Staff Report

United States Senior Judge Karl S. Forester ruled Wednesday to grant in part Appalachian Regional Healthcare’s request for a preliminary injunction against Medicaid Managed Care contractor CoventryCares.

As part of Forester’s ruling, the Coventry and ARH agreement will remain in effect and Coventry will continue to pay ARH at the rate initially agreed upon in its original Letter of Agreement with ARH from November 2011.

Additionally, Forester ruled that by Aug. 1, Coventry must provide ARH a list of Coventry members who have used ARH services during the past five years so ARH can contact them to make them aware that ARH will continue to accept the Coventry plan through Nov. 1.

With the threat of the contract between Coventry between ARH expiring on June 30 putting 25,000 eastern Kentuckians at risk of no longer being able to utilize ARH facilities, ARH had began an educational campaign to inform patients of how they could switch to an ARH-accepted Medicaid Managed Care provider. Due to today’s ruling, those with the Coventry plan are now under no pressure to switch providers unless they wish to do so and can wait until the August open enrollment period to make a change.

One major issue during ARH’s dispute with Coventry has been whether Coventry will be able to provide an adequate network of health care providers for its more than 25,000 eastern Kentucky enrollees when its contract with ARH ends on June 30.

To have an adequate network, Coventry must be able to offer the Medicaid patients covered under its plan sufficient access to providers to meet their health care needs within 45 miles or 45 minutes of their physician and 60 minutes to a hospital that is deemed to be an in-network hospital. With eight hospitals multi-specialty physician practices, rural health care clinics, home health care agencies, and other services, ARH is the largest provider of health care in eastern Kentucky. It serves approximately 350,000 people in a region where many individuals are economically disadvantaged and must rely on Medicaid for their health care needs.

According to Forester’s ruling, Coventry would not have an adequate network of services without the ARH facilities and the GEO Access software Coventry used to as evidence of its network adequacy using driving speeds of 65mph was not credible.

“We appreciate the fact that Judge Forester understands the plight of our patients and has seen the situation for what it is,” ARH President and CEO Jerry W. Haynes said. “Our patients have always been and will continue to be at the forefront of all that we do. Judge Forester’s ruling will afford ARH the opportunity to continue to serve our patients, be paid a fair rate, and educate patients in switching to an MCO that ARH has a contract with to ensure these patients have access to ARH providers if they choose to utilize them.”