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Kansas Health Department: Aetna Still Not Fulfilling Medicaid Contract Terms

(Photo by Chris Neal for the Kansas News Service)

Kansas Medicaid Insurer Aetna on Even Thinner Ice with State Officials
By Celia Llopis-Jepsen / Kansas News Service

TOPEKA, Kan. (KNS)  ― Aetna remains in hot water with the state of Kansas, which recently threatened to cancel the company’s Medicaid contract.  In late July, the Kansas Department of Health and Environment gave Aetna Better Health 10 days to resolve a laundry list of long-running problems.  

But on Tuesday, the agency said the insurer’s reply doesn’t cut it, “nor does it present a clear path to compliance.”  Aetna gets another shot at fixing what health care providers describe as chronic issues with payment, among other concerns.  

Aetna provides health insurance to around 100,000 Kansans under KanCare, the state’s privatized Medicaid system. It’s one of three companies with contracts to do so, and replaced one of the previous insurers in January.

The state health department did not provide a copy of Aetna’s compliance plan, explaining it is not yet a public document in its current unfinalized state. But in a cover letter that Aetna filed with the state on Aug. 7, says the company says it has fixed several issues and that many of the other problems “are well on their way to compliance.”

State health officials plan to meet with Aetna leaders, who asked in their letter for an in-person conversation in the event that Kansas remains unsatisfied. As for setting a new deadline for Aetna, officials intend to meet with company leaders first.

    Read our original story on complaints against Aetna, and on the state’s demands.

Complaints against Aetna include that the company doesn’t reimburse correctly or on time. Providers say they sometimes don’t get paid because Aetna demands advance permission for certain basic procedures. They also complain that the company hasn’t put together a complete directory of physicians and specialists that it covers.

The state’s written complaint to Aetna in July said that doctors and others struggle to secure provider credentials from the insurer, and that discrepancies in Aetna’s records mean Kansas can’t judge the adequacy of the company’s provider network for Medicaid recipients.

Aetna didn’t grant requests last week and this week for interviews, but said in an email that it will work with Kansas to “enhance” its corrective plan and “add a greater level of detail.”

Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. Follow her on Twitter @Celia_LJ.  The Kansas News Service is a collaboration of Kansas Public Radio, KCUR, KMUW and High Plains Public Radio - focused on the health and well-being of Kansans, their communities and civic life.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

 

(AP version)

Kansas Health Department: Aetna Still Not Fulfilling Medicaid Contract Term

TOPEKA, Kan. (AP) — The Kansas health department says insurance company Aetna is still not living up to the terms of its $1 billion contract with the state's Medicaid program. The Wichita Eagle reports that the state has rejected a corrective action plan Aetna submitted in response to a non-compliance letter Kansas sent it last month. The Kansas Department of Health and Environment released Tuesday Aetna's proposed plan. The company says it's addressed several concerns and many others are "well on their way to being brought into compliance" under the contract. But the state says the company's plan doesn't adequately address its concerns. It asked Aetna to submit a new one and plans to negotiate with company officials for a resolution. A Wichita Eagle request for comment to Aetna was not immediately returned.

 

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