A report from Gambit highlights some of the countless problems health care providers are facing amid the rollout of the state's privatized Medicaid system. 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.
Read more here and here.