Feds' push for Medicaid 'transparency' irks states; Minn. chips away at fraud; Kansas seeks more assisted living

Sep 7 2011

State governments wrestle with Medicaid issues.

The Hill: Medicaid Transparency Push Riles State Officials
A federal push for more transparency in how states run their Medicaid programs is pitting patient advocates and medical providers against state officials who fear being hamstrung. The transparency effort comes as states seek ever greater flexibility in how they manage their Medicaid programs to cope with historic budget woes. Federal regulators have expressed sympathy for states' concerns, but they are also required to answer Congress' calls for more public information about what states are up to (Pecquet, 9/5).

Minnesota Public Radio: Medicaid Fraud Investigators May Be Missing The Big-Time Cheats
Anita Soledolu, the owner of a defunct Brooklyn Park-based home health care service, is going to jail on Sept. 15. after pleading guilty to defrauding Minnesota's Medicaid program out of $900,000. ... Minnesota's Department of Human Services says the state's 2010 Medicaid outlays amounted to almost $9 billion. And department officials say anywhere from 4 percent to 10 percent of health care spending in this country is lost to mispayments or fraud. That would mean that as much as $900 million of Minnesota's Medicaid outlays are stolen or misapplied (Olson, 9/6).

Kansas City Monitor: State Cancels Contract With Troubled Medicaid Provider
One day after prob­lems with a Mis­souri Med­ic­aid con­trac­tor came to a light in capi­tol hear­ing, the state has can­celled its contract. On Thurs­day, the Depart­ment of Health and Senior Ser­vices announced that it has ter­mi­nated its con­tract with Syn­Care, an Indiana-based health care com­pany that has been crit­i­cized for fail­ing to keep up with patient demand (Aldrich, 9/5).

Kansas Health Institute News: Reform Plan Would Divert Nursing Home Residents To Assisted Living Facilities
The Kansas Medicaid program spends almost $1.2 million a day on care for people in nursing homes. ... Kansas Department on Aging Secretary Shawn Sullivan says that's unsustainable. "If we're ever going to rein in our Medicaid spending, we're going to have to lower our nursing home utilization rate," Sullivan said  ... One of the best ways to do that, he said, is to get assisted living facilities to take in more Medicaid residents. That won't be easy, he said, because most assisted living residents pay $3,000 to $4,000 a month for the services from their own private funds, whereas Medicaid pays about $1,200 a month for the same services (Ranney and Shields, 9/5). 

Kansas Health Institute News: New Worksheet For Elder Care Creates Some 'Consternation'
Until last week, state Medicaid officials might have let a caregiver in Overland Park bill for 40 minutes to help a frail elderly person shower, comb her hair and brush her teeth.  But they might have allowed only 20 minutes of billable time for the same bathing and grooming in Dodge City. ... Not anymore. KDoA recently adopted a one-page worksheet designed to help case managers figure out how much time each service should take (Ranney, 9/5).

Sacramento Bee: Delta Dental Awarded New Denti-Cal Contract
Dental benefits for 6.9 million eligible Medicaid beneficiaries will continue under a new contract awarded to Delta Dental of California by the state Department of Health Care Services. San Francisco-based Delta was selected to administer an estimated $7.3 billion, four-year Denti-Cal dental benefits contract. The award includes five possible one-year extensions (Glover, 9/4)