Managed Medicaid Could Compound SNF Headaches in Kansas as Aetna Pledges Improvements

After health care providers reported a range of issues with reimbursement, one of Kansas’s three managed Medicaid insurance companies promised improvement at a recent state government hearing.

“Clearly, the feedback we’ve received and some of the issues that have been brought to our attention and some of the issues we’ve seen internally have been extremely disappointing,” Randy Hyun, CEO of Aetna Medicaid, told lawmakers during a KanCare oversight committee meeting held Tuesday, in remarks reported by The Wichita Eagle.

Aetna is one of three insurance companies operating KanCare, Kansas’ privatized Medicaid program. It provides health insurance to about 100,000 Kansas residents, the radio station KCUR 89.3 reported. The company replaced Amerigroup as one of the three insurers in January.

Several health care providers in Kansas told lawmakers that they had experienced issues where payments stopped altogether for some providers, according to the Eagle. Other complaints include incorrect or delayed reimbursement, Aetna demanding advance permission for basic procedures, and incomplete directories.

Aetna has wrongly requested refunds to providers and made incorrect payments to nursing homes operated by Onaga, Kan.-based Community HealthCare System, CEO Todd Willert told lawmakers, as reported by the Eagle.

The issues with Aetna are reminiscent of those that existed when KanCare was launched in 2013, Cindy Luxem, the president and CEO of the Kansas Health Care Association said in remarks reported by the Eagle.

When Luxem spoke with Skilled Nursing News about a week before the hearing, the scope of the problem for SNFs hadn’t been determined. But she emphasized the challenges that operators face when they don’t receive timely payment.

“When the providers are already running a red situation with finances, to not be paid — it’s just ridiculous,” she told SNN before the hearing.

Kansas’s Department of Health and Environment (KDHE) sent a notice of noncompliance on July 24, which informed Aetna that “the contract is in jeopardy of being terminated for cause.” It also outlined 11 areas of concern that the state had in a separate document, citing the various problems that providers reported in the hearing.

Aetna submitted a plan to correct the issues on August 6, but that was rejected by the KDHE for insufficiently addressing the complaints, the Topeka Capital-Journal reported. Aetna, in response to the rejection of the initial corrective plan, removed the management team that oversaw the contract and pledged to install administrators with Medicaid experience, according to the publication.

Aetna has done other Medicaid contract work in several states, including in California, Texas, and Illinois — which should have helped it avoid problems in Kansas, state Rep. Brenda Landwehr, who serves on the oversight committee, said.

A spokesperson for the KDHE told SNN that the state received a second draft of a corrective action plan from Aetna on August 23, and is reviewing it to ensure it meets the needs of members.

In Kansas, 54% of nursing facility residents have Medicaid as their primary payer, according to 2017 data from the Kaiser Family Foundation.