A Surprise...

Carter Wrenn posted on June 29, 2009 21:39

Mid-June 2009: DHHS response to a Public Information request brought another surprise. Over six weeks before the request, DHHS notified Senate Fiscal Research Staffer, Melanie Bush that the CCME review Berger is referencing - showing that 45% of the Medicaid Home Care patients were ineligible, was inaccurate. Read the email below:

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From TalkingAboutPolitics.com

Carter Wrenn posted on June 29, 2009 19:02

Senator Doug Berger's Blooper

June 08, 2009

For the past month, State Senator Doug Berger has been telling just about anyone who’ll listen that 45% of the patients who get home care services through Medicaid are ineligible.

He’s gotten so worked up over the whole thing he wrote one lady, who disagreed with him, and told her the ‘ineligible’ patients’ children ought to be supporting their families – just like he supports his mother-in-law, adding: “Our family would like would like the luxury of someone helping us cook her meals and help keep our house clean” too.

Anyhow, Senator Berger got so exercised he rolled legislation out of his Senate Committee to cut the Medicaid budget for home health care a whooping 60%.

Then the whole thing started to come apart on him at the seams.

The Association for Home and Hospice Care of North Carolina wrote the Department of Health and Human Services and asked for a copy of the study Berger claims says that 45% of their members’ patients are ineligible for home care services. They got nothing. Zip. Zero. Nothing. Then they threatened to sue and got an eye full – the study popped out of

HHS and, lo and behold, it didn’t say what Berger claimed.

Senator Berger had said the study – by a state vender – analyzed a cross section of Medicaid patients. It didn’t. The focus was on paperwork and agencies that were out of compliance with paperwork requirements.

What about the claim 45% of the patients are ineligible? Dead wrong. Because the vendor’s preliminary patient reviews were reversed most of the time through a more in-depth review approved by HHS. HHS discovered ineligible patients weren’t ineligible at all.

For instance, a home care agency in western North Carolina had 10 of its 10 patients ruled ineligible by the contractor. Every one was reversed by HHS. Another agency had 7 of 10 patients ruled ineligible. Again, every one was reversed by HHS. A nurse with a third agency, again in western North Carolina, described how the contractor conducted the study: They “found that 85% of our patients did not qualify. One of these patients was a 90 year old blind man who could not bath, ambulate or toilet himself.” HHS decided every one of that agency’s patients were qualified too.

HHS made public detailed data for one month – January 2008. 70% of patients the contractor said were ineligible a year and a half ago are still receiving care today – with HHS approval. (The remaining patients either died, moved into a nursing home or moved off Medicaid – HHS can’t say which.)

Even worse, consider this: When Berger finishes cutting 36,000 patients home care a lot of them are going to be left with only one choice -- to go into rest homes and nursing homes. Let’s say 60% – the same number Berger cuts – do just that. The cost to the state of caring for a patient in home care is $9000 a year. In a rest home or a nursing home the cost is from $21,000 to $48,000. Do the math. That mistake could cost taxpayers almost a billion dollars a year.

Last week at their caucus, according to one legislator, House Democrats threw open the flood gates to increase taxes between $1-2 billion to balance the budget – but unless someone corrects Senator Berger’s mistake a good part of those taxes are going to pay for ‘Berger’s blooper.’

So how did Senator Berger commit such a blooper? Did he just get bad information from HHS Secretary Lanier Cansler, then whip a bill out of his committee that cut 36,000 disabled patients’ home care?

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Email to Senator Doug Berger from DHHS

Carter Wrenn posted on June 29, 2009 18:17

DHHS to Senator Doug Berger: The review does not show that home care patients are ineligable. Because the 'reviews' did not include a physical examination of a single patient. Read the email below:

From: Gray, Craigan [mailto:craigan.gray@dhhs.nc.gov]
Sent: Fri 6/12/2009 1:31 PM
To: Sen. Doug Berger
Cc: Cansler, Lanier; Feezor, Allen
Subject:

June 12, 2009

Senator Berger:

The first two attachments are the requests and responses. The last three attachments include the summary of the CCME survey where ~41% of surveyed were out of compliance. Keep in mind that of that percentage, some came back in to compliance with proper documentation, some got better and left the program, others moved to other programs, died, or in fact some did not qualify. We are breaking each category down for further analysis presently. The PCS group is anticipating an electronic surveillance tool in the future; however, all metrics are currently manual. I am asking the PCS management group to implement an enhanced metric-based surveillance program as a result of the most recent inquiry to improve the standard of performance from all parties.

I appreciate your interest in the PCS program and we remain available for further questions as needed.

C. Gray, MD

Craigan L. Gray, MD, MBA, JD
Director, Division of Medical Assistance
2501 Mail Service Center
Raleigh, NC 27699-2501
(919) 855-4101 phone, (919) 733-6608 fax
craigan.gray@dhhs.nc.gov

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E-mail from Tim Rogers to NC Legislators - CCME Percentages Inaccurate per Secretary Cansler

Carter Wrenn posted on June 29, 2009 17:50

From: Tim Rogers
Sent: Monday, June 15, 2009
To: NC Legislators
Subject: E-mail from Tim Rogers to Legislators

Dear North Carolina Legislator:

I want to share with you new information I have received since my last note (about the misleading chart HHS gave legislators, claiming 45% of the Medicaid patients receiving home care were ineligible).

That chart was based on reviews by CCME, a vendor to HHS. Friday, I had a note from Secretary Cansler stating he was informed several weeks ago – in a meeting with Senator Clary – the CCME percentages were wrong.

In addition, Thursday, we received information (attached) from HHS that the Department had decided, after receiving the study, not to notify even one of the 899 patients CCME said were ineligible that they would no longer receive care; it is also clear from the records we have received most of the patients continue to receive care with the Department’s approval.

HHS paid the vender (CCME) $1.29 million dollars for this study. As part of the study, HHS paid CCME a fee of $360 for every patient it reviewed. ($360 equals one-half the average cost of a month’s home care for a patient of $750.)

So, per the attached, HHS paid over a million dollars for the study, almost all of the patient reviews were reversed by the Department, then the Department gave the study to legislators knowing it was inaccurate.

As ever, thank you for allowing me to keep you informed.

Sincerely,

Timothy R. “Tim” Rogers, CEO

Assoc. for Home & Hospice Care of North Carolina

South Carolina Home Care Association

3101 Industrial Drive, Suite 204

Raleigh, NC 27609

919-848-3450

919-961-3555 cell

Member – State Health Coordinating Council – SHCC

Member – NAHC Board of Directors

Chairman – NAHC Forum of State Associations

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