As the state continues to phase in its new privatized Medicaid system, which contracts five private insurance companies to manage the health care of 1.2 million of Louisiana’s poorest residents, the horror stories from health care providers trying to adapt are plentiful.
New Orleans Gambit reports this week on just one sector that’s suffering — mental health — through the story of the McNeils, who own and operate a mental health clinic in Chalmette. Medicaid patients account for 95 percent of the McNeils’ business:
Clinical Advisor, a Medicaid reimbursement computer program built by state contractor Magellan Health Services, is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It’s not working. As a result, providers — many of which ... serve Medicaid clients — haven’t been able to submit Medicaid claims. What’s more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid.
Magellan is engineering and installing a massive database that will allow clinics to share information on treatment, patient prescriptions and medical history. While the state is paying the company per-patient fees for management services, individual providers get the software without charge.
Under the LBHP, he says, providers are no longer being paid for Medicaid claims for services provided over the phone. Some phone services, such as scheduling calls, were never covered ... Other phone services — such as calls to other clinics or to patients’ parole or probation officers — are now being handled by LBHP, and thus are not billable.
Having many previously billable claims denied under the new rules leaves clinics with several choices, none of them good. They can ask their staff members to work for free. They can refuse to take calls and risk possible malpractice charges. They can submit a claim for phone care as another, approved service — such as counseling — and possibly be charged with attempted fraud. Or they can pay for phone care out-of-pocket and cover those costs by cutting back elsewhere.
But the problems with implementing the new system extend far beyond what the McNeils are facing, as evidenced by a report from The Advocate on a recent legislative hearing where state Department of Health and Hospitals Secretary Bruce Greenstein addressed tough questions from lawmakers who remain skeptical about the new plan:
The state started phasing in the program in Livingston, Tangipahoa and the New Orleans area in February. Providers complained about having claims routinely rejected and long lag-times in payments on others. The complaints were mainly directed at what are known as “shared savings” plans operated by United Healthcare of Louisiana and Community Health Solutions of America.
Greenstein said problems in getting physicians, hospitals and other providers paid in areas where the program started won’t delay the April 1 expansion of the Bayou Health program into the Baton Rouge and Acadiana areas.
Greenstein’s comments came during and after a House committee meeting at which state Rep. Katrina Jackson, D-Monroe, asked whether Greenstein would consider delaying further expansion of Bayou Health.
“Before this plan is implemented in a new area, we need to have a real discussion on where the (health) plans are,” Jackson said.
“When physicians don’t get paid, they don’t treat Medicaid patients. If this hits Baton Rouge ... and it’s still not worked out, it’s going to discourage physicians in my area from accepting Medicaid patients,” Jackson said.
To post a comment, please log into your IND account. If you do not have an account, click the "register" button to create one. Facebook comments can be used as an alternative to creating an account at theIND.com.
DEC 6 Here we are, at the top of another bad list: this time, Louisiana has the (dubious) honor of beating out all other states when it comes to gutting higher ed funding, this Picayune story reports. The American Association of Colleges and Universities says our cuts (nearly 18 percent this year alone) are the highest in the nation. Three-fourths of the states increased funding last year, with the top spender increasing funding by 28 percent. This is a great legacy for our governor, right?
DEC 6 Blogger Lamar White Jr. takes a look at the creepy effort over in Baton Rouge, wherein the southern, lily-white area of the city wants to secede from the union, er, create its own "city" and take all the really fat sales tax cows with it. Turns out the group campaigning for the move is a for-profit corporation, and Lamar says that means its effort won't pass legal muster.
DEC 6 Blogger Tom Aswell tells us about some fishiness he found in the state worker's comp office. There's some confusion about when one guy started working there, and there's also some involvement by a GOP lege from Hammond. It's all just another example of the Jindal administration's actions that "defy explanation," Aswell says.
DEC 6 Edwin Edwards may think it's possible he will be governor again, but columnist James Gill isn't so sure. Edwards would have to get a presidential pardon to run for governor -- unless he wants to wait until he's 99, Gill says. But even Edwards' many supporters should probably hope he doesn't get that, because there's no real chance he can win, Gill says.
DEC 6 Here's an interesting post on DIG Magazine for football history buffs. It's about the Pelican Bowl, the Bayou Classic and the history of black college football. It's a trip down memory lane and the story of a "mythical black college national crown." What killed it? Trying to compete with the Bayou Classic.
DEC 6 Nelson Mandela became famous while sitting in prison, where he was a symbol of apartheid. But his enduring legacy was his ability to forgive, to reach out a hand of peace to heal his country of division and oppression, and the Picayune talks about this aspect of his personality. The story also reminds us of the more light-hearted moments Louisiana shared with the former President of South Africa.
DEC 6 We've all been passed by a nut on the highway and assumed the driver was on drugs. Maybe that's not hyperbole: here's a story from the Picayune about a guy riding around with a meth lab in his back seat. One wonders if his insurance policy included coverage for random explosions.
DEC 6 Here's a new blog in the NOLA Defender; it's called Shift Change, and it's all about cocktails. This installment by Rhiannon Enlil focuses on the sazerac, the enigmatic cocktail made with absinthe. But Enlil also introduces herself, a long-time NOLA bartender who has "a lot of booze" in her house.
Read the Flipping Paper!
Click Here for the Entire Print Version of IND Monthly