KentuckyOne Health cancels contract with Medicaid provider Coventry Cares

vhoneycutt@herald-leader.comAugust 16, 2012 

Kentucky's largest health care system on Thursday said it is terminating contracts at all its facilities with Medicaid managed care provider Coventry Cares.

KentuckyOne Health — which formed earlier this year to operate Saint Joseph Health System and Jewish Hospital & St. Mary's HealthCare — said the terminations will be effective Nov. 1 for Jewish Hospital & St. Mary's HealthCare and Dec. 1 for Saint Joseph Health System.

Coventry is one of four companies hired by the state to manage care for the 560,000 Kentuckians enrolled in the federal-state health insurance program for the poor and disabled. Coventry has given notice in recent months to many Kentucky hospitals and health care providers that it intends to terminate or renegotiate contracts.

KentuckyOne decided to stop working with Coventry after the Medicaid provider sent a contract termination letter to Our Lady of Peace hospital in Louisville on April 27 that was effective July 18, said KentuckyOne spokeswoman Barbara Mackovic.

Our Lady of Peace is one of the largest private, non-profit psychiatric hospitals in the country and works with all four Medicaid managed care companies to serve a high-risk patients with intellectual disabilities, Mackovic said.

"Many of the children served by Our Lady of Peace have no other facility to meet their highly specialized mental and behavioral health needs," she said. "In addition, 75 percent of patients at Our Lady of Peace are children and adolescents, many of which have developmental delays with dual diagnosis."

CoventryCares also terminated its contract with Taylor Regional Hospital in Campbellsville, another of KentuckyOne's facilities, she said.

"We feel CoventryCare's actions will ultimately hinder and prevent the care our communities need and deserve," Mackovic said. "That is especially true when a plan would put our most vulnerable patient populations at Our Lady of Peace at risk."

Officials with CoventryCares did not immediately answer a telephone call and an e-mail seeking comment.

Mackovic said KentuckyOne will continue contracts with Kentucky Spirit, WellCare and Passport, the other managed care organizations.

Mackovic said she did not immediately know how many KentuckyOne patients were Coventry members.

Cabinet for Health and Family Services spokeswoman Jill Midkiff said Thursday that the cabinet is aware of KentuckyOne's decision to terminate its contract with Coventry Cares.

As a general policy, the state encourages the four managed care organizations and health care providers to contract with each other whenever possible, Midkiff said.

"The cabinet continues to monitor the network adequacy of all managed care organizations," she said.

Medicaid members who want to change managed care organizations will have an opportunity during open enrollment, which begins later this month, Midkiff said.

KentuckyOne has nearly 200 locations, including hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies. It has more than 2,325 licensed hospital beds, officials said.

In another Coventry contract dispute, Appalachian Regional Healthcare filed a lawsuit in U.S. District Court in Lexington against Coventry when it said in late March that it would sever its contract with ARH on May 4.

A judge granted temporary injunctive relief in June to prevent termination and said Coventry must continue its contract with ARH through Nov. 1, to meet the medical needs of 25,000 Eastern Kentucky Medicaid patients.

In May, Coventry notified the Baptist Healthcare system, which includes Central Baptist Hospital in Lexington, that it wanted to renegotiate its contract that expires Nov. 1.

"We are in active negotiations and hope to reach a resolution soon," Baptist Healthcare spokeswoman Ruth Ann Childers said Thursday.

Valarie Honeycutt Spears: (859) 231-3409. Twitter: @vhspears.

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