HaysMed, patients await changes



Approximately two weeks into the state's new Medicaid program, it remains to be seen how the changes will affect Hays Medical Center patients.

Kansas has contracted with three private managed care organizations to administer Medicaid claims. Hays Medical Center, thus far, has contracted with only one of those companies -- Sunflower State Health Plan.

It is unclear if contracts will be entered for the other two policies.

"At this point, the way they're positioning right now, we're choosing not to contract with them as of today. There are a few terms in the contracts that are just not acceptable," Chief Financial Officer Bill Overbey said. "Hopefully, they change their position and we're able to contract."

The state's approximately 380,000 Medicaid enrollees randomly were assigned to one of the three companies, with the other two being Amerigroup of Kansas and United Healthcare of the Midwest.

Patients have 90 days, or until April 4, to change policies.  

If HaysMed does not reach agreements with the other companies, Medicaid patients under those policies still can receive care at the facility, but there would be more "hoops to go through," Overbey said.

One of those hoops would be a pre-authorization requirement for clinic visits.

"They'd have to be pre-authorized," Overbey said. "And if that MCO doesn't give that pre-authorization, they won't be able to see their primary care physician."

In that case, HaysMed staff would be tasked with helping patients obtain the needed authorization, he said.

Patients needing emergency care are admitted regardless of insurance policy or ability to pay.

The sticking point is language in the other two contracts regarding Medicaid claim administration, appeal and payment processes, Overbey said. One of the contracts, for example, stipulates the hospital will not receive payment if a patient is readmitted for any reason, he said.

"Which doesn't make sense," Overbey said. "They're here for an inpatient stay and come back for a legitimate reason. We won't get paid at this point."

"We wish they would have all just had the same administrative terms, and we could have just contracted with all three," Overbey said. "But they didn't make it easy."

Medicaid payments account for approximately 5 percent of the hospital's gross revenue, Overbey said. If the hospital has not contracted with the other health plans by April 1, HaysMed's Medicaid payment from those policies will drop to 90 percent of the predetermined rates.

HaysMed is not alone. Overbey said other hospitals throughout the state are facing similar situations.

Pawnee Valley Community Hospital in Larned, operated by HaysMed, also is contracted only with Sunflower.

For now, it's a waiting game. Negotiation efforts are continuing, and in the meantime, patients with questions or concerns can contact HaysMed customer service at (855) 429-7633. Medicaid patients wanting to switch plans can call (866) 305-5147.

"With any new program, there's always uncertainty," said Shae Veach, vice president of regional operations.

Administrators, however, said they are pleased with Sunflower's performance so far. Company employees last week spent time at HaysMed to provide staff training.

"All I've heard is great things," Overbey said. "Very positive feelings from the staff."