By MIKE SHIELDS
KHI News Service
HUTCHINSON — Citing “numerous difficulties” getting paid correctly, one of the state’s largest doctor groups sent a letter to its Medicaid patients telling them it might drop its contracts with two of the state’s three KanCare managed care companies.
The letter, sent last month by the Hutchinson Clinic, sparked concern among patients and downstream service providers who said the letter left them wondering what they could or should do now that KanCare open enrollment is upon them.
Choosing a new plan can be fraught with complications because it requires sorting out which doctors, pharmacists and other providers might be available through the plan’s network of service providers.
And the letter was interpreted by many who received it as an attempt to steer the clinic’s patients to Sunflower State Health Plan and away from the other two KanCare contractors: Amerigroup and UnitedHealthcare.
‘Promised choice’
“Steering” is a practice explicitly barred and penalized in some states that have Medicaid managed care plans and also is considered counter to federal rules intended to promote plan choice for Medicaid beneficiaries. One Kansas legislator suggested similar rules might be needed in Kansas in light of the letter.
“Our Medicaid recipients were promised choice when KanCare was launched. Any attempts to narrow or eliminate that choice by either providers or the managed care companies should not be tolerated. If it takes legislation or regulation to ensure choice, so be it,” said Sen. Laura Kelly, a Topeka Democrat, commenting on the letter after it was described last week by concerned service providers during a teleconference with state and federal Medicaid officials.
Sunflower State Health Plan officials said they had no knowledge of the letter before it was sent by the clinic and neither condoned nor endorsed it.
“We really had nothing to do with them (the clinic) sending it out,” said Monica Stoneking, communications director for Sunflower State Health Plan, “and we actually don’t want them sending something like that out.”
‘Frustrating for us’
Michael Harms, the Hutchinson Clinic’s chief financial officer, said the letter was sent without consulting any state or managed care company officials but reflected the frustration clinic officials have been experiencing since KanCare was launched Jan. 1, 2013.
Harms said the clinic has had problems with “thousands of claims” it has filed with the KanCare companies and is behind “hundreds of thousands” of dollars in payments due from them.
“It’s been frustrating for us,” Harms said in an email to KHI News Service, “because everyone wants to talk about the problems and (there is) no action. How about let’s set some hard deadlines for resolution of claims issues instead of letting the MCO companies drive the resolution of these claims problems on their terms. Let’s get the problems fixed!! It seems like the stakeholders should have some input into the resolution of the problems.”
Harms said between 5 and 10 percent of the clinic’s patients are enrolled in a KanCare health plan.
Included among them are clients of TECH, Inc., the nonprofit umbrella organization for the Reno County Community Developmental Disability Organization.
Brenda Maxey, TECH’s chief executive, said the letter had created ongoing consternation and worries among many of the 250 clients the organization serves that are on KanCare, most of whom are developmentally disabled.
Confounding the services ‘matrix’
Maxey said the organization had put considerable effort into building a “matrix” that mapped which area health care providers were aligned with which KanCare companies and what services each TECH client could receive.
She said she didn’t see how the area’s care system would work for her clients if the Hutchinson Clinic limited itself to contracting only with Sunflower.
“The Hutchinson Clinic being such a huge provider in our community, the idea of them choosing to contract with only one of the MCOs (managed care organizations) creates a huge problem,” Maxey said.
The clinic has more than 70 doctors and more than 600 employees.
That also would create problems for other Medicaid beneficiaries in outlying cities such as Great Bend, according to Mark Bitter, a businessman in that city and the guardian for a man there who has developmental disabilities.
Bitter raised several points about the clinic’s letter during last week’s teleconference with state and federal Medicaid officials.
He said his ward might end up having to travel “three hours to find the same service and there’s no promise those providers will accept the MCOs, either. How will that be addressed?”
Not entirely unusual
Kari Bruffett, director of the division of health care finance at the Kansas Department of Health and Environment, told Bitter and other listeners that decisions by providers to no longer participate in a particular KanCare plan as contract terms lapse or come due for renewal is “not going to be entirely unusual.”
But she said whatever plan a beneficiary is enrolled in would be obliged by the state to make services available within a reasonable distance, even if the company had to pay a provider out-of-network rates to secure the services.
And in a follow-up email to KHI News Service, Bruffett said KDHE officials had been in touch with the Hutchinson Clinic about the letter.
“We are committed to ensuring KanCare members have access to health services,” she said. “We have continued to gather information on the issues raised related to the Hutchinson Clinic, with a focus on any effect on members. We have spoken to the clinic and have been assured that its physicians will continue to see KanCare members, regardless of the MCO with whom the member is enrolled.”
‘Reaching out and continuing dialogue’
Apparently, the clinic also heard from at least one of the managed care companies that it criticized in the letter.
“Frankly, with this provider and all our providers’ agreements and provider manuals there is some clear language that they are really prohibited from directing members to choose an MCO,” said Maureen McDonnell, Amerigroup’s vice president of external communications. “We are reaching out and continuing dialogue to see what we can do to rectify the matter with them.”
Maxey and others said today that they still hadn’t heard anything from the Hutchinson Clinic about its intentions regarding the KanCare companies.
“I haven’t heard any resolution to it,” Bitter said. “I think it’s concerning as to where it may be leading.”
But Harms told KHI News Service that the clinic has since decided to continue contracting with all three companies through 2014 though it hadn’t yet informed all its patients of that decision.
“We are working on communication with patients,” he said in an email sent near the close of business hours on Tuesday.
The KanCare open enrollment process continues through March 4 for about 330,000 of the program’s 400,000 beneficiaries.