Thursday, January 31, 2013

Medicaid: Better budget news; stonewalling on audit trickery

Posted By on Thu, Jan 31, 2013 at 2:36 PM

The Department Human Services has released the expected improvement in the projected shortfall in money in operating the existing Medicaid program. Cuts to elderly services won't be necessary. From DHS:

New budget estimates released Thursday project a shortfall of $61 million for Arkansas Medicaid next
fiscal year, a much-improved financial outlook that will prevent the Department of Human Services (DHS) from cutting funding for Level 3 nursing care for the elderly and three other programs.

“No one wanted to cut funding for nursing care so I think this will be very welcome news,” said DHS Director John Selig. “Medicaid staff have worked hard to manage the program tightly and to be as innovative as possible. The new estimates, down from $138 million, show their work is paying off.” Selig said growth in the program is the lowest it has been in 25 years and that per-capita spending on every category of Medicaid beneficiaries has fallen. He and Governor Mike Beebe both attributed much of this new trend to the Arkansas Health Care Payment Improvement Initiative. The innovative initiative aims to reward doctors and other care providers financially for offering more efficient and better care for certain medical episodes.

“This historically slow Medicaid growth and smaller shortfall show that our providers are stepping up to work with our payment-improvement initiative,” Governor Beebe said. “Many of them are providing high-quality care with good patient outcomes while adopting more cost-effective practices. While the initiative only includes a handful of disciplines so far, other providers are getting ahead of the game and adopting a similar philosophy that benefits both our patients and our state budget.”

Selig said a review of Medicaid spending suggests that doctors and other providers may have, on their own, begun changing how they practice to adapt to the new health care environment that the initiative is creating.

In a meeting Thursday morning, Governor Beebe told Legislative leadership that the state must continue to move the initiative forward and build upon its momentum in order to meet the new budget projections.

Though DHS will not eliminate funding for Level 3 care, ARHealthNetworks, Medicaid’s adult dental program or community-based services for the elderly, it must move forward with previously released program efficiencies and provider rate cuts and freezes to address the funding gap.

Here's the new budget, which represents a $77 million improvement from the earlier forecast of a $138 million shortfall after the governor's recommendation for putting $90 million in new money and $70 million from reserves into the program. Republicans can be expected to say, if they haven't already, that the Beebe administration continues to present a moving target and that figures on Medicaid expansion should be viewed in that context.

Meanwhile:

I mentioned earlier, and others have reported, about Republican plans to hurry up a special audit of the Medicaid program in hopes of tarring Gov. Beebe's effort to expand the program. This includes release of past audits with only minor discrepancies and, according to the Department of Human Services, some highly suspect calculations apparently meant to harm the Medicaid effort.

Yesterday's blog post prompted a tip that I should look into efforts by Sen. Bryan King to influence this early audit release. He's a Republican co-chair of the Joint Audit Committee. He's the apparent reason Republicans packed an audit meeting yesterday in hopes of cheering bad news. He's the apparent source of leaks suggesting wildly inflated findings on fraud and abuse.

The tipster said:

How much influence should a member of the legilature have over an auditor?

Should a member of the legislature coach auditors?

Should a member of the legislature coerce and intimidate state employees during an audit?

So I requested an e-mails between King and Audit staff, including audit director Roger Norman (he who follows Bibilical principles in management and doesn't like to reveal his own salary details as a state employee).

My response came from Frank Arey, the audit counsel and a staunch Republican who once did legal work for Mike Huckabee (and my wife, I should add):

Under the provisions of Ark. Code Ann. §§ 10-2-129, 10-4-422(c)(1), and 25-19-105(b)(7), as applicable, we respectfully decline to provide the copies requested.

Under the provisions cited, some of which I'd argue with, King himself could authorize release of any communications he's sent to the audit staff. He did not respond to my email to his private address he uses to communicate with state employees. When the audit is complete, working papers should be open. I've requested them in advance. I expect similar cooperation then.

UPDATE: Ignore the obvious stench from Audit, House Speaker Davy Carter has their back. He said at a session with reporters today (I'd say it's pretty clear if he runs for governor he's planning to do so as a Republican):

Roger Norman and his group, they’re very professional. He and his staff would not be involved in any political stunt. [If there is] any inference that that’s the case, I want to stick up for them. They’re a class act. They would not be involved in anything like that.

David Ramsey asked Matt DeCample about the governor's thoughts: “We are avoiding speculation about the motivation of these actions, only saying that they do not seem consistent with the tradition of professionalism exemplified by Legislative Audit.”

More from Carter:

*Lower shortfall was good news but has no bearing on the expansion debate.

*He’s anxious to see the audit report and also to hear response from DHS.

* “There’s a perception out there that there’s some waste and abuse in the system. Whether or not that’s accurate, maybe this report will help in that analysis. I hope it does. We’ll be able to tell what’s in there and the importance of its content tomorrow. I want to wait to see that and hear all of the sides before we jump to conclusions.”

“If it’s something that’s eye catching and materially bad and that’s proven over the coming days and weeks to be the case in that report, that makes it awfully hard to dive in to something else before you go in and address the problems. I’m getting ahead of myself because I don’t know.”

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