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* This doesn’t happen very often, so it’s one of those “man bites dog” stories…
The governor recently rejected a measure (HB684) that would allow private ambulance companies to bill non-emergency transports through the state rather than through managed care organizations contracted by Illinois to coordinate care for patients on Medicaid, the state’s health insurance program for the poor.
Pritzker contended the billing switch could harm vulnerable Medicaid patients, by making it harder for them to get ambulance rides to doctors’ appointments and other services.
First the House, then the Senate, easily and overwhelmingly overrode Pritzker’s veto.
The ambulance industry said managed care organizations are so far behind in reimbursing them for rides and they’re so financially stretched that they’re unable to pay emergency medical technicians enough money, contributing to a shortage of ambulance drivers and technicians.
* More…
The measure would transfer the review of claims from managed care organizations, or MCOs, which are private insurance companies that oversee most Medicaid services in the state. The Department of Healthcare and Family Services, which opposed the bill, would be the entity handling those claims under the bill. They already do so for emergency ambulance services, a change made in April.
The Illinois State Ambulance Association said the measure, House Bill 684, is needed to counter arbitrary denials of claims by private insurers. The governor’s office and HFS, however, expressed “serious concerns for patient safety and cost.”
In his veto message, Pritzker said the bill “has the potential to disrupt care and reduce the quality of provided medical transportation services to some of the most vulnerable Illinoisans.”
But ambulance services said payment delays from MCOs threatened staffing, and the change would simply provide a way to “get paid for the services provided.”
posted by Rich Miller
Thursday, Sep 2, 21 @ 1:51 am
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Let’s just acknowledge that in this veto override, Republicans have said that state government can manage things better than the private sector.
Comment by Yellow Dog Democrat Thursday, Sep 2, 21 @ 5:23 am
Let’s just acknowledge that the governor was not served well by his top advisors and those who run HFS. Why veto a bill that passed both chambers unanimously?
Comment by Morris Day and the Time Thursday, Sep 2, 21 @ 6:33 am
Morris, because the GA was wrong. Trashing a program piece by piece instead of fixing it - and I’m even giving the providers the benefit of the doubt here and saying there’s a problem, which is questionable-is not way to run a program. Hoping the GA would see their error might be unwise but there’s a benefit to telling them their wrong as loudly as you can I think.
Comment by Perrid Thursday, Sep 2, 21 @ 8:48 am
An example, from the ambulance industry, of the old adage: “better to ask for forgiveness on the back end than permission on the front end.” The administration will get over it, even though they would never have said “yes” upfront.
Comment by anon Thursday, Sep 2, 21 @ 9:25 am
This was terrible legislation and the governor was right to veto it. It’s sad that so many were willing to throw the ambulance industry a bone simply because they don’t like the MCO industry. HFS repeatedly warned how bad this legislation will be for Medicaid recipients. We’ll soon see whether they were right.
Comment by Southern Skeptic Thursday, Sep 2, 21 @ 9:35 am
Isn’t there a better way to get people to their doctors for appointments than tie up ambulances?
Comment by Cheryl44 Thursday, Sep 2, 21 @ 9:53 am
I wonder if those of you who are saying the legislature made a mistake on that have a disabled adult child that has complex disabilities and complex health conditions and as power of attorney you deal with the MCOs. You have no idea how hard and how much time it takes. You have no idea of how many times State regulations are ignored. Also, the MCOs evaluate their own performance and basic contract compliance. Our tax dollars could be used better than to pay profit. This issue is very complex. Also, Managed Care has yet to actually save any money. The legislature listen to me, to the common man, to those on Medicaid and not the MCO lobbyists, the MCO’s million dollar CEOs and the high ranking politically appointed bureaucrats at HFS.
Comment by Almost retired Thursday, Sep 2, 21 @ 9:58 am
Thank you, Cheryl44 @ 9:53 am.
Comment by Responsa Thursday, Sep 2, 21 @ 10:49 am
Perrid, that’s quite a statement. This bill passed without a single no vote through two chambers. To say that every member was wrong is ridiculous. Many members have been working on health care policy for many years, and they are extremely knowledgeable. To say they all voted for something that they didn’t understand is almost as arrogant as the governor vetoing a bill that passed without a single no vote. This is a wake up call to the administration to start fixing the problems with managed care. In case you hadn’t noticed, just about every provider group has major problems with the MCOs. I guess they’re all wrong too, right?
Comment by Morris Day and the Time Thursday, Sep 2, 21 @ 10:49 am
MCO’s are a boondoggle and have been since the beginning.
Poorly run human rain delays in terms of providers being paid. An unmitigated disaster. Zero value added. None.
Perhaps this is the first step in voting these turds off of the island.
Comment by Say what? Thursday, Sep 2, 21 @ 10:50 am
Think about this and where we were: an industry/entity believes the State of Illinois will pay them quicker and on time for services rendered than a private entity/industry. So good on the State but just wow to the giant squid that is our healthcare system.
Comment by 1st Ward Thursday, Sep 2, 21 @ 10:51 am
Morris, if you don’t think that legislators will -at least sometimes, and I’m being generous there- bend over backward to give special interests consideration without caring about the impact you’re as naive as you think I’m arrogant.
Comment by Perrid Thursday, Sep 2, 21 @ 1:52 pm
Right, Perrid. Every Democrat AND Republican legislator did just that here. You’re ridiculous. If I were a legislator, I would be offended.
Comment by Morris Day and the Time Thursday, Sep 2, 21 @ 3:13 pm