(Will be updated as warranted)
The state health department has warned one of its Medicaid providers that it’s failing to comply with the standards of its contract.
The Kansas Department of Health and Environment notified Aetna Better Health of Kansas on July 24 that it wasn’t meeting its contractual commitments.
The agency gave Aetna 10 business days to submit a corrective action plan. The deadline is Wednesday.
“We must hold our contractors accountable,” KDHE said in a statement on Tuesday morning.
“It is our hope to work collaboratively with Aetna to come into compliance, so they can efficiently and effectively serve members.”
The letter warns Aetna that failure to correct the issue will lead to the termination of its contract. If the contractor fails to comply within 10 days, the state “may seek any and all remedies available under the contract.”
Aetna was contacted Tuesday morning and had not yet responded to a request for comment by 2 p.m.
The issues with Aetna’s performance were detailed in a complex report showing where the company was falling short of the requirements set out in the request for proposal.
Aetna, which serves about 100,000 beneficiaries in Kansas, was awarded one of the state’s three managed care contracts last year. It replaced Amerigroup, which unsuccessfully sued when it lost out in the bidding.
Aetna along with Sunflower State Health Plan and United Healthcare, Midwest Inc. provide managed care services under KanCare, the state’s $3 billion privatized Medicaid program serving about 400,000 Kansans.
Aetna has the fewest number of beneficiaries of any of the KanCare managed care companies. United Healthcare and Sunflower serve about 280,000 beneficiaries combined.
