By Ginger - Site Admin on Wednesday, July 05, 2017 8:47 AM

KHA released a report today on the performance of the five Medicaid Managed Care Organizations (MCOs) operating in Kentucky The report was compiled from public data from 2016. The report provides information on medical loss ratios, utilization review denial rates, quality scores, corrective action and prompt payment.

If you have any questions, please contact Nancy Galvagni at KHA (ngalvagni@kyha.com).

By Ginger - Site Admin on Thursday, June 30, 2016 9:07 AM

SB 20 Ceremonial Signing

On Tuesday, June 28, Spring View Hospital in Lebanon hosted a ceremonial signing for SB 20, KHA's top priority for the 2016 legislative session. KHA is grateful for Governor Matt Bevin's insight into the issues facing hospitals and is pleased to have this new Medicaid managed care organization appeals process in place.

KHA President Mike Rust represented the Association at the event and was joined by Lieutenant Governor Jenean Hampton and Senator Jimmy Higdon as the Governor signed this important legislation.

By Ginger - Site Admin on Tuesday, March 29, 2016 9:51 AM
SB 20, KHA’s priority legislation, passed the House yesterday by a unanimous vote. The legislation gives Kentucky’s medical providers a pathway to external, independent appeals of denied Medicaid managed-care claims. The bill is now on its way to Governor Matt Bevin for his signature. Please, take a moment to contact your legislator personally and thank him or her for their support. 

SB 20, sponsored by Senator Ralph Alvarado (R-Winchester) would allow medical providers to receive an independent third-party review of claims denied by Medicaid managed care organizations (MCOs). The decision of the third-party reviewer could then be appealed to the Cabinet for Health and Family Services, where the decision of an administrative hearing tribunal would be the last step before judicial review. This includes situations when a provider has continued to render care after a denial because, in their medical judgment, continued care was in the patient’s best interest. The process is needed to assure patients get...
By Ginger - Site Admin on Thursday, January 14, 2016 10:09 AM

KHA's priority legislation, SB 20, addresses the need for a Medicaid managed care organization (MCO) appeals process. Nina Eisner, CEO of Ridge Behavioral Health System in Lexington, testified before the Senate Health and Welfare Committee on January 13 and gave examples of why this legislation is desperately needed.

By Ginger - Site Admin on Tuesday, July 28, 2015 8:24 AM
The Cabinet for Health and Family Services (CHFS) in partnership with the Medicaid managed care organizations (MCOs) is once again sponsoring forums across Kentucky in August and September. These forums are designed to allow any and all health care providers (including behavioral health and substance use providers) who have contracts with MCOs and serve Medicaid consumers to meet face-to-face and discuss concerns about proper billing, prior authorizations, prompt pay, appeals processes or any other specific issues related to the continued implementation of Managed Care. In attendance will be senior level staff from each MCO, senior staff from the Department for Medicaid Services and Department for Behavioral Health, Developmental and Intellectual Disabilities.

CHFS encourages pre-registration 5 days in advance of the forum of your choice. You may also register on-site. Online registration is available at http://chfs.ky.gov/forumreg.

The forums will be held at the dates and locations listed below....
By Ginger - Site Admin on Thursday, July 09, 2015 7:55 AM
On Tuesday, July 14, KHA will host a two-hour Members Only Webinar from 10:30 a.m. to 12:30 p.m. (ET) to present the results of a year-long project involving analysis of Medicaid claims data across all sites of service. As part of the Association's Medicaid Reform Strategy, KHA engaged the national consulting firms of Dobson/DaVanzo and Milliman to obtain Kentucky’s Medicaid claims data from the Centers for Medicare and Medicaid Services (CMS) and perform this analysis to assist the membership as they consider new risk-based approaches to Medicaid payment. The analysis and an accompanying chartbook, which will later be made available to the membership, can be used as hospitals work to improve efficiencies in care delivery and negotiate with the MCOs.

Al Dobson of Dobson/DaVanzo and Rebecca Johnson of Milliman will conduct the webinar. Below is an overview of the presentation. Please make note of the presentation of data on episodic payments, which is something being considered by the Cabinet for...
By Ginger - Site Admin on Wednesday, May 27, 2015 8:07 AM
On Tuesday, May 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would update Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to better align them with existing commercial, Marketplace and Medicare Advantage regulations. The proposed rule, which is the first major update to Medicaid and CHIP managed care regulations in more than a decade, includes updates to managed care provider networks, quality measures, external quality review, and beneficiary rights and protections.

KHA staff is analyzing the rule for comments, which are due to CMS by July 27. KHA also submitted issues to CMS via AHA for their consideration in drafting the proposed rule to address problems experienced with managed care in Kentucky.

The regulation proposes a minimum medical loss ratio (MLR) of 85 percent beginning in 2017, standards around actuarial soundness of capitation rates, contracting standards and consumer protections. To read the entire rule, see...
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