KanCare. For many, the problems with Aetna have been a strong focus.
Watkins Health Center is not affected by the Aetna issues because the center does not contract with Medicaid, according to interim director Diana Malott. University students pay a required campus health fee each semester which entitles them to see a Watkins healthcare provider without charge.
“If one of our students does need a service for which there is a charge and does not want to have it done at Watkins, our case manager can help get them to an outside provider who is contracted with Medicaid, or we will work out a payment plan for them if they decide they do want to use Watkins,” Malott said.
Sen. Barbara Bollier (D-Mission Hills) is still confident KDHE and the Kansas Department for Aging and Disability Services can still ensure the state has "good, appropriate providers."
“They are working through those and [have] timelines in place to make that move forward,” Bollier said. "And if not, we'll change."
KDHE said there is no timetable on when it will decide if Aetna’s corrective plan is acceptable.
Representatives from the other Medicaid contractors, United Healthcare and Sunflower, presented to the committee on Tuesday as well.