Physicians who steer their Medicaid patients into specific health insurance plans could face heavy sanctions under an emergency rule the state health agency started this month.
Calder Lynch, the chief of staff for the state’s health agency, said the policy is needed “to ensure the integrity of the Medicaid recipients’ freedom of choice” when deciding into which of the five Bayou Health plans to enroll.
Bayou Health is the Jindal administration’s program that moved about 880,000 Medicaid recipients into privately run insurance plans that would manage their patient care.
Physicians could direct a patient to join a specific plan for reasons other than health, such as personally liking the plan’s administrative process. Under the new rule, physicians violating the ban on improperly steering patients would be subject to potential removal from the program and face a financial penalty of $5,000 per recipient steered to a particular plan.
A Louisiana State Medical Society official said the “anti-steering” policy goes too far and infringes on doctor-patient relationships.
“Are physicians not going to want to talk to their patients about plan benefits and services offered because they are scared of getting sanctions?” said Greg Waddell, the society’s vice president. If a patient asks their doctor which plan best suits their health care needs, the doctor should be able to advise them without fear of punishment, he said.
Waddell said the rule was heavily lobbied by the prepaid health insurance plans participating in the Bayou Health managed care program. The plans received a flat amount per Medicaid recipient, like an insurance premium. Three prepaid plans are competing with two companies that continue to be paid on the traditional Medicaid fee-for-service basis which have been more popular with patients and physicians.
Lynch said the Department of Health and Hospitals did not find widespread problems of doctors directing their patients to specific programs. “But we found we did not have clear authority to take action against an egregious violation,” he said.
A physician can advise their patient what benefits, what services are performed by certain plans and in which health plans they participate. “What we don’t want to see is a provider telling a patient that he’s only contracted with one plan and he’s actually contracted with others too,” Lynch said. That would constitute “steering” a patient.
Steering is defined as any conduct intended to recommend, “or can be reasonably concluded to lead” to a recommendation of, any specific or type of participating managed care health plan. “This shall include, but is not limited to the practice of offering recipients incentives for selecting one managed care health plan over another such plan and the practice of assisting a recipient in any way, (via utilization of fax, office telephone, computer in office, etc.) in the decision of, or enrolling into, a specific managed care health plan,” the new policy states.
Waddell said he understands what the health agency is trying to regulate “but I think the way the rule is written it is overly broad and captures communication which otherwise would be the patient-physician relationship.”
Waddell said he has seen no evidence that the “steering” activity the health agency is trying to prevent is occurring.
“They say they have letters and voice mail of physicians steering patients. I have yet to see anything,” he said.
Waddell said he plans to meet with health agency officials next week to see if they are open to some changes in the rule.