FRANKFORT — State Auditor Adam Edelen told a legislative panel Monday that an in-depth audit of the state's Medicaid system should be completed by early 2013.
Edelen told the Program Review and Investigations Committee on Monday that he expected the audit to begin later this year. Edelen reported to the committee the findings from an initial review that his office completed of the switch to Medicaid managed care.
The state moved more than 560,000 people in Medicaid to managed care on Nov. 1. The transition has not been smooth. Health care providers continue to complain about tardy payments and cumbersome pre-authorization procedures that delay patient care.
Edelen's office reviewed initial information from three private managed-care companies hired by the state before Nov. 1. Edelen's office looked at a host of information, including timetables for claims payments and pre-authorizations. The state auditor's office issued recommendations, including removing behavioral health from managed care. Edelen also recommended that the state come up with a more meaningful yardstick to determine whether the managed-care companies were paying providers promptly and delivering services.
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Edelen explained the results of the initial review to the legislative committee Monday. That review, conducted in February, was not an audit, Edelen said.
"I believe in managed care," Edelen said. But the state and the managed-care companies were not prepared for the Nov. 1 switch, he said.
"It is getting better," Edelen said of the payments to health-care providers and waits for pre-authorizations.
The managed-care companies did not have adequate staff. The providers and third-party billing companies used by doctors to submit claims to insurance companies also were not prepared for the switch to managed care, he said.
"There is plenty of blame to go around," Edelen said.
Edelen said he has established a special unit in his office to handle audit of the $6 billion Medicaid program.