One of three companies managing Medicaid in Nebraska faces sanctions for ‘serious deficiencies’ – Omaha World-Herald

LINCOLN — One of the companies managing Medicaid services in Nebraska faces state sanctions for “ongoing and serious deficiencies” in its performance.

Nebraska Medicaid Director Thomas “Rocky” Thompson disclosed the action taken against Nebraska Total Care at a legislative briefing Tuesday.

He said the company, a subsidiary of the St. Louis-based Centene Corp., has until Friday to submit a plan for correcting its problems and complying with contract requirements.

Those problems include failing to pay behavioral health and home health care providers accurately and on time, according to the sanction documents.

Problems also include the company’s failure to comply with a mid-March correction plan and failure to fix the payment problems promptly.

“We were deeply concerned,” Thompson said. “The timeline for resolution of the issues was not acceptable to us.”

Centene officials did not immediately respond to a request for comment.

The sanctions reflect the difficulties that Nebraska has encountered in launching a new system for administering the bulk of its Medicaid program.

Under the system, called Heritage Health, the Nebraska Department of Health and Human Services contracts with three companies to administer some $1.2 billion worth of physical health, behavioral health and pharmacy services for about 228,000 people.

The companies — United Healthcare Community Plan, Nebraska Total Care and WellCare of Nebraska — have been responsible for authorizing and paying for care since Jan. 1.

At Tuesday’s briefing, Thompson told members of the Health and Human Services Committee that there are still “bumps” that need to be resolved with the new system.

But he said the problems mostly involve behavioral health and home health services, and he sounded an optimistic note overall about the progress of Heritage Health.

“We’re seeing issues decline, so we see light at the end of the tunnel,” Thompson said.

Medicaid providers who testified later in the day, however, painted a gloomier picture of a system beset by difficulties getting claims paid, care authorized and providers credentialed.

Jessica Thoene, a speech-language pathologist from Kearney, spoke on behalf of a newly formed association of Heritage Health providers.

She said group members recently reported some $27 million worth of claims that have not been paid by the managed care companies in more than 60 days.

That includes money owed to hospitals, home health and behavioral health providers, nursing homes, doctors and others but probably underestimates the total amount of past-due Medicaid bills.

“It’s a huge issue,” Thoene said. “There are a lot of providers in financial crisis.”

As a result, some providers have cut back on the number of Medicaid patients they see or have reduced the level of services they provide, she said.

At least one took out a line of credit to pay staff, while three providers have filed for bankruptcy, she said. Some have decided to stop seeing Medicaid patients altogether.

Corrie Edwards, president and chief executive officer of Mid-Plains Center for Behavioral Healthcare Services in Grand Island, said her organization had about $100,000 in unpaid Medicaid claims at the end of May.

That was down from about $300,000 in late February, when she wrote a personal check to help cover staff payroll, she said.

“This has been going on way too long,” Edwards said of the payment problems. “It’s shutting people down.”

Edwards said she has stepped back from her executive duties and from other involvements to focus full time on straightening out claims with the three Heritage Health companies.

She also hired three new employees just to deal with the paperwork for Medicaid managed care.

“This is literally all we have done for six months,” she said.

Other providers offered similar accounts of unpaid claims and frustrating bureaucracy. They said they have experienced problems with all three Heritage Health companies.

State Sen. Merv Riepe of Ralston, the committee chairman, urged patience with the process, noting that the new managed care system is only in its sixth month of operation.

“We cannot tolerate low standards but the department (HHS) is not and never will be perfect,” he said.

Another committee member, Sen. Steve Erdman of Bayard, called the testimony “very disturbing” and “not acceptable.”

Riepe said he hopes the Health and Human Services Committee can provide needed oversight for Heritage Health and shine a light on problems within the system.

The committee plans quarterly meetings on Heritage Health. Riepe said he hopes in the future to hear from all parties involved with the system, including people covered by Medicaid.

State officials have said the goals of the new system are to improve care for patients, control the growth of Medicaid costs and make state government more efficient.

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