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Kansas providers press committee on MCO accountability, audits and late payments
Summary
Providers and provider groups urged stronger oversight of managed-care organizations, citing inconsistent service authorizations, documentation changes, payment delays (one speaker reported $152,000 outstanding receivables), and aggressive audits that threaten provider viability and beneficiary access.
Provider representatives told the Joint Committee they are seeing persistent operational and administrative barriers that reduce access for beneficiaries even where policy on paper is adequate. "At some point, we have to ask who is accountable," Megan Shreve, executive director of Interhab, said, describing inconsistent authorizations, repeated documentation requests, and payment delays that cumulatively harm providers and families.
Scott Lopez, an occupational therapist with Alliance Rehab and Medical Equipment, told lawmakers his company had more than $152,000 in Medicaid MCO receivables older than 90 days, with $83,000 over 180 days and some claims more than a year old. He described a pattern in which prior authorization is granted, services are delivered, and then payers recoup funds after retrospective audit, leaving small providers unable to cash-flow services.
Other witnesses testified about recoupments tied to change-of-ownership processes in skilled nursing, inconsistent interpretations between KDADS and MCOs, and the administrative burden of 15-minute unit billing for case managers. Several speakers urged clearer written guidance from KDADS, better alignment between state policies and MCO practice, and stronger contract enforcement to ensure timely payments to providers. The committee asked KDHE/KDADS representatives to return with oversight options and to clarify which agency is responsible for enforcing timely-payment contract terms.
