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.
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
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.
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
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?
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.”
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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
OH MY DEAR TARHEEL STATE, WHY CAN’T YOU GET IT TOGETHER? I love NC. Heck I lived there for 2 years. But its time for an intervention. News of $835M in misspent 2015 Mcd funds came out this week. Agency officials acknowledge the problem of improper payments, but challenge the number (but don’t provide an alternative number). Beth Wood (the state auditor) is sticking by her $835M number, which is based on a sample of 396 claims. For those of you with an NC connection (which is a lot of us in the Mcd world), you know this is just the latest bump in the road.
MO PUTS FOOT DOWN ON MCD BUDGET; IN OTHER NEWS HELL HATH FROZEN OVER- The Mcd agency was asking for an increase that would have consumed all new state revenues for the fiscal year. Instead, the Senate came back with a $55M cut for Mcd in the Show Me State. News of this unprecedented event (an actual cut to a Mcd budget, not a “we would have spent even more, so give us 10% more than last year and call it a cut”, cut) was immediately followed by swarms of locusts, great cracks in the ground swallowing cars and the Mississippi River turning to blood.
TEMPEST IN A TEAPOT: IOWA MCO TRANSITION GOING JUST FINE- The move to managed care can be painful. You’re taking what has been run by the government for decades, spawning hundreds of mini, protected, subsidized fiefdoms – and converting it into something that has to be run efficiently enough to turn a profit. There’s some growing pains. Iowa became the 39th state to make the switch to managed care this week, but only after months of “the sky is falling” and ripping of sackloth from the legacy stakeholders. As long as the Good Guvn’r Brandstad is right, there wasn’t much to fuss about. The transition is going smoothly. We can all hope for a 6-month honeymoon, at least until the MCOs begin the obligatory “our rates are too low, so this is why the sky is falling now” wailing. See- the sky is always falling in Medicaid. It’s only a question of who’s playing Chicken Little.
MCD EXPANSION = BOON TIMES FOR LOBBYISTS- If KY is any indication, anyway. Looks like health related lobbying has ramped up 30% this year compared with last. I think they measure that based on reported payments to lobbyists, but not exactly sure. Would love to hear what you are seeing in your statehouse if your state is one of the expansion holdouts.
ANYBODY KNOW A GOOD CHARITY FOR VETS? For the last several years I have wanted to do a fundraising campaign for vets to be timed with Memorial Day / 4th of July. Both always sneak up on me … If you have a good one you recommend, please email it in.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Start the ticker and let’s see who wins this week’s award. Elva Santos and Manuel Gomez of TX got pinched for two very similar (but not related) scams this week. Santos pilfered $581K of Mcd dollars with her DME company; Gomez did the same with his, but added a patient data buying scheme to the charges. Gomez’s tab rings up at around $2M. Christina Benson of Tallahassee plead guilty Mcd fraud- she got $170k by paying homeless men and women to pretend to be Mcd patients and then bill for home care solutions they did not need. Mr. Gomez – you win!
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 (its almost time to plant!) 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
ābi le‘alemi hone kewelidi bek’eri welidimi
We spoke with Brooks Daverman (TN Division of Healthcare Financing and Administration) and and Patti Killngsworth (Bureau of TennCare). They covered lots of topics with the group, including the Tennessee Health Care Innovation Initiative, the Primary Care Transformation Strategy, use of Episodes of Care for Bundled Payments, and the TN Long Term Services and Supports (LTSS) strategy.
OK NOT OK – A 25% provider rate cut is on the table to address budget holes. Hospitals are wailing, with individual facilities beginning to report impact. (Hit to Duncan Regional – $2M). The cut comes right on the tails of a proposal (blocked this week) to remove 111,000 from the rolls via a waiver excluding non-pregnant, able-bodied adults under 65.
NM PASSES THE HAT TO PAY THE PIPER- NM is looking at the increasing expansion costs over the next few years (it ain’t free forever, people), and is starting to socialize the idea of getting counties to chip in more revenues to cover the bill.
OH ASKS BENNIES TO SPLIT THE TAB- Or at least pay for the appetizers. Kasich is pushing forward a plan to require Medicaid members to pay into an HSA to help cover the costs of their own medical care. Bennies would lose their card if they don’t pay 2% of their income (or $99- which is roughly what 1 carton of Marlboro Reds – what I used to smoke back when I did – now costs in Toledo, OH. Or 3 weeks of a daily Starbucks for those of us who grew up into fancy hipsters. Or 1 prescription for those of us with insurance we pay for under the “new normal” prices for everyone not on Medicaid).
ARE YOU WANTING TO CONTINUE YOUR MEDICAID HOSPITAL FEDERAL FUNDING, BUT DON’T WANT TO EXPAND? NOW YOU CAN (HERE’S HOW)- A little birdy brought a CMS letter to MS Mcd to my attention this week. In the letter (dated Mar 22), CMS tells MS Mcd that their plan to incorporate $533M of hospital UPL payments into its MCO rates as a pass through violates 42 CFR 438.60. But – since MS went ahead and did it, it would be hard to undo so CMS will look the other way for now. I uploaded the letter to the site here (http://bit.ly/1qm8oeG) for those who want to spend a little more time with it and tell me all about how I’m wrong to think this is questionable.
TN MCD DIRECTOR STEPPING DOWN- Darin Gordon has “sat in the chair” since 2006, and is now leaving TennCare. Gordon is widely respected on both sides of the political aisle, remaining in his spot for 10 years and through gubernatorial transitions. Congrats on a great tenure at TennCare, Darin! If you’re reading, I would love to interview you for the book I am working on about Medicaid directors. Working title – “A Day in the Life: The Medicaid Director’s Job Really is Rocket Science.”
ACA TURNS 6- Hard to believe that shining example of bipartisan politics, that grand-ole bill that passed with broad support from both parties elected to represent roughly 50% each of the American people, that policy that passed definitely not by procedural tricks and legislative bullying and good ole’ ram-it-through-no-matter-what-they-think elbow grease – [insert sound of vinyl record scratching to a halt here]. ACA turned 6 this month and a new round of analysis of impact is out. Punchline – for all its bluster about reducing the uninsured with exchanges and reforming commercial insurance, ACA is one big, fat Medicaid expansion. Which is great for us who live and breathe Medicaid. Not so great for the 50% of Americans (those evil Republicans) who are becoming more aware that Medicaid is another tax. Medicaid rolls have grown 25% since 2013 (when exchanges opened, and ACA really began in full force); Commercial coverage has dropped by 9M using CBO numbers (check the twitter feed for links to these #s).
FARRIS’S FANTASTIC FRAUD FOLLIES– I put lots of goodies in the twitter feed for all your fraudies that need your fix this week.
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 (its almost time to plant!) 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
Die Vader het die Seun aan die wêreld te red
Linda Rosenberg is the featured panelist for the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!
Medicaid Who’s Who: Linda Rosenberg – President and CEO, National Council on Behavioral Health
A: Mental health and addictions – behavioral health: advocacy and education
A: President and CEO, National Council for Behavioral Health
A: More than I care to count – 25 years
A: Mental Health First Aid; Expansion of the Excellence in Mental Health Act – creating Certified Community Behavioral Health Centers to expand access to services and support services of the highest quality
A: Being with my grandchildren
A: Dorothea Dix – her effective advocacy on behalf of people with mental illness
A: Frozen devil dogs
A: Personally – raising two wonderful sons; professionally – bringing Mental Health First Aid to the US.
A: Not a thing – it is not my style to look back
A: Establishment of Certified Community Behavioral Health Clinics; development of a continuum of community based services that reflect addictions as chronic medical conditions; pressure on candidates for President/party platforms to detail how they would increase mental health and addictions service capacity and quality
Don’t miss hearing Linda Rosenberg during the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!
