Nearly a year after a Kentucky hospital sued the state over its expanded Medicaid managed-care program, Gov. Steve Beshear has unveiled an “aggressive plan” to resolve payment disputes between payers and providers.
Beshear outlined the plan April 5 after vetoing House Bill 5, which was designed to help healthcare providers receive prompt payments from the state's three Medicaid managed-care contractors. The bill would have required the state Department of Insurance to investigate payment complaints—something it already does in the private insurance market.
The issue came to a head last April after Appalachian Regional Healthcare, Lexington, sued the Cabinet for Health and Family Services for illegally setting Medicaid reimbursement rates that covered only 75% of its costs. It also sued two managed-care organizations for failing to make timely payments, leaving it on the hook for millions of dollars in claims.
Kentucky expanded its managed-care program in November 2011 to cover all 120 of its counties, estimating it could save $1.3 billion over three years.