Are different MCOs treated differently by the state?
Terry Boyd at Insider Louisville has been out front in reporting on the emerging lawsuits by at least one major Medicaid provider against at least two Medicaid Managed Care Organizations (MCOs) that are handling Medicaid managed care for the Commonwealth. Thank you! I have already expressed my opinion that these suits are like canaries in the cage telling us that something is very wrong with the health of Medicaid in the state and by implication, for the health of Medicaid beneficiaries, medical providers, and those who finance the system. Keep it up!
I am still confused by the nature and details of the claim by Coventry that they were treated differently than at least one other MCO by the state in terms of their requirement to have Appalachian Regional Healthcare (AHS) in their provider network. (I too assumed that the “other” was Kentucky Spirit, but Mr. Nolan of Coventry seems careful not to name the other organization.) From their lawsuit against Kentucky Spirit (KS), it appears that ARH opted not to sign a full provider contract with KS that would have required it to accept the payment rates of KS as well as other contractual agreements. That would make ARH an out-of-network provider for KS. Despite this, KS continued to authorize and therefore agreed to pay for at least some patient services from ARH. Continue reading “Medicaid Managed Care Lawsuits: Further Thoughts”