Anthony Cloud
Staff Writer
State Rep. Rick Nelson has introduced a bill to the House of Representatives that could help keep school clinics open. House Bill 144 was introduced to the House on Feb. 5 and to Health and Welfare on Feb. 6.
The bill states that if any breach of contract occurs or has occurred between a Medicaid managed care organization and any agency, department or cabinet of the commonwealth to reimburse a school district Medicaid provider, then services to school district Medicaid patients served under the contract shall immediately cease and school district Medicaid patients will be transitioned to a Medicaid fee-for-service program.
Nelson’s bill also clarifies that any school district Medicaid provider who is due funds as a result of a contract between a Medicaid managed care organization and the commonwealth will still be able to recover them.
Nelson explained that the bill will allow health departments to break contracts with managed care organizations if there is a breach of contract. If the contract is broken, the health departments would then send bills to the Kentucky Health Cabinet.
Nelson stated the bill was introduced in an attempt to rectify the problem of health departments not getting payments in a timely manner.
In January, the Kentucky Finance and Administration Cabinet determined Medicaid managed care organizations contracts legally cover services to students provided by school nurses at health clinics operated by local health departments, according to the Kentucky School Boards Association (KSBA) in Frankfort.
In a Jan. 3 letter from Robin Kinney, executive director of the Finance and Administration Agency’s Office of Administrative Services, the agency denied Kentucky Spirit’s appeal of an August 2012 decision by the Cabinet for Families and Children (CFC).
In that decision, the CFC determined school-based health services are a “historical” service of local health departments, which may continue to bill managed care contractors for reimbursement.
All students in the Bell County school system have equal access to the school clinics and are provided services regardless of whether or not they have Medicaid. Each student receives the same treatment as if they do have Medicaid.
Medicaid is an approximate 70-30 percent federal and state matching fund grant. The local health department pays the state’s 30 percent match out of local tax money for all Medicaid services provided by local health services. This means the state currently does not have to pay for any of the costs associated with the clinics.
Anthony Cloud can be reached via email at acloud@civitasmedia.com or by phone at 606-248-1010, ext. 208.
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