Amelia HollidayStaff Reporter
May 31, 2013
HAZARD — Kentucky Spirit, a Medicaid managed care provider that faced trouble earlier this year for trying to back out of its contract prematurely with the Commonwealth, is now facing another multi-million-dollar bill to pay to the state’s health care system.
A Franklin County judge ruled Tuesday that the provider must pay the 59 health departments in the state a back payment of $7.9 million for treatments provided by school nurses starting around November 2011, the Lexington Herald-Leader reported this week.
Karen Cooper, director of the Kentucky River District Health Department located in Perry County, said her health department is owed $570,000, based on recent numbers from Frankfort.
“That puts a pretty significant crimp in your cash flow, it makes it really difficult for us to operate,” Cooper said.
While this ruling may seem like a victory it is really the start of a long wait, she said.
“Common sense tells you that they’re (Kentucky Spirit) probably going to appeal this decision because $8 million, or right at $8 million, is at stake,” Cooper said.
Kentucky Spirit has argued that they should not have to pay for school nurses contracts because the work they do is not “done under the supervision of a doctor at the local health department,” the Herald-Leader reported.
“The health departments have always, or as long as I can remember, had an agreement worked out with Medicaid because we don’t have physicians in our building, some of our counties don’t have physicians that live in the county,” Cooper said. “That doesn’t fly because they’ll pay the same nurse to do the same service inside the health department, but they won’t pay across, you know Owsley County’s health department is next door to the school, so they won’t pay them across the parking lot, which doesn’t make sense.”
With an appeal, Cooper said the already delayed payments could be held for even longer.
“I really truly don’t expect it anytime soon because I fully anticipate that they will appeal that ruling. It just depends on the outcome of that. One of the directors (at the health department) threw out a possibility of 12 to 24 months. It’s just really money that we can’t count on getting,” she said.
In the past, before managed care, Cooper said the department would team up with school systems in the district who wanted to use the school nursing plan they provided. The school would, at that time, have to pay $5,000. Now, since the delay in payments for nearly a year and a half, Cooper said the department has had to ask the schools to triple their payments, to $15,000.
“Owsley County still wants to keep one nurse, they had two in the past, and Jenkins Independent wants to keep one nurse. (We) have not heard anything officially. I think Letcher County may still be going to keep theirs, not heard from Perry County, not heard from Knott County,” she said.
The Kentucky River District Health Department serves seven counties, including Perry, Letcher, Knott, Lee, Wolfe, Breathitt, and Owsley.
“I would have loved to have had a check in the mail this morning,” Cooper said. “We’ve paid these nurses, we’ve paid the people who enter the bills, we’ve paid our staff, and we’ve earned that money, we just can’t get it.”