Mendoza turns sights on MCOs
Thursday, Feb 7, 2019 - Posted by Rich Miller
* Pantagraph…
Illinois Comptroller Susana Mendoza is backing legislation that would require insurance companies that manage much of the state’s Medicaid program to publish more information about how promptly they are reimbursing claims.
The insurance companies, known as managed care organizations, or MCOs, contract with the state to manage the care of individuals enrolled in Medicaid. Among other things, that involves working with patients to make sure they receive routine exams and preventive care, and coordinating services provided by their primary physicians and other specialists.
The goal of a managed care system is to reduce costs and improve health outcomes by preventing the need for many emergency room visits and the complications that can result when patients don’t receive follow-up care.
Last year, Illinois greatly expanded the managed care system to make it available in all counties. But in a statement Wednesday, Mendoza said it is difficult for her office to know what happens to the roughly $63 billion a year the state now spends on managed care after the money is handed over to the MCOs.
…Adding… The article is in error. That $63 billion is the total number from the procurement. The annual spending is far lower.
…Adding… The comptroller’s office says current fiscal year is roughly $14 billion all funds for MCOs.
* From Mendoza’s press release…
“South Shore Hospital has been devastated by delayed and denied payments from the MCOs, and it threatens our ability to keep the doors open,” South Shore Hospital Chief Executive Officer Tim Caveney said. “South Shore cares for the state’s most vulnerable patients. MCOs, as for-profit companies, deny and delay payments to maximize their profits. Today, we are still owed millions by the MCOs and seeing more than 20 percent of our cases denied by the MCOs, for no legitimate reasons. This cannot continue.”
Caveney said he commends Comptroller Mendoza and the sponsors of this legislation for working to bring transparency to the process. “It is only through the good work of Comptroller Mendoza and other policymakers that we can advocate for Illinois’ most vulnerable residents and protect the fragile health care safety net that is the only option for so many,” he said.
House Bill 2117 /Senate Bill 1238 would require MCOs to publish provider payment information on their websites every quarter. The information posted would include:
* Total number of claims received by the MCO for that quarter
* The number and amounts paid to providers
* When the payments were made
* When the claims for those payments were received
* When the service the payment is for was rendered
“The Medicaid program represents a massive area of state spending. This basic level of transparency is needed to protect taxpayer dollars and to ensure MCOs are paying what is owed to providers who serve Medicaid patients,” Representative McSweeney, R-Barrington Hills, said.
“Providers offering care to sick children and others in need are struggling because of payment delays, and they have no reliable way of knowing when their next payment is coming.” Senator Fine, D-Glenview, said. “As more and more state dollars are filtering through MCOs, it just makes sense to require transparency and give some predictability to our health care providers.”
The MCO Transparency Act is a natural outgrowth of Comptroller Mendoza’s Debt Transparency Act that opened the windows on unpaid bills held by state agencies and her other transparency reforms that shed light on the off-shoring of the Governor’s staff; the Vendor Payment Program and the state’s obligations to pay Late Payment Interest Penalties.
- Anonymous - Thursday, Feb 7, 19 @ 9:24 am:
Isn’t she running for Mayor?
- Huh? - Thursday, Feb 7, 19 @ 9:25 am:
Sounds like Mendoza is better suited as comptroller than mayor.
- wordslinger - Thursday, Feb 7, 19 @ 9:34 am:
–Mendoza said it is difficult for her office to know what happens to the roughly $63 billion a year the state now spends on managed care after the money is handed over to the MCOs.–
Um, the reporters and editors of this Pantagraph story need to invest a couple of hours and acquaint themselves with some Illinois budget basics.
That way, they’d know how preposterous it is to publish that Illinois now spends “roughly $63 billion a year” on managed care.
That’s a four-year number, the amount of the long-term MCO contracts Gov. Rauner signed last year.
By the way, the Rauner administration wrote the specs, sent out the RFPs, then selected the winners of those $63 billion in contracts.
Anyone still believe the speaker’s office is the most powerful in the state? Having the sole authority to award $63 billion in contracts — that’s real power.
https://www.sj-r.com/news/20171129/democrats-want-answers-on-medicaid-managed-care-contracts
- Bobby Beagle - Thursday, Feb 7, 19 @ 9:37 am:
Probably best to start turning her focus back to her day job. Losing the mayoral election is one thing, but then being vulnerable to attacks that she was distracted from her current position by these failed ambitions is salt in the wound of her next campaign.
I’m just glad it’s all gone so poorly for her. Good marketing can only get you so far when it’s in opposition to some uncomfortable facts about your resume and connections.
- wordslinger - Thursday, Feb 7, 19 @ 9:44 am:
To the bill, it’s surprising that the Rauner administration did not require this level of basic transparency when they wrote the contracts.
I mean, when you award $63 billion in contracts, you should want to keep tabs on how it’s being spent, correct?
Good to see a bipartisan effort to fix this curious oversight.
- Chicagonk - Thursday, Feb 7, 19 @ 10:03 am:
Is Mendoza complaining that the MCO isn’t paying providers what they want to be paid? Isn’t that the point of an MCO? Just imagine the budget situation if providers were automatically reimbursed for the full amount of every bill they submit.
- Rich Miller - Thursday, Feb 7, 19 @ 10:05 am:
===isn’t paying providers what they want to be paid?===
Delayed payments are an issue.
- JAH - Thursday, Feb 7, 19 @ 10:10 am:
I think she is part of the reason for delay
- Annonin' - Thursday, Feb 7, 19 @ 10:12 am:
“To the bill, it’s surprising that the Rauner administration did not require this level of basic transparency when they wrote the contracts.”
Mr/Ms WS nearly spit our coffee on the video screen GovJunk wanted no transparency for any part of managed care. Remember his goal was managed care = no care
- JAH - Thursday, Feb 7, 19 @ 10:13 am:
I think she is part of the reason for delayed payments
- Oswego Willy - Thursday, Feb 7, 19 @ 10:18 am:
===But in a statement Wednesday, Mendoza said it is difficult for her office to know what happens… the state now spends on managed care after the money is handed over to the MCOs.===
No matter the amount of money that is in this discussion, the oversight once that transaction happens is something if you’re against, what kind of argument would you have not wanting accountability?
- historic66 - Thursday, Feb 7, 19 @ 10:22 am:
===I think she is part of the reason for delayed payments===
Care to elaborate?
- Whatever - Thursday, Feb 7, 19 @ 10:37 am:
==I think she is part of the reason for delayed payments ==
Because she won’t bounce checks? Or perhaps because she doesn’t make Medicaid payments the absolute number 1 priority, including giving them priority over bond payments and wage payments?
- Perrid - Thursday, Feb 7, 19 @ 10:53 am:
“I think she is part of the reason for delayed payments”
The MCOs pay the providers themselves. There have been times, especially during the impasse, when the state was delaying payments to MCOs and some of the MCOs decided not to pay their providers until they got paid (I say chose because at least some of them absolutely had the reserves to do it).
- Roland Burris' Mausoleum - Thursday, Feb 7, 19 @ 11:06 am:
If this is anything like her last two big policy pronouncements, she will rescind it tomorrow.
- LTSW - Thursday, Feb 7, 19 @ 11:18 am:
Under the old fee for service arrangement providers received interest on the late payments. Now they don’t. Asking the MCO’s to pay the providers when the state is delaying payments to the MCO’s seems a stretch. I’m willing to bet an analysis of the MCO payments to providers will show they are roughly delayed about what they were under the fee for service method. Illinois’ Medicaid program was set up and managed for the benefit of the medical provider community since the beginning. With the exception of a few GA members, patient health outcomes has never been a consideration. Getting certain groups of providers paid has been the goal.
- RPh on the ropes - Thursday, Feb 7, 19 @ 11:22 am:
Even though these bills target the timeliness of the payments from MCO to provider, the actual payments from the state to the MCO should be in question as well. It’s been almost two years since the release of the report from the Auditor General office identifying the complete lack of control of the MCO payments from HFS. “Auditors determined that the Department of Healthcare and Family Services (HFS) did not maintain the complete and accurate information needed to adequately monitor $7.11 billion in payments made to and by the 12 MCOs during FY16.”
Pharmacies are required to service these patients while taking a drastic reduction in reimbursement rates, experiencing ridiculous denials in service and given no opportunity for negotiation.
I applaud Mendoza for shining some light on this fiasco.
https://www.auditor.illinois.gov/Audit-Reports/Performance-Special-Multi/Performance-Audits/2018_Releases/18-Medicaid-MCOs-Perf-Digest.pdf
- "Old Timer Dem" - Thursday, Feb 7, 19 @ 11:32 am:
I guess Mendoza figures making some news as the State Comptroller will get her a reprieve from all the Mayoral negative press she is getting for her associations with Solis, Burke and now Proco Moreno. Mendoza’s campaign for Mayor is imploding.
- Blue Dog Dem - Thursday, Feb 7, 19 @ 12:11 pm:
Delayed payments are bigger than a huge difference. They can break a home in months.
- Anonymous - Thursday, Feb 7, 19 @ 12:42 pm:
It says they want the service dates paid for in the quarter. That would literally give you dozens, probably over 100, lines if you go by the actual date. The same for received date. Then I assume there would be less paid dates, but the MCO could make payments everyday. Not a small report, and pretty much close to useless if you lump all providers together.
- Impatient Patient - Thursday, Feb 7, 19 @ 2:31 pm:
@Roland “If this is anything like her last two big policy pronouncements, she will rescind it tomorrow.” If this is anything like her last four transparency bills, it will pass both houses with unanimous or near-unanimous majorities. She’s got the persuasive abilities you want in a Comptroller. Or a mayor.
- faxing - Thursday, Feb 7, 19 @ 3:51 pm:
the state already has all this data, this is a nice press pop for a mayoral candidate
- Perrid - Thursday, Feb 7, 19 @ 5:20 pm:
@faxing, that would have to be a fairly recent change, considering the audit realeased last year says “Therefore, according to the EUM, HFS’ MMIS only accepted $4.67 billion (66%) in encounters of the $7.11 billion paid to MCOs for FY16.”
The state never got a receipt for $2.5 billion.