The United States Department of Health and Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is “Improving the health, safety, and well-being of America”.[2] Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).
Further reading –
Since inception in 1997, the Health Care Fraud and Abuse Control (HCFAC) Program has been at the forefront of the fight against health care fraud, waste, and abuse. Since 2010, the U.S. Department of Health & Human Services, Office of Inspector General (HHS OIG), the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Justice (DOJ) have been able to expand their capacity to fight fraud and abuse by using powerful, new anti-fraud tools to protect Medicare and Medicaid by shifting from a “pay and chase” approach toward fraud prevention. Through the groundbreaking Healthcare Fraud Prevention Partnership, stronger relationships have been built between the government and the private sector to help protect all consumers.
Further reading –
Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health care facilities and board and care facilities. MFCUs operate in 49 States and the District of Columbia. The MFCUs, usually a part of the State Attorney General’s office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually recertifies each MFCU, assesses each MFCU’s performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU’s operational costs.
Further reading –
https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp
Center for Program Integrity – In April 2010, Secretary Sebelius aligned the Medicare and Medicaid program integrity functions with the creation of the Center for Program Integrity (CPI). This newly-established Center brought together oversight of Medicare and Medicaid program integrity to coordinate resources and best practices for overall program improvement. The Affordable Care Act and the Small Business Jobs Act of 2010 provided additional opportunities to strategically combat fraud, waste and abuse with a coordinated approach in Medicare and Medicaid.
Further reading –
https://www.cms.gov/About-CMS/Components/CPI/Center-for-program-integrity.html
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2md4Wpt (for what ails ya!)
For optimist readers- http://bit.ly/2mbQpKW Do not forget Veteran’s Day!
LET’S TALK SHOP AT MEDICAID INNOVATIONS 2018 – I will be in Florida again (7th year for me, I think) for the Medicaid Innovations Conference. If you are going, let’s plan on meeting up. Jan 31-Feb 2, 2018. Check it out here- http://bit.ly/2mbKtl1
PINE TREE STATE VOTES YES ON EXPANSION – Mainers voted yes on Question 2 on Thursday, making the preference of 59% of voters known. In an interesting move, the state elections officials set up a PayPal kiosk at polling places to collect the money needed to pay for the voters’ decision. While 59% voted yes on expansion, only $13.73 was collected on voting day. Seems voters want someone else to pay for it (they did their part by voting). If you are out of state and would like to contribute to the state share for the expansion, you may be able to make a donation via the Maine State Treasurer’s Office – http://www.maine.gov/treasurer/ I have also agreed to be a donations bundler for the state expansion lobby, so if you send me your personal bank account information to clay@mostlymedicaid.com I will be happy to make you’re your personal commitment to the cause is made known. #Resist!
CONSTITUTION STATE RETHINKS ITS EXPANSION MODEL- New Hampshire is looking to continue covering the expanded population now the waiver is up for renewal. But it wants to move expansion bennies from the exchanges (a premium subsidy program) to be covered under one of the actual Medicaid MCOs. Also wants to add work requirements for non disabled adults with no children.
HAWKEYE STATE DEM CANDIDATES POOH POOH MCOS- All four of the brilliant Iowa Guvn’r candidates on the left side are promising to rollback managed care and return the state to its Halcyon days of fee for service, in all its unmanaged, abysmal quality and cost management glory. Idiots.
OLD DOMINION STATE GUBBNERS RACE RESULTS RESTARTS EXPANSION HOPES- Dems picked up 5 house seats in recent Virginia elections. Which will help to soften resistance to expansion in the legislature (its been shot down for several years). The Guvnr-Elect Northam also campaigned on expanding Medicaid.
WHAT THE LADY SAID – Flexibility. Work requirements. Faster approval for waivers and SPAs. The sleeper issue in Mrs. Verma’s speech to NAMD this week? State dashboards using new CMS data systems. Can you imagine the fallout if states were showing up on a regular report of poor quality metrics? Right now there might be a report of a few states on a few measures using data that lags 4 years. State dashboards would be the best thing to happen to Medicaid. Ever.
TREASURE STATE TO SPEND MORE TREASURE- A Montana legislative committee has put the kibosh on (did you know that word was originally kye-bosk, with the earliest citation in Dickens?) a proposed 2.9% provider rate cut. The state DHS officials are understandably frustrated because they feel avoiding the cut now will just make them have to make deeper cuts later. And, oh yeah – the same freaking legislature holding up the cuts ordered them to cut costs.
NEW HHS PICK MAY COME FROM PHARMA- Rumors have it that Alex Azar of Lilly USA fame may replace Price. As long as Azar can follow aviation policies, of course. (Ba-doom-boop-boom).
PRAIRIE STATE OBTAINS BOND TO PAY MEDICAID BACKLOGGED BILLS- MCO shareholders across the nation rejoiced on the news that Illinois sold $9B in bonds to help pay off debts to Medicaid providers. So we have finally done it – made Medicaid like the subprime mortgage fiasco by factoring the debt to outside investors. Holy cow. You can now basically buy stock in how poorly a Medicaid program is run via bond issues from states in fiscal default.
WELCOME TO THE SHOW MR BAKER, THE GENTLEMAN FROM THE PALMETTO STATE- Joshua Baker of SC Medicaid got promoted to the Director Chair this week. Glad to have you Mr. Baker!
GOOD GUVNR BROWN DECIDES TO GET THAT CASH BACK FROM MCOS AFTER ALL (THE BEAVER STATE)- A few weeks of bad press and the milk has soured. The gloves are off. Although early reports suggested Oregon would not attempt to recoup capitation payments made in error to MCOs, this week Dem Guvn’r Brown directed the agency to do just that. (After her GOP opponent in the 2018 race called her out on it). The errors are on the state enrollment side- people who should not have been enrolled, or duals for whom which Medicare should have paid first. Current total of snafu is $74M. We covered this in last week’s news show by the way if you want to check out the recording- http://bit.ly/2yinw1i
SUNFLOWER STATE ASKS FOR $90M TO REDUCE WAIVER WAITING LIST- Kansas thinks it can open up a bunch of new waiver slots for HCBS waivers if the legislature will approve it.
SOONER STATE PULLS TRIGGER ON $34M IN PROVIDER CUTS- Oklahoma legislators said no-dice (short by 5 votes) on the new taxes (at least I think that’s how to translate “revenue-raising measures”) needed to fill the Medicaid budget hole this week. A total of $35M in cuts went into effect this week, with providers getting between 4 and 9% reductions.
BUCKEYE STATE OWES FEDERALIS TRUCKLOAD OF CASH. CMS ASKS FOR IT ALL IN SINGLES- We have seen this issue in other states. Basically ACA handed out lots of rewards cash for increasing Medicaid enrollment, but it was only supposed to go for non-kids and non-ABD members (people who generally get pretty decent coverage; Mr. Obama was looking to add new types of people to the rolls, not those already eligible). Anywho- federal OIG says OH got $30M too much for improper classification of new enrollment, and they want CMS to get the money back.
BBBBUT MEDICAID IS UNDERFUNDED! GOLD RUSH IN THE GOLDEN STATE- A new report over at Kaiser Health News shows California MCOs making ridiculous (in the eyes of the beholder) amounts of profit on Medicaid operations. Would we ever see a story that shows the CA Medicaid budget “deficit” side by side with MCO “obscene” profits? Doubt it. That would not be helpful to the #Resistance.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph… Sorry friends, not this week. I have already been too verbose. Lots of fraud goodies for you in the twitter feed. Don’t worry, we lost millions again this week as well. Same as last week. And the week before…
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 (send out your Christmas party invitations) and keep running the race (you know who you are).
FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Bavê Kur şand ku cîhanê rizgar bike.
Advance Planning Document (APD) refers to an Initial advance automated data processing planning document or Initial APD, providing a recorded plan of action to request funding approval for a project which will require the use of ADP services or equipment, including the use of shared or purchased services in lieu of State acquired stand-alone resources.
Further reading –
https://www.acf.hhs.gov/sites/default/files/ocse/apd_guide_2.pdf
Balanced Budget Refinement Act of 1999 (PL 106113) – The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 [1] (also called the Balanced Budget Refinement Act or BBRA) is a federal law of the United States, enacted in 1999.[2] The BBRA was first introduced into the House as H.R. 3075 on October 14, 1999 by Rep. William M. Thomas (R-CA) with 75 cosponsors. It was read twice and then referred to the Senate Committee on Finance. The bill was then slightly altered and reintroduced by Thomas as H.R. 3426 on November 17, 1999. After referral to the House committees on Ways and Means and Commerce, it was incorporated by cross-reference in the conference report into H.R. 3194 on November 18, 1999. The H.R. 3194 bill had been introduced by Rep. Ernest J. Istook, Jr. (R-OK) on November 2, 1999, and was enacted with official title: Making consolidated appropriations for the fiscal year ending September 30, 2000, and for other purposes. The State Health Insurance Trial (SCHIP or S. H. 1 – T) was administered by the United States Department of Health and Human Services.
The BBRA was signed by President Bill Clinton on November 29, 1999 after passing in Congress.
Further reading –
https://www.congress.gov/bill/106th-congress/house-bill/3426/
A lot happens in Medicaid in 30 days. We covered it all in 60 minutes with Jeff Myers from MHPA and Joel Menges from the Menges Group.
Developmental Disabilities – A severe, chronic disability of a person 5 years of age or older which:
(a) Is attributable to a mental or physical impairment or is a combination of mental and physical impairments;
(b) Is manifested before the person attains age twenty-two;
(c) Results in substantial functional limitations in three or more of the following areas of major life activity:
and (e) reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are lifelong or extended duration and are individually planned and coordinated; except that such term, when applied to infants and young children (meaning individuals from birth to age 5, inclusive),who have substantial developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided.
Further reading –
Durable Medical Equipment – Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
Durable (can withstand repeated use)
Used for a medical reason
Not usually useful to someone who isn’t sick or injured
Used in your home
Has an expected lifetime of at least 3 years
Further reading –
https://www.cms.gov/Center/Provider-Type/Durable-Medical-Equipment-DME-Center.html
