“Black legislators question DHHS as agency touts accomplishments.” Where Are the White Legislators?
A colleague sent the following article to me this morning. When I first read it, I was thrilled, because I have been beseeching the North Carolina legislators to demand accountability of the Department of Health and Human Services (DHHS), Division of Medical Assistance (DMA) for the sake of health care providers who accept Medicaid in NC (especially behavioral health care providers).
So few providers accept Medicaid as is. But with the Medicaid system in such a downward spiral, more providers decide to NOT accept Medicaid every day. Providers just don’t want to deal with the harassment (not to mention the low reimbursement rates).
According to this News and Observer article below, “black legislators” are demanding accountability from DHHS.
Again, my first response was, thank goodness, at least someone is. But when I talked to my husband about this, he asked, “Why are just the black legislators demanding accountability? Where are the white legislators? Where are the other ethnicities?”
I agree.
Providers across NC are having their Medicaid contracts erroneously terminated or not renewed. Providers are going out of business. Providers are not accepting Medicaid. Medicaid recipients are being denied medically necessary services. Medicaid recipients are unable to find providers willing to accept Medicaid. Especially in behavioral health. What will it take for people to care? A Columbine?
Is this a “black” problem? A “white” problem? A Republican or Democrat problem?
NO! It is a North Carolina problem.
So, bravo, members of the Legislative Black Caucus!!! Bravo for being a leader. But I hope your leadership causes all legislators, no matter the color or party-affiliation, to question DHHS.
Here is the article:
Leading black legislators are calling on the head of the Department of Health and Human Services to explain delays in Medicaid payments to providers, problems getting food stamps to the needy, and agency employee raises.
Members of the Legislative Black Caucus said at a news conference Wednesday that they were not receiving timely and accurate information about activities in the department. Their news conference came a few hours after DHHS distributed information touting the department’s accomplishments.
DHHS spokesman Ricky Diaz said the agency provides legislators with regular updates and will continue to do so.
The department has been under scrutiny for the past few months for personnel decisions and problems with expensive computer systems.
The department included on its list of accomplishments the Medicaid payment system called NC Tracks. The system continues to frustrate some providers who have trouble getting paid for patient care.
The lawmakers, all Democrats, sent their letter to Dr. Aldona Wos, the department’s secretary, and Gov. Pat McCrory. The letter was full of questions about NC Tracks and NC FAST, another computer system, which handles food assistance. The letter also asked questions about personnel matters.
The department has a personal services contract with Joe Hauck, a vice president in Wos’ husband’s firm, that has paid Hauck more than $228,000 for about eight months of work as an adviser.
Rep. Garland Pierce, a Scotland County Democrat and president of the Black Caucus, referred to the Hauck contract as one of the “questionable decisions made by her that almost call her integrity into question.”
Wos sent an email to a small group of legislators last week saying Hauck has done important work for the department. Black Caucus members said the email should have been widely distributed.
Legislators also questioned salaries and raises given to new staff and long-time top administrators.
Diaz explained that Wos walked into a department without a leadership team or a succession plan. She had to find top people quickly, he said.
“We have attracted talent to the department to take on these challenges,” Diaz said. Meanwhile, the agency has cut its payroll $23 million, he said.
Lawmakers said they need accurate information from DHHS because health care providers ask them when the agency’s computer problems will be fixed and because low-income people are going hungry.
Sen. Earline Parmon, a Winston-Salem Democrat, said she was on a conference call with Wos and others in the department about two weeks ago, where they offered a “glowing perspective” on the computer systems.
“A few minutes later, I got information that everything they told us was not factual,” Parmon said. “First of all, we need for them to sit with us and admit that there are problems.”
The legislators’ letter included a report from the Triangle Business Journal that said for the week ending Aug. 23, the department missed three of four targets for approved Medicaid claims and had a backlog of more than 90,000 items.
Diaz noted that the system has processed 29 million claims and paid out $1.4 billion.
The department told the public there would be a 60- to 90-day rough patch once NC Track started running, Diaz said.
“Those who are trained come to realize the benefits of it,” he said.
Posted on September 12, 2013, in Accountability, Behavioral health, Division of Medical Assistance, Harassment, Health Care Providers and Services, Legislation, MCO, Medicaid, Medicaid Contracts, Medicaid Recipients, Medicaid Reimbursement, Medicaid Services, Mental Health, Mental Health Problems, Mental Illness, NC DHHS, North Carolina, Provider Medicaid Contracts and tagged Aldona Wos, Behavioral health, Division of Medical Assistance, Health care, Health care provider, Managed care, Managed Care Organizations, MCO, Medicaid, Medicaid Mental Health System, Medicaid recipients, Mental health, NC DHHS, North Carolina. Bookmark the permalink. 6 Comments.
In the midst of an erroneous Dental Medicaid review case, I find solace in your article. My client faces an ungodly recoupment for 2009 changes in required treatment documentation and billing changes on dentures. On the first appeal we cut the recoupment by 2/3. Now the contractor, PCG, has made further errors in determining and advising DHHS. Off to administrative appeal, then hopefully to court with this.
Steve, I wish you the best of luck!!!
“Those who are trained come to realize the benefits of it,” he said. Trained in what, self-delusion? Who needs to waste time in training for that-you can get that from a bottle of whiskey.
I saw a news report on News14 last week in which the WakeMed CEO mentioned that they are missing about $2.5 million in Medicaid reimbursement. I was happy to hear that, not because I might not like WakeMed (they did misdiagnose my ruptured lumbar disc, actually), but because I know that if the big players start getting shorted, then heads will roll at CSC and DMA.
I hope that there are journalists in this state who will continue to put all such stories front and center so the public can see what our wonderful administration in Raleigh is doing for them.
Great post. So, who at medicaid reviews the prior approvals and what are their qualifications? I am investigating this as my client’s records were reviewed and denied by a trained hygienist – not a licensed dentist. Has anyone looked at the credentials of those sitting in judgment?
Steve, You are absolutely correct! That hygenist (to the best of my knowledge) reviews all dental. Prior to her hire, the auditors were not even hygenists!
By licensing law they cannot review radiographs and therefore cannot proceed with an audit opinion. The problem we are having is that the hygienist that reviewed my clients records stubbornly stated that over 12-20 minutes per person should be spent documenting the appointment. Upon review of this consideration with the local dentists who do not share in this practice, we found that simply a radiograph spoke more to the quality of service and history, than any written documentation. These same radiographs, which hygienists may not read or interpret, are the information all Dentists most rely upon.
My next issue with Medicaid dental reimbursement is the idea of waiver. My client worked for Medicaid as a provider since 1993. Among the select few to pioneer the program, now is in controversy with billing a denture upon impression and not delivery per a change in 2009 provisions. My issue is, with all prior approvals, Medicaid had the ability, as with many other claims, to deny the claim because there was no delivery CDT code to trigger proper payment. When my client bought Ace Dental practice management, billing on delivery was not possible as there is no CDT code that Medicaid would pay. After many years, and thousands of claims, waiver would have to apply.
So, we head towards the NCOAH contested case. I have much in store if we can just get into Superior court. There – shall be a reckoning.