LINCOLN — A special legislative committee to oversee Nebraska’s revamped Medicaid system appears unlikely this year as state officials and critics offer sharply differing views on the new system’s performance.
Several health care provider groups have renewed their push for such a committee recently, in light of persistent problems they have encountered with the year-old system known as Heritage Health.
“We understand that Heritage Health is how we’re going to operate from here on,” said Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations. “We want it to work.”
They are supporting Legislative Bill 442, introduced by State Sen. Kate Bolz of Lincoln.
The bill would create a special committee charged with looking at the quality of care, cost of services, coordination of care and other aspects of Heritage Health. Committee members would include leaders from the Health and Human Services and Appropriations Committees, plus three other lawmakers appointed by the Executive Board.
But state officials and the chairman of the Health and Human Services Committee oppose the idea, arguing that such a committee is unneeded.
Sen. Merv Riepe of Ralston, the committee head, said he doesn’t believe there are enough votes in the Legislature’s Executive Board to advance LB 442. But if the bill does get out of committee, he vowed to fight it vigorously.
He said the proposed oversight committee represents an attempt to usurp the responsibility of the HHS Committee, which he heads. The HHS Committee held quarterly meetings last year to get reports on Heritage Health and hear from the public.
“Some people don’t think we are going after the managed care organizations as hard as we should,” he said.
Thomas “Rocky” Thompson, the interim state Medicaid director, said the implementation of Heritage Health has been one of the most successful in the nation and is producing “overwhelmingly positive outcomes.”
Since Jan. 1 last year, Nebraska has contracted with three private companies to manage and pay for the bulk of Medicaid services.
The companies — United HealthCare Community Plan, Nebraska Total Care and WellCare of Nebraska — administer some $1.2 billion worth of physical health, behavioral health and pharmacy services for almost all Medicaid recipients.
HHS took action against the three private contractors eight times in the system’s first 11 months. HHS imposed financial sanctions once, required corrective action plans three times and issued four written warnings.
Each contractor received at least a warning. The financial sanctions were waived when the company showed progress in correcting its problems.
The most recent indication of concerns was a survey done in December by the Nebraska Heritage Health Stakeholder Coalition, an organization of health care providers.
The unscientific survey indicated that more than half the respondents had encountered problems with getting proper payment for claims submitted 30 days earlier. Nearly two-thirds of the 158 providers that responded to the informal survey said they had problems with claims submitted 90 or more days earlier.
Nearly two-thirds also said they had to use more staff time to handle the administrative requirements of the new system.
Nine respondents said they had stopped taking Medicaid patients because of Heritage Health reimbursement problems and 26 said they had reduced the number of Medicaid patients they accept.
Dubas acknowledged that the survey had limitations. But she said it shows that there are issues among a wide variety of health care providers, including hospitals, doctors, behavioral health providers, nursing facilities and others.
“I think it gives a pretty good snapshot,” she said.
Thompson and Riepe panned the survey. Thompson questioned whether the results accurately represent the experience of the 30,000 health care providers that participate in Heritage Health.
Riepe noted that the survey was done by the same groups that have been criticizing the new system.
Bolz said the survey shows there are continued problems with Heritage Health. But she argued that the proposed oversight committee would have value even if the system were operating smoothly.
It would have a charge backed by the Legislature and could bring a number of interested parties together to examine the new Medicaid managed care system.
“I see LB 442 as a solution-oriented bill,” she said. “I think that this is a bill whose time has come.”