Frustrations continue for some despite fixes to state Medicaid managed care system

LINCOLN — State lawmakers heard very different views Friday about the performance of Nebraska’s new system of managing Medicaid services.

State Medicaid director Thomas “Rocky” Thompson said the three companies that administer the services have resolved their broad, systemic issues.

The problems remaining, he said to the Health and Human Services Committee, tend to be limited in scope and specific to certain types of providers.

But representatives of several provider groups, along with a couple of patients, said they continue to be frustrated with getting claims paid and getting care authorized.

Melanie Standifer, with CenterPointe, a behavioral health treatment center, said the three companies have made improvements but not quickly enough for providers and patients.

“It’s really inexcusable that we’re here in September and still experiencing this level of difficulty,” she said.

The managed care system, called Heritage Health, launched Jan. 1.

Under the system, the Nebraska Department of Health and Human Services contracts with three private companies to authorize and pay for care for about 228,000 Nebraskans.

The companies — United Healthcare Community Plan, Nebraska Total Care and WellCare of Nebraska — are responsible for administering $1.2 billion worth of physical health, behavioral health and pharmacy services.

In June, payment problems led HHS to impose sanctions on Nebraska Total Care.

On Friday, Thompson said the sanctions were lifted after the company made major efforts to improve its payment process. The efforts included hiring more staff and working with a consultant.

But the state now is threatening sanctions against WellCare if it does not fix its “ongoing and serious” performance problems.

Those problems include leaving a critical position — the finance director — vacant, inappropriately denying payments to behavioral health providers and durable medical equipment providers, and failing to correct problems with payments for people covered by both Medicare and Medicaid.

Thompson said WellCare has submitted a corrective action plan that will be reviewed by the state.

Lauralie Rubel, WellCare’s state plan president, said she is confident the company can fix the problems and believes the plan offers the company an opportunity to improve.

Providers who testified pointed to problems with each of the three companies.

Jon Novak, with Total Respiratory and Rehab, said his company is owed $1.4 million for wheelchairs provided to Medicaid patients. Most of that is because of problems getting one company to approve the chairs as medically necessary.

Vicky McHugh, an Omaha physical therapist, said her biggest problem is with a different company, which denies about half of the claims submitted because of clerical issues.

Patients, too, have run into difficulties.

One Medicaid recipient, Jody Faltys, said it took multiple phone calls to get approval to keep seeing her doctor of 15 years. It took 35 days to get authorized for a new wheelchair battery.

martha.stoddard@owh.com, 402-473-9583

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