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Legislators Press DHS on Medicaid ‘Passes’ After Rocky Rollout; DHS Offers Operational Fixes and Extensions
Summary
At a joint Senate–House hearing, the Arkansas Department of Human Services detailed steps to fix payment and enrollment problems in the Medicaid managed-care rollout, including compliance notices to plans and a commitment to honor prior authorizations through Sept. 1; lawmakers pressed DHS on capacity, readiness reviews and provider outreach.
The joint Senate and House committee on State Agencies heard a lengthy DHS update on problems tied to the March 1 rollout of managed-care "passes," with legislators pressing the agency to resolve provider payment delays, enrollment backlogs and assessment bottlenecks.
DHS Director Cindy Gillespie and senior staff said the agency has sent compliance notices to the managed-care entities and pharmacy benefit managers to ensure pharmacies are paid on the same timetable as other providers. Deputy Director Paula Stone told the committee that DHS reminded plans of contract timetables—"70% of all clean claims within 7 days, 95% within 30 days, and 99% within 60 days"—and asked plans to provide additional monthly performance detail.
DHS also extended several operational protections to limit disruption while fixes are put in place. Passes have agreed to honor prior authorizations issued before March 1 through Sept. 1, DHS officials said, and DHS postponed open enrollment from May to October and is allowing for-cause changes so beneficiaries can continue seeing their existing primary care physician during the transition.
On provider enrollment, Janet Mann, DHS division director for provider enrollment, reported an inventory of 393 new applications and said staff completed 155 site visits in two weeks; 35 of those providers were already enrolled. Mann said roughly 50–58% of new applications require at least one return to provider for missing information, which is why DHS plans to move to an online enrollment system to reduce repeated back-and-forth paperwork.
Legislators repeatedly asked whether DHS has sufficient capacity to manage the transition. "Are we currently looking to hire additional people? Yes. We have openings," Director Gillespie said, adding DHS has used contractors and reassigned internal teams to do site visits and other short-term work while recruiting permanent hires.
Committee members also questioned the readiness-review process. DHS confirmed a consultant, Anthony Rogers, performed pass-specific readiness reviews and produced reports for each managed-care plan. DHS said the consultant’s work built on prior vendor reports and that the consultant had been involved with the program across multiple phases.
Managed-care plans attending the hearing described progress on claims processing but acknowledged remaining inventory. Arkansas Total Care, Empower Healthcare Solutions and Summit Community Care each told the panel they have increased claims paid since March and continue to work with providers to clear outstanding edits or denials.
The hearing included multiple requests for follow-up materials: the committee asked DHS and the passes to provide (1) consultant readiness-review reports, (2) detailed pharmacy quarterly data, (3) maps of network adequacy by county and provider type, and (4) counts and timelines for pending assessments that must be completed by Aug. 31. DHS said the first quarterly pharmacy and utilization reports will be available in mid-May.
The committee adjourned with lawmakers and agency staff committing to additional meetings and targeted follow-up to monitor whether the operational fixes and added staffing bring payments and enrollments to expected timeliness standards.
