Healthcare Business News
Mississippi Gov. Phil Bryant

Miss. governor, Blues clash over exclusion of HMA hospitals

By Beth Kutscher
Posted: October 24, 2013 - 3:45 pm ET

(This story has been updated with a correction.)

Mississippi Gov. Phil Bryant has intervened in a dispute between Health Management Associates and Blue Cross and Blue Shield of Mississippi after the insurer dropped HMA's hospitals from its network. But BCBS is fighting the governor's action to force it to include HMA's hospitals in its network, calling it unconstitutional, and has launched some provocative attacks on Bryant personally.

In an executive order, Bryant ordered the Blues to reinstate 10 terminated HMA hospitals in the state. BCBS dropped the hospitals in July, just weeks after HMA had sued the insurer, alleging that it had been paid below contracted rates for two years.

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The insurer on Friday filed a lawsuit asking for a temporary restraining order against the governor's mandate, which it called “unconstitutional” and “unprecedented.” The lawsuit also states that the contract dispute with HMA is not about access to care, but the “exorbitant prices” HMA charges that can be more than double other area hospitals.

The insurer also said Blues subscribers still can receive emergency care from HMA as well as other services at out-of-network rates.

But BCBS' lawsuit also takes aim at Bryant himself, stating that he has a conflict of interest because he has an immediate family member who is a lawyer with the same firm representing HMA in its lawsuit against BCBS.

Moreover, the insurer's suit says: “The governor's sudden interest in access to healthcare is interesting given that he blocked approximately 300,000 Mississippians from participating in the Medicaid program. Instead, the governor's actions appear to be motivated by politics and money. The governor and members of his staff have stated that this dispute is an 'economic development issue' for Rankin County.”

That was a reference to the fact that Bryant and his fellow Republicans who control the Mississippi Legislature have refused to expand Medicaid to adults with incomes up to 138% of the federal poverty level, which is allowed by the Patient Protection and Affordable Care Act.

BCBS last week offered to reinstate four of the HMA hospitals, but HMA declined the offer, saying that the insurer insisted on terms and conditions that don't apply to other hospitals in its network, such as lengthy prior authorization processes.

The insurer disputed HMA's categorization and said the terms are based on prior agreements and any preapprovals are part of its efforts to coordinate high-risk care.

Bryant's executive order requires BCBS to reinstate the hospitals under the terms of their prior contracts for up to 60 days while an investigation is performed into whether the insurer broke any laws. In particular, his order cites the Mississippi Patient Protection Act of 1995, which requires insurers to provide beneficiaries with “reasonable access to care with minimum inconvenience.”

A spokeswoman from BCBS could not be reached for comment at deadline.

Bryant emphasized that the order is not intended to take sides on the payment dispute and HMA's subsequent legal action.

A news release from the governor's office obliquely addresses the insurer's claims and statements about Bryant. It quotes Democrat Attorney General Jim Hood saying, “The inflammatory comments made by Blue Cross in its legal filings about the governor are unprofessional at best, and are counterproductive to our primary goal—to protect Mississippians' access to healthcare.”

BCBS has market shares of 81% in the state's large group market, 73% in the small group market and 57% in the individual market, according to the governor's executive order.

(This story has been updated to indicate that Attorney General Jim Hood is a Democrat.)

Follow Beth Kutscher on Twitter: @MHbkutscher

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