Clay discusses the Medicaid news with Ray Hanley of the Arkansas Foundation for Medical Care, Cathy Huff of Fetch Multimedia and Kris Vilamaa of Germane Health Solutions.
Medicaid News Roundtable: May 2016
Category: Amazing Free Content
Medicaid State Spotlight: New York
We spoke with Jason Helgerson, the New York Medicaid Director. He covered lots of topics with the group, including the Medicaid Redesign initiative, New York’s Delivery System Reform (DSRIP) program, and the Payment Reform project.
Medicaid Industry Who’s Who Series: Ray Hanley
Ray Hanley is a featured panelist for the upcoming Medicaid News Roundtable Webinar on May 27th. RESERVE your seat today at bit.ly/1S4sns9!
Medicaid Who’s Who: Ray Hanley – CEO of Arkansas Foundation for Medical Care
- What is your current position and with what organization?
A: The CEO of Arkansas Foundation for Medical Care, a 240-employee organization that sprang from the old PROs of the 1970s, but which today does a wide variety of work for Medicaid, Medicare and others.
- How many years have you been in the Medicaid industry?
A: I began as an Medicaid eligibility caseworker in 1974, went on to managed Medicaid UR, and then Medicaid Director for Arkansas for 16 years, then to EDS/HP as client executive working with Medicaid agencies.
3. What is your focus/passion? (Industry related or not)
A: Improving access to health care and improving the quality of that care which is one of the reasons I led the 35 organization “AR Health, AR Jobs Coalition” that worked to pass expanded Medicaid coverage in Arkansas.
- What is the top item on your “bucket list?”
A: Help move Arkansas substantially up in health rankings among states.
- What do you enjoy doing most with your personal time?
A: Biking around the world since I had to give up running marathons 4 years ago with bad knees, so far I have biked on four continents. Otherwise spending time with my family at a log cabin near the Buffalo National River in the rugged Arkansas Mountains.
I’ve also put into print 20 Arkansas history books.
- Who is your favorite historical figure and why?
A: Teddy Roosevelt who created the conservation movement from his “bully pulpit”
- What is your favorite junk food?
A: Pizza
- Of what accomplishment are you most proud?
A: Two daughters who, while raising 4 young children between them, turned out to be outstanding people and health care professionals in their own right.
- For what one thing do you wish you could get a mulligan?
A: Since I’ve never played golf, I have no idea how to answer that.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
- Access … too many states have not expanded coverage, especially in the South.
- Access … in that too many providers won’t see Medicaid patients in part because the rates are too low … coverage without access is self-defeating.
- Quality improvement … driven by wider use of outcome-based payment metrics and refinement of the patient-centered medical home concept.
Clay’s Weekly Medicaid RoundUp: Week of May 2nd, 2016
BUCKEYE STATE ON FOOLS ERRAND- Ohio has the laudable, but laughable, goal of implementing a requirement that Mcd bennies chip in $99 bucks (or about 1.5 cartons of Marlboro Reds in Ohio) a year. The member contribution would go to a health savings account. There would also be new copay requirements (the state would dump a grand into the HSA to help with those). I give this less than a 5% chance of passing given the “your-evil-for-even-suggesting-there-be-the-slightest-cost-to-the-member” mentality of most of those in our Mcd world.
EMPIRE STATE CONSIDERING MCD COVERAGE FOR EX-CONS- The Good Guvn’r Cuomo is horse-trading with CMS as we speak to get Mcd funding for the plan. His plan appears to be a limited scope benefit, designed to help with substance abuse and a defined set of medical conditions.
UPDATE ON AL MCD USING BP OIL MONEY FOR FIX- It didn’t happen. Seems that some state senators wanted to use the money AL got to deal with the coastal disaster on roads instead of Medicaid. Officials are now foreshadowing the areas to be cut the most. It’s getting hot down here, and its not even June.
SUNFLOWER STATE SLOWS DOWN ON WAIVER INTEGRATION PLAN- The Good Guvn’r Brownback of KS will not veto a legislative directive to stop efforts on the integrated waiver services for Kansans with disabilities. The planned waiver was aimed at increasing HCBS services for members, but advocates were concerned of the speed and ambiguity of the plan.
WE DID NOT THINK OF THE IMPACT OF THE MINIMUM WAGE HIKE ON MEDICAID COSTS, COMRADE- When NY decided to raise its minimum wage from $9 to $15 by 2018, seems no one did the fiscal impact analysis on Mcd costs. As we in our insulated, behind-a-computer-or-on-a-plane-each-week jobs often forget, the healthcare industry employs many minimum wage workers. This provider increase (the wage hike) will add $13M to this year’s NY Mcd costs and $88M to next year’s. And the year after that, and the year after that . . . No worries. Close your eyes and remember the money trees in Washington, D.C. They’re so pretty this time of year.
LOTS OF LITIGIOUS PAYDAYS FOR STATES- Lots of cash flying around this week, mostly from big pharma to states. KY got $5M from Pfizer related to drug rebates not paid on Protonix (an antacid drug – [INSERT HEARTBURN JOKE HERE]). IN got $9M from the same lawsuit. WA got $23M. Total payout to all states and federalis was $784M (ouch, Wyeth. But at least you can move on and watch the stock price rise now that the settlement is done, right?).
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Wayne Wilson of Statesville, NC is headed to the big house for 18 months for stealing $210k for services he did not perform. Wayne is a doc who thinks Mcd didn’t pay him enough, so he “padded” his claims. Dwight and Charmetra Reece (man, there is a lot of husband and wife Mcd fraud) of Oklahoma City were charged this week with stealing $99k from Mcd. The couple operated a counseling agency and billed for services not delivered. Including payments for Charmetra’s mother (who is not a licensed counselor). Agape Health of Alexandria, VA has settled with Mcd this week over allegations it billed for transportation services not provided. Total bogus cab fare – $386k. Agape – you win! Follow that cab! (to jail. Do not past Go.)
I CAN’T NOT WRITE ABOUT THIS- George Clinton will release a new album this year entitled “Medicaid Fraud Dawgs.” I am not making this up.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (the sun is up earlier now!) and keep running the race (you know who you are).
—-
FULL, FREE newsletter: http://eepurl.com/ep81Y
News that didn’t make it and sources for those that did: twitter @mostlymedicaid
Pitāra biśba sanrakṣaṇa putrakē pāṭhiẏēchilēna
Medicaid Special Topics Series: Long Term Care (May 2016)
We spoke with Camille Dobson of the National Association of States United Against Disabilities (NASUAD) and Warren Hebert of the Louisiana Homecare Association about key topics in the Medicaid industry today. Camille provided insights about new federal LTC regulations, and Warren spoke from the perspective of a family caregiver for a member with long term care needs.
Clay’s Weekly Medicaid RoundUp: Week of April 25th, 2016
BRITISH PETROLEUM TO FUND AL MEDICAID- Lawmakers struggling to scrounge up funds to fill the Mcd budget gap have come up with a way to leverage money the state is owed from the BP oil spill. It’s a little tricky for me to understand but it involves a bond issue that then gets paid off with BP money and I think somehow a new (or quicker) $85M pops out to plug Mcd. Not sure yet on the reaction from coastal residents who may see the move as snatching the funding tied to the devastation of their environment six years ago.
EMPIRE STATE TO COVER HEP C DRUGS- This follows a recent lawsuit requiring commercial plans in NY to cover drugs like Sovaldi and Harvoni. There are 25,000 new Hep-C cases in NY each year. At some point, each of those could become eligible for the drug, creating a new $2B annual spending item for Hep-C rx alone.
LA MEDICAID EXPANSION IS ROLLING OUT NOW- The state is beginning to migrate members from existing programs that already meet the Mcd expansion population requirements. Members of Take Charge Plus and New Orleans Community Health Connection were asked to update addresses this week so that they can receive their brand new Mcd cards.
AZ HOSPITALS RECEIVED MORE THAN $1/2B RETURN ON THEIR MCD “TAX”- The Medicaid Magic Money machine strikes again. St Joe’s had the biggest ROI on the “tax”, receiving more than $24M than it put in. The money trees in D.C. did look a little sickly last week, but they were watered and rebounded quickly.
MOUNTAIN STATE WILL GLADLY PAY YOU ON FRIDAY FOR A HAMBURGER TODAY- It’s never a good sign when the Mcd agency sends you a letter saying it may be a while before you get paid because state revenues are down. Yet that’s what WV did to 24,000 Mcd providers this week. At least they gave you a heads up, I guess?
MCO WINS IN THE KEYSTONE STATE- Centene and UPMC won bids in SE PA this week under a new effort to negotiate pay for outcomes MCO contracts (up to 30% of payments tied to outcomes). Congrats to our friends and colleagues in Centene and UPMC!
AH, THE MEGA RULE- As most of you by now know, the final Medicaid Managed Care Rule was released Monday. There’s simply too much to cover but 2 quick things- the already voluminous 653-page rule more than doubled itself to 1,425 pages (maybe they fed it after midnight, or got it wet?). And #2- everyone I know says it seems like CMS just ignored most of the comments. Not sure on that last one, but hope to do a show on it soon and have some good discussion on it.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Darin Cox of NY got $80k in Mcd payments for his taxi service carting bennies to appointments. Thing is, he didn’t have a taxi license. Robert Rouzaud of Cleveland, OH got charged this week for false Mcd claims for tooth fillings. Mr. Rouzad got paid $343k for fillings for teeth that had previously been pulled, or for patients with dentures. And in one of our rare (rarely detected, anyway) cases of member fraud – Jennifer Garret of Chandler, AZ got indicted this week. Mrs. Garret received more than $70k in Mcd (and other) state benefits, all while her and her husband made loads of cash on their car restoration business. Enough to buy a Nissan 350-Z and Mercedes SUV while toting a Medicaid card in her pocket. Mr. Rouzad, you win! Mr. Cox – perhaps you should consider an Uber career? Mrs. Garret – perhaps Mr. Cox could borrow your Mercedes if he gets out before you do?
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (remember to water those seedlings!) and keep running the race (you know who you are).
—-
FULL, FREE newsletter: http://eepurl.com/ep81Y
News that didn’t make it and sources for those that did: twitter @mostlymedicaid
Ata dünya saxlamaq üçün Oğlunu göndərdi
Medicaid News Roundtable: April 2016
Clay discusses the Medicaid news with Joel Mengers of the Menges Group, Bruce Greenstein of Blend Health Insights and Dr. Craigan Gray of Salient Health Solutions.
Clay’s Weekly Medicaid RoundUp: Week of April 18th, 2016
Join me on a magical Medicaid movers and shakers tour, this week organized mostly by state and those organized by year they entered the Union (because its interesting) …
THE OLD COLONY STATE (1788) CAN’T TELL THE GOOD GUYS FROM THE BAD GUYS – WHY CAN’T THE BAD GUYS JUST WEAR BLACK HATS LIKE THEY DID IN THE OLD WESTERNS? MA State Auditor Suzanne Bump released a report this week showing about $427k in claims to providers who were supposed to be barred from the Mcd program. Just like the punchline of every research study is “needs further research,” this audit followed the audits script and ended with “insufficient internal controls.” Most of the no-no payments went through MCOs – similar to a report last year showing MCOs paying out $500M in improper payments (not all to barred bad guys, though).
THE HEART OF IT ALL STATE (1803) GETS THE TAB ON LONG NIGHT OUT AT BAR- One of those evil, mean, terrible – dare I say – conservative!?- watchdog sites has started reporting on the costs of Mcd expansion in OH. The Good Guvn’r has swelled spending by $7.9B so far for his expansion efforts. That’s worked out to be about $394M of additional Mcd spending each month since expanding. But don’t worry – everyone knows most of that is not state money, it’s federal money. And we all know federal money grows on the money trees in D.C. Haven’t you seen them lining the streets when you visit the nation’s capital? They bloom each spring, and millions flock to see them. They’re right next to the giant beanstalk that sprung up from one of Jack’s beans. And that, children, is how Medicaid financing works.
THE NATURAL STATE (1836) PLAYS OPPOSITE DAY- AR policitians used a poison-pill maneuver to save the hybrid / private option expansion plan that’s been the darling of dems and the thorn in conservatives’ sides for a few years now. Legislatures shrewdly put in a provision to end the expansion, which the Good Guvn’r Hutchinson vetoed – so by saying no, he said yes to what he and his allies wanted. And the program is thus extended. You have to admire such brilliant tactics.
THE WOLVERINE STATE (1837) IS IN THE MONEY (WELL, THE MCOS ARE ANYWAY)- Reports of skyrocketing MCO profits came out this week, all tied to the new Michigan contracts and expansion. According to one source, MCO profit grew 627% when the state took the ObamaCare deal. The state health plan association targets a 2% annual profit margin; the surge in underwriting income now has it at 3.9%. Not to worry – association execs assure us that this “double the target” profit margin is helping to make up for lean years past.
THE LONE STAR STATE (1845) GETS A CIVICS LESSON- If you’re following the TX Medicaid cuts ordered by the legislature (apparently that’s some sort of branch of government elected by “popular vote” that still has some amount of power, but truthfully I was always taught in government school that Judges rightfully run this country), you know that there have been a few stands in the courthouse door to stop the agency from following the law. Thursday saw an appeals court uphold the cuts, frustrating activist hero Judge Sulak, who remains convinced he gets to decide what TX does with all that Medicaid money, not those pesky “elected representatives.”
FARRIS’S FANTASTIC FRAUD FOLLIES– Just not enough space this week my fraudster friends. Lots of good stories in the twitter feed for those who need their fix.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (spring planting is done!) and keep running the race (you know who you are).
—-
FULL, FREE newsletter: http://eepurl.com/ep81Y
News that didn’t make it and sources for those that did: twitter @mostlymedicaid
Hayrn ugharkets’ ir Vordun p’rkelu ashkharhy
Medicaid Industry Who’s Who Series: Warren Hebert
Warren Hebert is a featured panelist for the upcoming Medicaid and Long Term Care Webinar on May 2nd.
RESERVE your seat today at http://mostlymedicaid.com/medicaid-ltc-webinar/
Medicaid Who’s Who: Warren Hebert – CEO of HomeCare Association of Louisiana
1. What segment of the industry are you currently involved?
A: I am involved with skilled home health care, primarily Medicare patients, as the executive for the state association. In that role I find myself engaged in conversations about long term care for seniors and those with physical and cognitive challenges. We are also Medicaid consumers, as our 25 year old daughter has Down Syndrome and has a waiver that provides her with assistance. She has direct service workers who have been godsends in keeping her engaged in the community and allowing my wife and I to continue to work.
2. What is your current position and with what organization?
A: I have served as CEO of the HomeCare Association of Louisiana for 18 years, handling advocacy in the regulatory, legislative, and reimbursement arenas. Our organization also hosts workshops and educational conferences here in Louisiana and across eight states. This role has included Congressional advocacy, engagement with an IOM study on the future of home health, as a grant reviewer for the Centers for Medicare and Medicaid Innovation, and on a CMS technical expert panel.
3. How many years have you been in the Medicaid industry?
A: I have provided care as a home health nurse to all patients, including Medicaid, as far back as 1974 when I was a student X-Ray Tech, and later a nurse at Charity Hospital in New Orleans. My home health career involved work in rural impoverished areas, where Medicaid was the primary payer. And now the association executive role involves advocating for fair reimbursement for Medicaid beneficiaries. One might argue that we have access to care issues in many states due to poor reimbursement for services provided to Medicaid beneficiaries.
4. What is your focus/passion? (Industry related or not)
A: My focus is family caregivers. There are over 45 million family caregivers across the country. My wife and I are caregivers to our daughter. Though very high functioning and fiercely independent (she is a university student and in a college sorority), we are still her primary caregivers. My family cared for my father over his seven year challenge with Alzheimer’s and Parkinsonism. He was not hospitalized once over those years, even when he was bed & chair bound in his last 12 months. Family caregivers provide over 80% of all long term care, at no cost to taxpayers, insurance companies, or government. The Rand Corporation estimates that has an economic impact of $522 Billion a year. One study showed that heart failure patients, going home from the hospital to a family caregiver, is less than half as likely to be readmitted to a hospital than a person going home alone.
I have hosted a weekly radio program, Family Caregiving, for seven years on a station that broadcasts on the web, and across seven states. Three of those stations reach into Houston, Chicago, and New York City. I focused my Doctoral project on family caregivers. They deserve our support.
5. What is the top item on your “bucket list?”
A: I would like to see as many of our National Parks as I can. I’ve been to Rocky Mountain, Glacier, Hot Springs, Hawaii Volcanoes, Mammoth Care, and Jean Lafitte here in Louisiana. I would like to visit Acadia in Maine, Bryce, Zion, and Arches in Utah, Grand Canyon & Petrified Forest in Arizona, and Yellowstone.
6. What do you enjoy doing most with your personal time?
A: Our ten grandchildren are the greatest enjoyment for my wife and me. The oldest is 8 and the youngest is due to arrive in June, but we’re counting him already. Eight live within ten minutes and the other two are just 90 minutes away. This past weekend we rode bikes, planted Marigold and Sunflower seeds, and had an early morning around our backyard fire pit. We have taken Saturday morning hikes and visited local cultural sites here in Cajun country over the past few months. We also love spending weekends at our local state park cabins.
7. Who is your favorite historical figure and why?
A: I’d like to name two, Mahatma Gandhi, because of what he accomplished via nonviolence in leading India to independence.
The second is our most recent historical figure, Pope Francis, born Jorge Mario Bergolio. He is the first Pope from the Americas, and the first Jesuit Pope. He selected the name of Francis of Assisi, who loved the poor. The Pope’s compassionate approach to leadership is shaking things up in the name of love and concern for those on the fringes and margins of life. He seems to have a strong bias for the marginalized in society.
8. What is your favorite junk food?
A: Do I have to have just one?? OK, an ice cream made in Brenham, Texas, sold in many southern states, Blue Bell, and Homemade Vanilla is my favorite flavor.
9. Of what accomplishment are you most proud?
A: Our children. Two daughters followed Dad into nursing, one is a Neonatal ICU nurse, the other a Family Nurse Practitioner with an oncology group. Our eldest son is a Chiropractor, and our younger son an Assistant District Attorney. And our Daughter with Down Syndrome indicates she wants to “work in a hospital helping little children so they don’t cry.” They are all compassionate people, who married compassionate people. So our grandchildren should all turn out to be very loving human beings.
10. For what one thing do you wish you could get a mulligan?
A: Sorry, no mulligans!! One of my favorite books is entitled Everything Belongs. It was written by a Franciscan priest, and the premise is that everything that has happened in our lives belonged there. Our mistakes, failures, omissions, faux pas, etc., have all impact the person we become. So I’m good not taking a mulligan, thanks for offering. (On the golf course I would definitely take that offer though!!)
11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
- Recognize the family caregiver’srole and be creative in supporting them. Whether it’s tax breaks, pay for those who need it, extra time away from work to give care, training, counseling, or more, we should support family caregivers to a far greater extent than we do now.
- Remove constraints to practice from Advanced Practice Nurses. As a nurse myself I have a bias. Nurse Practitioners are educated and trained to provide primary patient care. Research has quantified NP’s effectiveness as at least equal to the outcomes of physicians. Nurse Practitioners have had a positive impact on access to care, especially in impoverished urban areas and rural areas that cannot recruit physicians.
- Advance health policy that promotes equityin care for those on Medicaid. The poor, among them those on Medicaid, have a right to fair, just treatment. If all things were equal, then we would be OK with equal treatment of all. But all things are not equal. We often have different starting points, different resources. That’s why we need health policy that promotes equity. Equity goes beyond equality. It involves trying to understand each individual’s situation, and giving people what they need to enjoy full, healthy lives.
A quote that best illustrates equity is one from former Vice President Hubert H. Humphrey. “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”
To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter and join the discussion on LinkedIn.
Clay’s Weekly Medicaid RoundUp: Week of April 11th, 2016
GOLDEN STATE WANTS ITS MONEY BACK- By now I don’t even have to tell you the details. If “MMIS” is in the sentence, you can tell me the rest: overbudget, late and ugly. CA just signed the divorce papers with Xerox (old ACS for anyone returning to the space, or those – who like me- never could make the mental switch from ACS to that company that makes copiers). The implementation is far from finished, but the state has decided its better to just start over. I’m sure CMS is happy, since they paid 90% of whatever has been paid so far. Xerox has agreed to pay the state $120M, and continue operations until 2019. Ouch.
BEEHIVE STATE EXPANSION COULD BEGIN NEXT YEAR- If CMS approves it. The main hitch is that the UT plan will cover about 16,000 new members. If UT has just been a good little soldier and taken the expansion exactly as offered, about 100,000 would have been covered. The expansion will cost UT $30M each year, and hospitals have volunteered to be “taxed” to cover about half of that.
PINE TREE STATE POLITICIANS PASS SYMBOLIC EXPANSION VOTE- Dems in the Maine Senate and house passed a largely meaningless bill this week- but everyone still expects the big bad wolf, er, I mean the Good Guvn’r LePage to veto it. Don’t count it out just yet – the GOP governors have fallen one by one on expansion the last few years. LePage just needs to figure out how to make it not look like “ObamaCare” in the press release.
LONE STAR STATE CUTS GO THROUGH – TX Medicaid agency have to follow the budget as passed by the legislature (egads!), which includes $350M in cuts. Although our hero, District Judge Tim-Screw-Checks-and-Balances Sulak blocked the cuts made in accordance with the law of the land last September, the TX Health and Human Services Commission testified this week that it has to follow the legislature’s instructions and make the cuts.
UPDATE ON OUR SUPPORT VETS FUNDRAISER- Last week I asked for suggestions on a charity we (the Mostly Medicaid Motley Crew) could all donate to between now and 4th of July. All you Readers who wrote in – thank you! I got several great suggestions, and will start running links to them in the newsletter each week until 4th of July. I don’t know a really good way to calculate how much we all give combined (and that’s not the point anyway). If you do give to one of those listed, please post a note in the Mostly Medicaid LinkedIn group, or comment on one of my posts related to this. $ amount doesn’t matter – let’s just encourage and challenge our healthcare industry colleagues to show support with a focused effort the next few months.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Shifo Healthcare Services (a home health company) of Ohio is under investigation for $2M in overpayments as of this week. OH Auditor Dave Yoast is digging but not finding documentation supporting the claims. Yury Baumblit of NY runs a flophouse (had to look that up), and got charged this week with $2M in Medicaid kickbacks related to addicts living in the flophouse. Seems Yury forced tenants to attend Medicaid group therapy sessions for substance abuse, and providers paid Yury and his wife (Rimma) kickback fees. Step by Step Senior Care (another home health company) of Little Rock, AR agreed to pay back $472k this week for charges related to billing for imaginary patients. Miami fraudsters David and Cecilia Krochmal were arrested this week for $100k in Mcd payments related to services not delivered for I/DD members. Mr and Mrs Baumblit – you win! And wow. That’s some really terrible stuff.
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (spring planting almost done!) and keep running the race (you know who you are).
—-
FULL, FREE newsletter: http://eepurl.com/ep81Y
News that didn’t make it and sources for those that did: twitter @mostlymedicaid
‘arsal al’ab w alaibn li’iinqadh alealam