(Updated to include company comments from Tuesday afternoon)
A top state regulator said Tuesday that Aetna is moving to comply with its obligations under the state’s privatized Medicaid program after it was warned it could lose its contract.
“We’re happy with where things are going, but we know there’s still a lot of work to be done,” said Adam Proffitt, the state’s Medicaid director.
Proffitt’s comments came Tuesday morning as he addressed the legislative panel that oversees the state’s Medicaid program known as KanCare.
Last summer, the state health department put Aetna on notice that it could lose its contract to provide Medicaid services because it wasn’t living up to its contractual obligations.
Aetna submitted one plan for correcting its deficiencies that the state rejected. The company later submitted another plan that the state accepted on Sept. 1.
The new plan, Proffitt said, provided greater detail and a clearer path for how it would come into compliance with its obligations. While there are still items that need to be corrected, the company is making “steady progress.”
Although the state is closing multiple items on the corrections plan, Proffitt noted that doesn’t necessarily get the company in the clear.
He noted that each item carries a certain weight, meaning some items that are still open can be vital to getting everything fixed.
“We’re continuing to enforce high standards on them. We are not taking our foot off the gas,” he said. “We’re continuing to press…and to expect high results. We think they’re going to be in much better shape at the end of the year.”
Company officials said they expect to have many of their problems remedied by the end of the year, if not earlier. Of the 12 problem areas the company is trying to resolve, six of them have been closed.
“I am extremely proud of the progress we’ve made. The work is not done yet, but we’ve come a long way,” said Randy Hyun, chief executive officer of Aetna Medicaid. “We certainly made it a top priority and brought in quite a bit of resources to make it happen.”
Republican state Sen. Gene Suellentrop, chair of KanCare oversight committee, was optimistic about the company’s efforts.
“We are encouraged with the comments from the department and others about the work you have done,” Suellentrop said. “Thank you for that.”
David Livingston, chief executive of Aetna Better Health of Kansas, walked lawmakers through the improvements the company has made in recent months.
Livingston said Aetna is credentialing providers much faster now.
He said there was backlog of credentialing for 3,400 providers, leaving the impression that the company had a smaller network than what existed.
He said all but about 100 of those providers have been credentialed. Of the providers that have not been credentialed, the company is waiting on information such as malpractice insurance and copies of licenses.
The company’s turnaround time for credentialing now runs 38 days, well within the 60 days required by the contract with the state.
“We brought in resources, put in new processes,” Livingston said.
“Really, a lot of this is just bringing operating discipline, making sure we do things right the first time.”
Livingston noted that Aetna now has a network of about 32,000 providers, up from about 21,600 at the end of June.
The number is comparable to the other companies administering the Medicaid program. Sunflower Health Plan has about 30,000 providers, while UnitedHealthcare has almost 49,000.
“We know there are still gaps, especially in some of the rural areas, but we’re continuing to have people with feet on the street reaching out to get those contracts executed.”
Aetna serves about 101,000 Medicaid beneficiaries, or almost 27% of the 382,000 KanCare members statewide. By comparison, Sunflower Health plan has 36% of the beneficiaries, while UnitedHealthcare has 37%.
Performance data released Tuesday showed that Aetna still trailed the other providers in the percentage of clean claims processed in a timely manner.
While Sunflower and UnitedHealthcare processed nearly 100% of their clean claims within 30 days, Aetna was at about 85% in August and July.
The company hovered at about 90% in May and June. It was close to 95% in March and April.
