Category: MM Curator

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PROVIDERS (NH)- Senate Finance votes to reduce Medicaid payment increase for providers by $15 million

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ask for $200M more, get $119M more.

 
 

 
 

PROVIDERS (NH)- Senate Finance votes to reduce Medicaid payment increase for providers by $15 million – New Hampshire Bulletin

 
 

Clipped from: https://newhampshirebulletin.com/briefs/senate-finance-votes-to-reduce-medicaid-payment-increase-for-providers-by-15-million/

 
 

Providers had requested an additional $200 million in the next budget. (Getty Images)

Mental health centers, midwives, home health care aids, and other human service providers may see a smaller increase in Medicaid payments than the $134 million the House approved. 

The Senate Finance Committee voted, 5-1, Tuesday to cut the House’s increase by $15 million, which would give providers about a $119 million increase. 

With the federal match for Medicaid, that is at least a $30 million decrease in Medicaid funding.

Providers had requested an additional $200 million in the next budget. The governor proposed $24 million. The House increased that to $134 million after providers said the state is paying them so little in Medicaid that they can’t hire staff or adequately care for the state’s most vulnerable residents.

Senate President Jeb Bradley, who authored the amendment reducing the House amount, called the $119 million a “huge appropriation of dollars.” 

“We’ve got several huge items: housing, child care, pay raise for state employees, education funding, and Medicaid provider rates,” Bradley said. “If we don’t, at least in my opinion, make a pretty concerted effort to enhance our Medicaid provider rates, our health care system and everybody that depends on it is going to suffer.”

Bradley’s amendment would also give the Department of Health and Human Services more flexibility than the House did in deciding how to target increases to various providers. 

Sen. Cindy Rosenwald, a Nashua Democrat on the Senate Finance Committee, was the lone no vote. She noted that the committee also cut other Medicaid funding by more than $100 million on Tuesday. 

“I’m really concerned about this,” she said. “We do have the revenues to do it in the next biennium, and I would hope we would have the will to continue with this important workforce piece.”

The Senate Finance Committee’s proposed budget will go before the full Senate next, and then to the House, which can agree or challenge Senate changes. 

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PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Details on poor quality in the RI nursing home market. In this article, explained entirely by payment gaps (that have been in place for 11 years).

 
 

PROVIDERS (RI)- Medicaid and leadership challenges, as state takes over nursing home

 
 

Clipped from: https://www.mcknights.com/news/medicaid-and-leadership-challenges-as-state-takes-over-nursing-home/

 
 

 
 

A Rhode Island nursing home with more than 30 citations for deficiencies and whose administrator’s license was suspended last month has been put into state receivership. 

While declining to comment about the situation at the facility itself, the sector’s leading advocates in the state told McKnight’s Long-Term Care News that the broader picture of nursing homes in distress has become acute due to surging labor costs and chronic underfunding. 

“Rhode Island Medicaid has been chronically underfunded for more than a decade,” said John Gage, president and CEO of the Rhode Island Health Care Association.

The state’s Medicaid rates are based on 2011 actual costs inflated by approximately 1% per year since 2012, Gage said. The estimated shortfall is $50 million to $60 million per year, and the pre-pandemic gap between reimbursement and the cost of care was approximately $30 per patient per day. Both Gage and his counterpart at LeadingAge Rhode Island, which represents nonprofit facilities, said the gap is likely much higher now.  

“We have a high rate of Medicare Advantage beneficiaries, and those plans don’t pay as well as 

traditional Medicare, so providers are squeezed on that end,” explained LeadingAge Rhode Island CEO James Nyberg. 

On top of that, the state’s skilled nursing facility workforce is down approximately 20% since the pandemic – registered nurses are down 16.5%, licensed practical nurses are down 18.3%, and certified nursing aides are down 25.4%, Gage said, adding that the usage of expensive staffing agency personnel has quadrupled.

What’s more, in 2021, the state approved a staffing minimum requiring 3.58 hours of direct care per patient per day that Gage said will cost approximately $60 million per year while funding was set at just $12 million per year. 

“Clearly, something has got to give,” he said. 

There are 80 nursing homes in Rhode Island, including the Charlesgate Nursing Center, which is in the process of closing due to staffing challenges and inadequate Medicaid reimbursements, Gage said.

Pattern of issues

The state Department of Health made a surprise inspection of the Pawtucket Falls Healthcare Center in October. What followed has been detailed in local media as a volatile situation in which a resident’s broken bone from a fall was not noticed for two days, staff medical errors, improperly administered COVID tests, and other problems. 

State investigators also said that former Administrator Sami Almadi “tried to deceive them” about discharge papers for a resident, who complained about an improper discharge. NBC10 reported that Almadi presented a discharge form on which at least one of two nurse’s signatures was forged. Almadi’s license was suspended last month, the station’s report said.

A court-appointed receiver has now been charged with overseeing the facility. A statement from the state’s interim health director said the department “tried to help the facility stabilize” but that a “pattern of health and safety issues” over the last seven months led to the receivership, NBC10 reported.

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MCOS (TX)- Bonnen’s Deal To Prioritize Profit In Medicaid Coverage

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: 2 brothers are working to help national MCOs crack open more of the LoneStar state. One of them is the chairman of the House Appropriations Committee. The other is the former Speaker of the House. Not making this up.

 
 

 
 

Clipped from: https://www.reformaustin.org/texas-legislature/bonnens-deal-to-prioritize-profit-in-medicaid-coverage/

 
 

As the budget fight in the Texas Legislature heats up over school vouchers, a quiet addition being pushed by the Bonnen Brothers could start funneling Medicaid dollars into more private, profit-driven companies’ pockets.

According to Quorum Report, former Texas Speaker of the House Dennis Bonnen has been pushing for a budget amendment on behalf of Amerigroup, a for-profit national medical coverage company that provides health insurance to low-income people. In practice, that means that Amerigroup stands to make billions of dollars when they win contracts to administer Medicaid coverage.

His brother, Greg Bonnen, is currently the chairman of the House Appropriations Committee. He is supporting a new rule that would judge potential Medicaid vendors based not on quality of care, but by how profitable they are.

This comes during a time when a significant fight is happening over how Medicaid will be run in the state. Currently, for-profit entities like Amerigroup are trying to circumvent county programs that also offer Medicaid through their hospital systems. These non-profit organizations control 11 percent of the state’s Medicaid managed care networks and re-invest back into their local communities.

Because of this, they legally receive preferential treatment over for-profit organizations who instead put any excess money in investor pockets. Two bills this session have tried to eliminate the preferential treatment, making it easier for for-profit companies to swoop in and take over the contracts.

The budget addition would allow the voting process to be circumvented, and possibly not even be debated on the chamber floor.

In other jurisdictions where Amerigroup has taken over Medicaid, they have reported enormous profits up to 30 percent. They have also had to settle fraud lawsuits over denying care to patients that totaled in the hundreds of millions. In Texas, Amerigroup has been fined for denying care to disabled residents.

By allowing profit margins to determine a Medicaid managed care provider’s worthiness, it prioritizes companies that deny the most coverage as that increases their profitability. Poor Texans, especially in rural areas, will end up with fewer options for care and will be forced to go without.

Currently, insiders who spoke to Quorum Report say that Greg Bonnen is making the budget rider a top priority in the House, and has spoken to his counterpart Joan Huffman (R-Houston) in the Senate abut keeping the rider in the final budget bill. With all the fighting over school vouchers and property tax relief dominating the media coverage, a simple change to Medicaid managed care might very well fly under the radar.

Medicaid currently serves 5.4 million Texans, by far the largest medical insurance used in the state. It is also one of the stingiest programs in the nation, being completely unavailable to most non-disabled Texans regardless of income. Texas continues to refuse the Medicaid expansion offered by the Affordable Care Act, the largest state to still do so. Texas Republicans have allowed a small increase in availability for post-natal Texans that was aimed at curbing the state’s abysmal maternal mortality rate.

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OP ED (PHE) – Why is Medicaid still treating COVID-19 as a public health emergency?

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: In which the author criticizes Medicaid payments for testing of a disease that some sources say killed 15M people worldwide before we stopped counting. But we all know Joe Rogan has the real scoop..

 
 

Clipped from: https://www.washingtonexaminer.com/restoring-america/community-family/why-is-medicaid-still-treating-covid-19-as-a-public-health-emergency

The federal public health emergency for the COVID-19 pandemic came to an end Thursday, more than three years after it was first enacted in 2020. That comes on the heels of the World Health Organization’s declaration on May 5 that COVID-19 was no longer a global health emergency.

And on the same day, the Centers for Disease Control and Prevention announced it would stop tracking new cases. In other words, the pandemic is largely behind us. Yet Medicaid is still covering over-the-counter COVID-19 tests for beneficiaries free of charge. That makes little sense. No other payor is under the same obligation. Provisions requiring Medicare and private insurers to cover up to eight at-home tests per month for free expired along with the public health emergency.

THE LEFT’S NEW SCHOOLING SEGREGATION

But under the American Rescue Plan Act, which was passed in 2021, state Medicaid plans must continue offering at-home tests to enrollees free of charge. The requirement won’t sunset until the end of September 2024 — roughly a year and a half after the end of the public health emergency. Why are taxpayers covering the cost of tests for a virus that no longer constitutes a public health crisis? It’s not cheap. Medicaid and the Children’s Health Insurance Program cover 93 million people. Even assuming just one test per person over the next 16 months, the additional cost would run into the hundreds of millions of dollars.

CLICK HERE TO READ MORE FROM RESTORING AMERICA

But what’s a new nine-figure cost when Medicaid already accounts for $734 billion in annual spending each year? Even the public health establishment has declared that it’s time to move on from COVID-19. Medicaid should follow suit.

Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes. 

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FWA (PHE)- Phone scam targets New Yorkers enrolled in Medicaid amid renewal push. What to know

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: This was always going to happen.

 
 

https://www.lohud.com/story/news/2023/05/15/medicaid-renewal-phone-scam-targeting-new-yorkers-what-to-know/70212823007/

 
 

David Robinson

New York State Team

0:30

2:02

Authorities warned Friday of a new telephone scam targeting New Yorkers enrolled in Medicaid and other related government health plans.

The scammers are deceptively calling people and asking them to pay hundreds of dollars to maintain their health insurance through Medicaid and related programs, said Attorney General Letitia James and Acting Health Commissioner Dr. James McDonald.

The truth is that there is no charge or fee to renew your health insurance in Medicaid, Child Health Plus, or the Essential Plan. 

 
 

The scheme aims to capitalize on the monumental state and federal effort underway to renew Medicaid or related coverage for millions of New Yorkers after pandemic-era measures expired. The renewal process paused during the pandemic but recently restarted. The renewal reviews will continue through spring 2024.

 
 

From <https://www.lohud.com/story/news/2023/05/15/medicaid-renewal-phone-scam-targeting-new-yorkers-what-to-know/70212823007/>

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EXANSION (NC)- NC Senate budget: Where does Medicaid expansion stand

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Ruh-roh. When I said I was ok with removing CON, I did NOT mean the ones that protect my fiefdom. (Read this line in the voice of the NC Hospital Association).

 
 

 
 

Clipped from: https://www.newsobserver.com/news/politics-government/article275435491.html

Politics & Government


By Luciana Perez Uribe Guinassi

Updated May 16, 2023 7:21 PM

The Senate budget unveiled Monday cuts state laws that regulate hospital competition, placing Medicaid expansion, and health coverage for thousands of low-income North Carolinians, in conflict.

During last year’s Medicaid expansion negotiations, a key disagreement between the House and the Senate was Certificate of Need laws, which limit where hospitals, clinics and other health care facilities can be built. The Senate wanted to pass expansion with Certificate of Need changes but the House did not.

But this year, there was a breakthrough, and in early March, the Senate and House announced that they had reached a compromise deal: Medicaid expansion would pass and it would cut some CON regulations for health care facilities.
The compromise bill would also include a new reimbursement program for hospitals.

By the end of March, Gov. Roy Cooper signed expansion into law at a ceremony at the Executive Mansion in downtown Raleigh, opening the door for health insurance coverage to 600,000 low-income North Carolinians, who would be newly eligible for the program under its enhanced eligibility parameters.

There was a big caveat, though. Expansion would be contingent on the passage of the state budget, setting up the stage for roadblocks during potentially contentious budget negotiations.

The Medicaid expansion law signed by Cooper eliminates CON requirements for behavioral health beds and chemical dependency beds, among other cuts.

Meanwhile, the Senate’s budget bill takes “a sledgehammer to those archaic and unnecessary Certificate of Need laws that remain on the books,” said Sen. Ralph Hise, Monday, during a press conference to unveil the budget.

“These common sense changes will build on the CON reforms we included in the Medicaid expansion package and drive down costs and increase availability for patients,” he said.

What happens next?

Senate leader Phil Berger addressed Monday how the proposed CON changes could affect the House compromise and Medicaid expansion.

“I suspect there’ll be a number of things in this version of the budget that will create conflict with what the House did and we’ll work that out,” Berger said at during a budget press conference Monday.

The House passed its version of the budget in April. Berger said the Senate expects to pass its version this week, followed by negotiations between both chambers.

“That’ll set up conference, because I’m pretty sure that the House will not concur in the changes that we make,” Berger said. “So even if it takes us three weeks in conference, that’s still the middle of June getting it done. So I think, we’re on track to get the budget done before the end of the fiscal year.”

Pressed further on how expansion fell through because of CON change disagreements, Berger said, “I don’t anticipate us reaching a stalemate with the House. We will see what happens but I don’t anticipate that.”

Details on changes

The compromise expansion bill signed into law eliminated certificate of need requirements for behavioral health beds and chemical dependency beds. For counties with a population of 125,000 or more, it eliminates CON requirements for MRI machines and ambulatory surgical centers. These provisions would become effective years down the line, as previously reported by The News & Observer.

Under the new Senate budget, CON laws would be repealed:

  • for ambulatory surgical centers and facilities with Magnetic Resonance Imaging (MRI) machines, in counties with a population under 125,000 that do not have a hospital.

     
  • for mobile MRI machines, linear accelerators, physician office-based vascular access for hemodialysis, and kidney disease treatment centers.

     
  • for the conversion of special ambulatory surgical programs to multispecialty programs and for the addition of a specialty.

The North Carolina Healthcare Association, a powerful interest group that represents hospitals, had been against cutting CON laws — and tying CON reform to Medicaid expansion — saying that it would erode access to care.

By limiting how many providers can offer lucrative services, CON helps hospitals ensure they can offset operations losses for things such as Medicaid care, said the NCHA, as previously reported by The N&O .

Cynthia Charles, a spokesperson for the NCHA, said Monday that the association was reviewing the budget proposal and didn’t yet have a comment about the changes.

How Medicaid funds are spent in the budget

Beyond CON provisions, the Senate budget lays out how Senate Republicans would like to spend the Medicaid funds — including a one-time, $1.6 billion bonus from the federal government granted under the American Rescue Plan Act.

Hise said the Senate prioritizes spending the money to address behavioral health needs and health care workforce shortages.

The state Department of Health and Human Services has seen a vacancy rate of 25.9%, as previously reported by The N&O.

According to a press release by Republicans, of the sign-on bonus:

The budget also allocates $6 million of the money to the nonprofit Carolina Pregnancy Care Fellowship for crisis pregnancy centers.

This story was originally published May 15, 2023, 7:04 PM.

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IL to Spend $1B on Medicaid for Undocumented Seniors

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

[MM Curator Summary]: The cost is now 500x what the politician who sold it originally said it would be. Shocked. I am shocked, I tell you. And its 100% state costs.

Clipped from: https://www.fairfieldsuntimes.com/opinion/il-to-spend-1b-on-medicaid-for-undocumented-seniors/article_964ed289-fc69-5310-9605-291a4e6ba38d.html

Illinois is forecasting that its program to provide healthcare to undocumented immigrants will cost the state $1 billion in 2024 – far more than the $2 million that Illinoisans were promised it would cost at the program’s inception, according to Wirepoints.  

In May 2020, Illinois became the first state to offer Medicaid for undocumented immigrants over the age of 65. Now-Congresswoman Delia Ramirez, then an Illinois state representative, sponsored the bill, and claimed the program would cost just $2 million per year. Unfortunately, this estimate was completely uninformed, with the program exceeding that in its first month.

At the time, she said the coverage will save the state money in the long run, and the cost of $2 million, “is nothing to a $2 billion Medicaid bill,” The State Journal-Register reported.

Since then, the program has grown to include people as young as 42, causing enrollment and costs to balloon. A closed door presentation to IL lawmakers (that has since been made public) reveals that the total cost of this program in 2024 is projected to be $990 million. Enrollments have far exceeded expectations — 51,914 compared to the estimated 33,500 in 2023, or 55% more.

“No portion of that cost is reimbursable by the federal government,” Wirepoints reported.

Illinois is being crushed by fleeing citizens and an ever-growing mountain of debt, which stands at more than $154 billion. This program would be an expensive investment for even the most fiscally sound states, but in Illinois, it’s unaffordable and pushes the state closer to the brink of economic ruin.

The #WasteOfTheDay is brought to you by the forensic auditors at OpenTheBooks.com

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PROCUREMENTS (FL) – State prepares for Medicaid dental procurement

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The new dental RFI is out in the Sunshine State.

 
 

 
 

Clipped from: https://floridapolitics.com/archives/612211-state-prepares-for-medicaid-dental-procurement/

 
 

Florida Medicaid officials released a request for information (RFI) seeking input from potential vendors as it prepares to put its Medicaid Prepaid Dental Program out to bid.

Responses to the four-page RFI are due by 5 p.m. May 30.

The agency must start the procurement process this year for the six-year dental contracts, which will take effect sometime in 2024.

The document solicits information on innovative ideas and best practices to improve Florida’s dental care services for Medicaid beneficiaries.

There appears to be an emphasis on ways to improve dental care services to people with intellectual and developmental disabilities enrolled in the Medicaid waiver program called iBudget.

 
 

For instance, the RFI seeks ways to: improve the integration of dental and primary care services for iBudget enrollees; and to identify different options for integrating sedation dentistry into dental services for iBudget enrollees.

The RFI also requested information on identifying certification(s) and accreditation(s) that allow for the safe and high-quality provision of dental care for individuals with intellectual and developmental disabilities; and educating future dentists about providing dental services for individuals with intellectual and developmental disabilities.

The RFI also asks for ways to:

—Utilize value-based payment (VBP) designs to simultaneously increase quality and reduce costs;

—Improve integration of dental and primary care services for children, adolescents, pregnant women, and the elderly;

 
 

—Provide enhanced orthodontia services;

—Innovate delivery methods for the dental care model, including care bundling, that empower recipients in making more informed health care decisions.

—Improve providers’ and recipients’ experiences with the prepaid dental program; and

—Achieve cost savings throughout the prepaid dental program.

Three prepaid dental plans currently have contracts with the state to provide dental care to Medicaid beneficiaries.

There was a legislative dogfight during the 2022 Session over Medicaid dental services and whether they should continue to be administered through a separate managed care program or be combined with the statewide Medicaid Managed Care Program, which also encompasses managed medical assistance, long term care, and specialty care.

The fight pitted the insurance industry, which wanted the program rolled into the larger managed care program, against dentists, who wanted the program to remain bifurcated. Ultimately, the Legislature agreed to keep them separate.

In April, the Agency for Health Care Administration published an ITN for the statewide Medicaid Managed Care Program.

Interested parties have until May 30 to submit written questions to the state about the ITN.

AHCA has not replied to Florida Politics’ requests for the questions or the names of the companies that submitted the questions.

The statewide Medicaid Managed Care Program contracts are worth tens of billions of dollars to the companies that submit winnings bids. Companies that don’t secure contracts with the state are essentially locked out of Florida’s Medicaid market.

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FWA (AR) Governor Hobbs Announces Actions Against Fraudulent Medicaid Providers

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The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: A developing (and concerning) story out West.

 
 

 
 

Clipped from: https://azgovernor.gov/office-arizona-governor/news/2023/05/governor-hobbs-announces-actions-against-fraudulent-medicaid

PHOENIX— Today, Governor Hobbs, alongside Attorney General Mayes, Salt River Pima-Maricopa Indian Community President Martin Harvier, AHCCCS Director Carmen Heredia, representatives from 13 tribal nations, and law enforcement, announced actions against over 100 Medicaid behavioral health residential and outpatient treatment service providers believed to be engaging in fraud. These providers have taken advantage of vulnerable individuals, particularly in tribal communities, and profited off their pain and suffering rather than providing real care. 

“Prior to my administration, AHCCCS had taken a piecemeal approach to targeting these fraudulent providers,” said Governor Katie Hobbs. “Under my administration this will change. Thank you to our law enforcement officials and AHCCCS for taking action, and to our MMIP Task Force for helping bring to light these fraudulent providers and the stories of those who have been affected by them. Together, we are going to bring about the systemic reforms we need to root out this problem and deliver true accountability.”

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FWA (TX) – Paxton’s Medicaid Fraud Control Unit Helps Secure Swift Conviction of Healthcare Marketer for Illegal Kickback Scheme

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Mr. Osemwengie stole $17.7M of your tax dollars. He did not say thank you.

 
 

 
 

Clipped from: https://www.texasattorneygeneral.gov/news/releases/paxtons-medicaid-fraud-control-unit-helps-secure-swift-conviction-healthcare-marketer-illegal

Attorney General Paxton’s Medicaid Fraud Control Unit successfully secured a conviction against Patrick Osemwengie, of Richmond, Texas, in a Houston federal court. Osemwengie played a supporting role as part of a larger home health conspiracy that resulted in $17.7 million in fraudulent Medicare and Medicaid billings. 

“The outstanding efforts of our dedicated Medicaid Fraud team have once again ensured that those who exploit our healthcare system for personal gain are brought to justice,” said Attorney General Paxton. “My office is committed to aggressively pursuing those who engage in healthcare fraud, safeguarding taxpayer funds, and preserving the integrity of vital healthcare programs.” 

Osemwengie illegally sold patient referrals to Grace Healthcare and Ebra Home Health Services, whose owners pleaded guilty to charges stemming from this investigation. Osemwengie charged $500 for new patients and $250 for recertifications. The home health providers then billed Medicare and Medicaid for home health services that were never provided. Several recipients have confirmed that Osemwengie paid them kickbacks to sign up for home health services. Other recipients were prevented from receiving genuinely needed home health services because of the scheme. 

A federal jury deliberated for 15 minutes following a two-day trial before finding Osemwengie guilty of conspiracy to pay and receive health care kickbacks.

The investigation was conducted by Sergeant Joyce Combest, Investigative Auditor Shen Wang, and Captain Rick McCollum of Paxton’s Medicaid Fraud Control Unit, in cooperation with the Department of Health and Human Services’ Office of Inspector General and the FBI. Assistant Attorney General Abdul Farukhi, who also serves as a Special Assistant U.S. Attorney, prosecuted the case along with Assistant U.S. Attorneys Christian Latham, James Hu, and Justin Martin.