Call to Order and Roll Call
The 1st meeting of the Budget Review Subcommittee on Human Resources of the Interim Joint Committee on Appropriations and Revenue was held on<Day> Thursday, June 18, 2015, at 10:00 AM, in Development Room C at The METS Center, 3861 Olympic Blvd., Erlanger, KY. Senator Ralph Alvarado, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator Ralph Alvarado, Co-Chair; Senators Denise Harper Angel, Christian McDaniel, and Morgan McGarvey; Representatives Tom Burch, Donna Mayfield, and David Watkins.
Guests: Ms. Sarah Nicholson, Vice President of Government Relations, Kentucky Hospital Association (KHA); Mr. Steve Miller, Vice President of Finance, KHA; Mr. Josh Greeman, Director of Cooperative Care, Ephraim McDowell Regional Medical Center; Ms. Martha Mather, Chief Operating Officer, Our Lady of Peace Hospital; Ms. Amber Goodpaster, Chief Financial Officer, Clark Regional Medical Center; Dr. Ron Waldridge II, KentuckyOne Health; Ms. Vickie Marshall, Central Kentucky Radiology; and Dr. Molly Rutherford, Renewed You Clinic.
LRC Staff: Cindy Murray, Jennifer Anglin, and Amie Elam.
Kentucky Hospital Association
Ms. Sarah Nicholson, Mr. Josh Greeman, Ms. Amber Goodpaster, Ms. Martha Mather, and Mr. Steve Miller spoke on the impact of Medicaid Managed Care on healthcare providers.
In response to questions from Chair Alvarado concerning national Medicare guidelines, Ms. Mather said that there should be one nationally recognized set of guidelines.
In response to a question from Chair Alvarado concerning claims paid by the Cabinet for Health and Family Services (CHFS), Ms. Mather said that claims sometimes take up to two years to be paid. Mr. Greeman said that there is a possibility that 98 percent of claims are paid, but that many of those claims were under-reimbursed.
In responses to a question from Chair Alvarado concerning Medicaid Managed Care (MMC) patients, Mr. Greeman said that about 20 percent of patients at Ephraim McDowell Regional Medical Center are on MMC, Ms. Mather stated that a majority of patients at Our Lady of Peace Hospital are on MMC, while Ms. Goodpaster said that roughly 25 percent of patients in Clark Regional Medical Center are MMC patients.
In response to questions from Chair Alvarado on the appeals process for denied claims, Mr. Greeman said that roughly half of all emergency department claims that go to appeals are recovered, but that the most challenging part of appeals is the 30 day limit to file an appeal. Ms. Goodpaster said that Clark Regional Medical Center currently has 1,215 appeals which is a significant cost to the hospital. Ms. Goodpaster said that it usually takes four to five months to receive judgment on an appeal, and the hospital only sees roughly one-third of appeals overturned. Ms. Mather said that each claim can take one person eight to ten hours to complete.
In response to a question from Rep. Burch concerning payments from those not in MMCs, Mr. Greeman said that every payer/provider relationship has issues. Mr. Greeman stated that it would be very difficult to provide care for emergency room patients on less than $50 because of the various physicians and technicians involved.
Outpatient Healthcare Professionals
Dr. Ron Waldridge, Dr. Molly Rutherford, and Ms. Vickie Marshall spoke on the impact of Medicaid Managed Care on healthcare providers.
There being no further business before the subcommittee, the meeting was adjourned at 11:47 AM.