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 The leading web portal for pharmacy resources, news, education and careers November 20, 2017
Pharmacy Choice - Pharmaceutical News - NEBRASKA MEDICAID MANAGEMENT The system needs stability - November 20, 2017

Pharmacy News Article

 5/19/17 - NEBRASKA MEDICAID MANAGEMENT The system needs stability

Nearly 227,000 low-income or disadvantaged Nebraskans depend on Medicaid funding for health care or mental health services. It's crucial to process claims efficiently and properly handle authorization of care so that important services can be delivered.

A key example is home health care. Another is mental health counseling. These supports are vital for many Nebraska households.

Nebraska shifted on Jan. 1 to a new system in which companies or nonprofits providing those services can choose among three managed care companies now administering the bulk of the state's Medicaid program.

The new approach provides a major plus by bringing behavioral health under the same umbrella as physical health. As a result, the system provides incentives to treat patients' whole range of conditions, mental as well as physical.

But five months into Nebraska's new system, the claims processing and authorization of care have run into major problems.

World-Herald reporting this week pointed to examples in which claims were left unpaid for some behavioral health and home health providers, and care wasn't authorized for some individuals.

These misfires have triggered a host of complaints, including from Nebraska lawmakers, who say they will increase their oversight.

The unpaid bills have led CenterPointe, a behavioral health treatment center with programs in Omaha and Lincoln, to take out a line of credit for the first time in 44 years. The new system places increased administrative obligations that can weigh significantly on some small-scale providers.

HHS says processes have improved, pointing to the increased volume of payments to providers in the last six weeks. Most of the complications involve individual cases rather than large-scale processing issues, HHS contends.

Under CEO Courtney Phillips, HHS has commendably achieved efficiencies in some of its operations. The department streamlined the procedure for low-income Nebraskans to apply for federal nutritional assistance. It reduced the waiting times for families seeking state help for loved ones with developmental disabilities.

HHS and the three management companies need to demonstrate similar progress now with Medicaid management.

It's crucial that they work with providers to resolve the entire range of problems, to ensure the services to clients and to give much-needed reassurance to the public.

© Copyright (c) 2017 Omaha World Herald

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