Under the contract, Magellan is required to pay at least 95% of clean claims — meaning claims for services that have no errors — within 30 days. The managed care organization is meeting this requirement, but the results have varied among providers.
Cook said he’s received complaints from providers in his area that they were not receiving timely payments.
Magellan of Idaho Executive Director David Welsh spoke at the meeting, and said that in August, the organization had paid $1.5 million from clean claims to federally qualified health care centers — which provide these services to patients regardless of their ability to pay. In September, it paid $2 million, Welsh said.
Another bump was that provider payments were sent by paper check for the first 60 days as a security measure because of a national data breach.
The department also sent a letter to Magellan on Aug. 16, notifying them that they appeared to not be in compliance with requirements for communication with participants, especially for intensive care coordination. Charron said that by September, most of the issues had been resolved, and the department is working with the organization to improve training for care coordination in Idaho.
Sen. Melissa Wintrow, D-Boise, said some of these issues with the intensive care coordination had come to her attention.
“There’s been some negative impacts to families, in particular, maybe resulting in institutionalization or Department of Corrections for youth,” she said Monday. “At the end of the day, we’re talking about all this data, but boy, when you have a kid with complex needs and they’re going to keep you in the Department of Corrections instead of into the appropriate treatment, that’s a problem.”
OTHER CONTRACTS, PANEL’S GOALS
The panel members received an overview of a variety of Medicaid’s contracts, which included 12 administrative contracts — many of which are federally mandated — totaling about $27 million. Contracts for Medicaid management information systems, which is in the process of being updated, total around $42 million.
Managed care contracts, which in addition to behavioral health also include dental programs and a program for people dually enrolled in Medicaid and Medicare, total more than $1 billion.
Cook asked a number of questions about the dental program, known as Idaho Smiles.
He told the Idaho Press he’s received complaints from the Idaho Oral Health Alliance that the organization was not given a seat at the committee formed to oversee the program, when the contract stipulated that it should.
Cook said this was an example of where he wants to see the Legislature get more involved in understanding the state’s contracts and holding the agency and its vendors accountable.
Wintrow told the Idaho Press that she had originally voted against forming the panel, because she thought its function could be handled by the existing House and Senate Health and Welfare Committees, but she found Monday’s meeting valuable.
“It really helps the Legislature have a picture of how we are spending taxpayer dollars and for what,” Wintrow said.
The panel is likely to meet again during the legislative session, which begins in January, said co-Chairperson Julie VanOrden, R-Pingree.
Guido covers Idaho politics for the Lewiston Tribune, Moscow-Pullman Daily News and Idaho Press of Nampa. She may be contacted at lguido@idahopress.com and can be found on Twitter @EyeOnBoiseGuido.