Aetna could be out from under a corrective action plan as early as this summer as it works to comply with its obligations under the state’s privatized Medicaid program.
Adam Proffitt, the state’s Medicaid director, told lawmakers last week that the corrections plan could be lifted by the time the current fiscal year ends on June 30.
“Quite honestly, they’ve done a remarkable job over the last couple of months,” Proffitt told the legislative panel that oversees the state’s Medicaid program known as KanCare.
Last year, state health regulators threatened to end Aetna’s contract with the state because it wasn’t complying with its contractual commitments.
The company later shook up its Kansas management staff, installing a new acting chief executive officer and a new chief operating officer.
A top company official apologized to lawmakers for Aetna’s failures leading to the noncompliance notice.
Since then, state officials have indicated that Aetna’s performance has been improving.
Proffitt said the state has looked to Aetna to work itself into compliance in recent months.
“We were there to serve as a resource,” he said. “Our agency was there to stand ready to help, but we weren’t going to do it for them.”
Proffitt said Aetna for Better Health had resolved 10 of the 12 problem areas identified in the corrective action plan.
He said Aetna closed another two items that were not part of the original corrective action plan.
Among the issues still being worked on are claims payments to providers and reports that show whether Medicaid beneficiaries have good access to the provider network.
Performance data show that Aetna has improved significantly in processing clean claims in a timely manner.
Aetna processed about 98% of its clean claims within 30 days last November compared to about 88% in August and July.
By comparison, Sunflower Health Plan processed about the same percentage of clean claims in November, while UnitedHealthcare was at 100%, the data shows.
Aetna serves about 102,000 Medicaid beneficiaries, or almost 27% of the 385,000 KanCare members statewide.
By comparison, Sunflower Health plan has 36% of the beneficiaries, while UnitedHealthcare has 37%.
Based on the progress made so far, Proffitt said he expected the corrections plans could soon come to an end.
But he also warned that the state would continue to vigilantly monitor how Aetna performs in the future.
“Clearly, we need them to demonstrate that they will have long-term plans in place to ensure that we won’t fall back to where we were,” Proffitt said.
