What's the Whole Story Behind Louisiana's Medicaid Expansion for the Dead?

I've read the legislative auditor's report and various articles on Louisiana compensating private industry insurers for Medicaid services rendered to dead people; and the more I read, the more unanswered questions I have.

In this article, Kathy Kleibert blamed it on Social Security records.

Department of Health and Hospitals Secretary Kathy Kliebert said Monday that the problem occurred because DHH was relying on “a very sloppy database in Social Security” to determine who should be enrolled in the managed care plans. Most of the cases involved older adults with disabilities qualifying for Medicaid through the Social Security system, she said.

“In the future we are going to be using our vital records database,” she said, referring to the state’s registry of birth and death records.
http://theadvocate.com/home/7492510-125/auditor-state-pays-health-coverage

This Town Talk article implies the state relied on data from the DHH vital statistics office.  http://www.thetowntalk.com/viewart/20131104/NEWS01/131104017/Audit-Louisiana-DHH-paid-1-9M-Medicaid-dead-people

The legislative auditor definitely used DHH Vital Stats data to conduct the audit, but why would he use that method if the state uses/used Social Security info? http://app1.lla.la.gov/PublicReports.nsf/5BBFA4B0591132DB86257C14004DD0C4/$FILE/00035F69.pdf

Also, wouldn't Kleibert's response suggest that all of those people kept receiving federal and/or state SSI payments after they died?

I understand using a different methodology to audit payment errors.  That makes sense, but why wouldn't the state legislative auditor also use the same methodology as a means for comparison to lend more validity to his findings?

Or did the auditor intentionally employ a methodology that provides a safety escape hatch for DHH?

I Am So Not Gellin', Magellan!

Louisiana completely privatized mental health services on March 1, 2012.  The behavioral health insurance company Magellan is now the gatekeeper to pretty much ALL mental health services paid for by the state.  

True, there appear to be some advantages.  Services heretofore unavailable to LA Medicaid recipients, such as group therapy and reimbursement for meeting with your child's therapist without the child having to be present, are now available. 

Other than that, it's been HELL.  Where do I even begin?

1. Provider reimbursement rates have been SLASHED by about 30%.  Imagine finding out    

on March 5th that your salary would be cut by 30% -- beginning March 1st.  Yes, March 1st of the same year.  Uncle Bobby Jindal decided to privatize healthcare, or so he says, because the private sector provides the same or better services for lower costs without all the bureaucratic overhead and logjams.  What he didn't mention is that in his kingdom, he would let the private sector insurance company pay psychiatrists and therapists 30% less for services provided to its Medicaid customers than it pays the very same psychiatrists and therapists to see its non-Medicaid customers. 

2.  As of yesterday, zero of my clinic's claims appear to have been processed, so we have no feedback regarding whether Magellan is the type of insurer that will regularly deny 15%, 30% or whatever% of our claims (i.e., payment for services already provided).  You would think the lauded private sector would understand that to keep a business from going under you need to be able to project your revenue.

3. As reported yesterday by Gambit, Clinical Advisor still doesn't work.  

Clinical Advisor is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It's not working. As a result, providers — many of which, like the Guidance Center, serve Medicaid clients — haven't been able to submit Medicaid claims. What's more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid. [Gambit, 3/20/2012]

4. Forget about Magellan paying for your child to undergo a formal psychological evaluation.  They are denying ANY test that in ANY way could POSSIBLY be used to diagnose learning or educational problems even if the test has other uses, AND even if the psychologist states s/he wants to use that test for one of its other uses.  Magellan reasons that the federal government already provides that service.  In reality, the federal government mandates that school districts evaluate any child 0-21 years of age suspected of having a learning or emotional disability.   They just don't provide the schools with all the funding needed to accomplish that.  

5. Our insurance specialist has spent most of her time on hold when calling Magellan, one time for 30 minutes before the call was simply disconnected.  I emailed a question to the provider account plastered all over their website and on DHH's site -- 8 days ago.  Still no response, not even a form reply stating they have received my email.

6. We have heard that Magellan is requiring inpatient psychiatric providers to obtain daily authorization for hospitalized patients, a process that colleagues say is taking about 2 hours/day.  This despite what is written on page 15 of their 21-page FAQ document for providers [updated 2/24/2012]:

Q: For our inpatient unit, I was requesting authorizations practically every day, for different patients. I would get multiple authorizations of two days or three days or four days. If a patient comes in to this short-term unit, am I going to have to get an authorization every day?

A: You do not have to obtain an authorization every day, but the authorizations will be for short periods of time. We want to be sure first of all that the person still clinically needs the inpatient level of care and could not be safely returned to services in their community. Secondly, we want to have a discussion at every review about the discharge plan. Discharge planning, in our view, begins at the time of admission. We want to make sure that members have a well-established plan for aftercare services in place when they are discharged. So we are going to be reviewing every two to three days depending on the status of the person’s clinical condition and the plan for discharge.

And those are just the things I care to write about right now. 

The Real Story Behind Unpaid Sanitation Fees

UPDATED 8/28/2011: Through checking my phone bill and a little internet sleuthing (this nola.com story from April 2011), I'm pretty sure the collection agency that hit me up for "unpaid" sanitation fees that I already paid is Alpat Company, Inc. in Slidell.

Fox 8 ran this story tonight about Councilwoman Hedge-Morrell owing more than a couple of thousand dollars in sanitation fees.



Sadly, no one featured in this story -- not the outraged citizen, not Bureau of Governmental Research President Janet Howard, not Councilwoman Head, not the person who crafted the statement from Mayor Landrieu's office, and not even Councilwoman Hedge-Morrell -- seem to have a clue what's going on.

I think I do, and these folks should too. Have you ever directly paid your sanitation fee directly to the Sanitation Dept.? No. You pay it to the Sewerage and Water Board.

At the beginning of this year, I received a notice from a debt collection company hitting me up for about 3 months of unpaid sanitation fees. (Of course, the only thing I've thrown away in 25 years is the piece of paper with this company's name on it, but I do remember the company was in Slidell.) I spoke with a customer service rep at the New Orleans Sewerage & Water Board who explained that when you pay your water bill late, they do not forward that month's fee for trash collection to the Sanitation Department. Thus, if you pay your bill even one day after the due date, SWB keeps your $24/month sanitation charge (+ your late fee, of course). You are still on the hook for the sanitation charge even though SWB has never informed us of this payment arrangement they have with the Sanitation Department and even though your next and subsequent bills don't show an unpaid sanitation fee balance.

The customer service rep, who was quite courteous and merely communicating SWB's policy, explained to me that, no, they do not show this on your bill. SWB, however, does keep track in your account file.

So, to sum it all up, because of a clandestine payment agreement between SWB and Sanitation:

So tell me, why don't any of the government officials featured in this story seem to know this? And why did Mayor Landrieu's office say they are working with SWB to improve collection efforts when the problem seems to largely be one of internal policies dictating how SWB applies payments it has already received -- not a problem of receiving the fees?

Like After Katrina, Outside Folks Getting the Disaster Contracts

The fine folk over at The Lens informed the citizenry today that "Gulf Coast states lag behind other states in getting contracts for oil disaster work." Only 12% of the $53.3 million in federal oil-spill related contracts have gone to Louisiana companies. Most of the rest of that has been contracted to companies in Pennsylvania, Virginia, Massachusetts, and Colorado -- not to other Gulf Coast states suffering the direct environmental and socioeconomic consequences of this disaster.

People in other states need work too, and it seems quite plausible to me that some of corporations best able to execute the particular terms of some contracts are not Gulf Coast business. Maybe many Gulf Coast businesses were already at full capacity due to having already received state or local contracts or contracts directly from BP to do disaster-related work.

My point is I just don't know enough about the details to know whether we're getting shafted down here in the federal contracting game for this disaster. I do know, based on past experience, that we need to dig deeper into this before it becomes like the Katrina recovery in which local workers were brazenly left out of the citizen driven recovery we were promised. That is, if it's not too late. I blogged about it on 9/16/2006, and I'm going to be quite pissed if this sort of thing is happening again...

The Army Corps, Bechtel and Halliburton are using the very same "contract vehicles" in the Gulf Coast as they did in Afghanistan and Iraq. These are "indefinite delivery, indefinite quantity" open-ended "contingency" contracts that are being abused by the contractors on the Gulf Coast to squeeze out local companies. These are also "cost-plus" contracts that allow them to collect a profit on everything they spend, which is an incentive to overspend. [Corpwatch.org, 8/17/2006]

...and we were supposed to have learned our lesson so that our federal government could protect us from shady contract deals.

I hope that last part didn't make you laugh TOO HARD.

Why Is Jindal Taking Our Money?

I just read two news reports that share an interesting common thread. The first story involves the dissolution of the Louisiana Recovery Authority, formed after Katrina to guide the state in its expenditure of federal recovery dollars:

HB1173 would have required legislative approval of proposals and contracts for the use of more than $50,000 in recovery dollars while HB1175 would have allowed parishes to seek alternative uses for allocated recovery funds. Under opposition from the Jindal administration, neither bill won final passage.[Louisiana New Link].

With the dissolution of the LRA, the Jindal administration essentially is allowed to write a blank check on the remaining funds"[2theadvocate.com]

The second story is about how Jindal wants to hold on to the money the state has gotten from BP and prefers that the affected coastal parishes go obtain any money BP owes them on their own.:

Gov. Bobby Jindal unleashed his veto pen late Friday, nixing lawmakers’ attempt to direct $24.9 million to parishes and small towns affected by the oil leak...In his veto message, Jindal said BP should pay the municipalities directly for the impact of the April 20 rig explosion in the Gulf of Mexico.

Left unnoted in Jindal’s veto message was the fact that the money legislators wanted to give to the municipalities comes from a fund fattened by a grant from BP. The Jindal administration wants state agencies to have use of the money. “If it’s acceptable use for state government, then why isn’t acceptable for local governments?” said state Rep. Sam Jones, D-Franklin, who co-sponsored the amendment that would have diverted much of the BP money in the state’s Oil Spill Contingency Fund to help 11 coastal parishes and the towns of Lafitte and Grand Isle. [2theadvocate.com]

Unfounded Racism Not the Same as Unfounded Concern

Let me get this out the way now: Good transparent government is good transparent government regardless of race, and Mayor Nagin is a terrific asshole as well as an out-of-touch, incompetant mayor.

That said, it bothers me that some white people don't take some of these racial issues seriously. Although some white people don't see how race plays into some issues, when white politicians just dismiss the race issue as "unfounded," that adds fuel to the city's race problem as much as the black politicians who cry racism when there is none. It's akin to a doctor telling you that there's no physical cause of the back pain you've suffered for years and that it's really all in your head; but he's not the one experiencing the pain. I don't think the white councilmembers' actions were racially motivated, but that doesn't mean they get to ignore black citizens' suspicions. If I remember correctly, what Hedge-Morrell said was that some of her constituents viewed the issue as a racial one. Good politicians take their constituents' concerns seriously and don't just ignore them (something Mayor Nagin does all the time), which is an extremely patronizing and thing to do and infuriating to the person with the concerns.

Black politicians like Nagin are playing the same games that white politicians have long played in this state. White people in New Orleans have gotten rich off of back room deals for centuries, so you can't just chalk it up to paranoia when black citizens ask why is that white people want to create transparency now that black people have the power to enrich a few other black people -- along with alot of white people who still benefit from being politically connected (e.g., the Business Council of N.O.). Like Oyster said, these are tricky issues and you can't just blow them off without addressing them. As much as it sucks, white politicians have to tell us why their vote isn't racially motivated and they have to be convincing -- as convincing as I have to be that I'm not a thief when pulled over by the police or when I'm followed around the store by white salesclerks. This shit sucks, but you have to deal with it.

St. Bernard Redevelopment Rumored To Be Halted

Sources tell me that the redevelopment of the St. Bernard public housing complex has come to a screeching halt due to the Louisiana Housing Finance Authority's (LHFA) inability to secure investors to purchase the tax credits allocated to finance the project. I'm hoping this is not the case even as I write this because if true, we have been misled in the most egregious manner by our city officials. As I recall it, the riotous city council meeting at which the council voted to unanimously approve demolition, they and Mayor Nagin assured us that demolition could not proceed until all stipulations of the provisos attached to the order allowing demolition were met; and I believe one of the provisos was that the developers had to first prove that financing had been secured.

The Times-Picayune reported that enough funding was in place to "launch" the 1st phase of construction.

"the Bayou District Foundation has secured $62 million through low-income tax credits and $27 million from federal block grant money. That's enough to launch the first phase of 465 apartments next year."

Then again, it's the T-P. These are the same people who fervently endorsed Jindal for governor. However, to their credit, the same article reports that many had doubts about the reality of getting people to invest in tax credits for such an ambitious project -- twice the scope of the Atlanta East Lake project after which the St. Bernard plans are modeled.

Another few key points:
The redevelopers of the St. Bernard, Columbia Residential, are closely tied to the allegations of corruption that directly led to HUD Secretary Alphonso's firing or resignation or whatever the feds called it. This was reported by the OB Rag Blog on December 27, 2007, mere days after the council's vote to demolish the projects:

A report today in the online publication Government Executive details mounting evidence from federal investigations linking HUD Secretary Alphonso Jackson to scandals in New Orleans-including the demoliton contract for the St. Bernard public housing complex.

"the feds are going after Scott Keller, described as Jackson’s “right arm,” for his role in steering the St. Bernard demo contract towrds Colombia Residential, a company Jackson once worked for, and which still owes him hundreds of thousands of dollars."

In June 2006, Sec. Jackson put Keller in charge of HUD. “Keller was smack in the middle of the HANO decision to award the $127 million redevelopment to the team that included Columbia Residential to restore [sic] the St. Bernard public housing projects”

“Internal HANO records show that the Columbia Residential team barely won the evaluation, 68 points to 67.”

One more thing. I'm also told that Columbia has already been paid $9 million dollars for demolition (also reported on the OB Rag Blog) compared to the $4 million dollars the developers of the other 3 housing projects were paid for demolition.

Jill on S-CHIP Veto (and Getting Your Priorities Straight!)

President Chimpy actually vetoed health insurance for children. FOR CHILDREN Y'ALL! Thirty-five billion dollars is apparently too much to spend on making sure working- & middle-class kids stay healthy. A trillion or so in tax cuts for the wealthy is apparently not. Neither is a few hundred billion to CONTRACT out this war and Katrina clean-up to cronies in his inner circle.

If you didn't make noise over the tax cuts which decimated the Treasury, if you didn't pitch a fit when the 3 states hardest hit by Katrina & Rita received only 16% of the billions Congress allocated for recovery, then maybe it's time you call folks like Sen. Vitter, who says he will not vote to override this veto and remind them we put them there to actually be of HELP! (I think "Vitty Cent" done really lost his damn mind as of late.)

My first ever guest blogger, Jill, is not pleased; and she is back to have a word with some of you (you know who you are):

It's on, people! PLEASE MAKE YOURSELVES HEARD ON THIS ISSUE! There are tools all over the web for you to write letters and send emails to your congressmen and women; there will be rallies held all over the country tomorrow as well. Also, now is as good a time as any to check your voter registration -- if you're not registered, get registered; if you need to update, do it.

At the risk of calling folks out, I'll go ahead and make it plain -- I got about a hundred emails from people about that ignorant Don Imus some months ago. I got a ton about the "Read a *&^%^ Book" video. Some folks even sent messages expressing outrage at PepsiCo for taking "in God we trust" off of their marketing materials or some similar foolishness. If y'all have time and energy to engage that madness -- you've certainly got time and energy enough to stand up for the health and wellness of our poor and near poor children. Let your reps know in no uncertain terms that this is a priority issue, and their vote gets yours. Let's go!

All the best,

Jill

Fuzzy Math?

OK, let me see if I got this straight. The LRA is giving $40 million to private schools to cover rebuilding costs...and the 188,251 households of N.O. get to split $116 million to rebuild? I can be a bit slow at times, but that seems a little lopsided.

Also, I wonder if the private schools have to submit rebuilding plans before they get this money.

And why is New Orleans only getting $116 million when there is over $445 million left to distribute? It still wouldn't be enough, but it'd be 4x as much as 116 mil.

Moreover, why are we getting $116 million to rebuild neighborhoods that are to last longer than our lifetime when ICF is get $750 million to fuck up for a year?

And So This Is Christmas...

I keep hearing in my head the lyrics to that song "Happy Christmas (War is Over)":
So this is Christmas,
And what have you done?
Another year over
And a new one just begun...

It's Christmas again, for the 2nd time post-K, and what have we done? It was hard putting myself into the Christmas spirit this year with the constant thoughts running through my head that things are not looking good down here, this long after the fact. Even though I was surrounded by family and loved ones, there weren't as many as usual because some of them don't live here anymore. Everyone who was there didn't seem to be in as festive a mood as in past gatherings. Maybe it was just my own perception, but a friend from New Orleans shared that her family gathering felt more subdued, perhaps even a bit depressing, too. After all, Baton Rouge just isn't home to them -- not yet anyway. Last Thanksgiving and Christmas was like this too, but that was to be expected less than 4 months after the fact.

I am certainly not ungrateful for the people and the things I still have and for this Christmas, which was still more than many people will ever have. Still, it's not MY Christmas, and I can't help but wonder how many more Christmases before Katrina doesn't dominate our conversations and our new lives, and when our "new lives" will just feel like regular ole everyday lives.

Hope, however, does spring eternal. Otherwise, why would we still be here? Fortuitously, for the first time since I can recall, I wasn't infuriated or completely disheartened by the news. There were actually developments to be hopeful about. The new Congress will FINALLY look into the fat no-bid disaster contracts that went to already wealthy companies well-connected to the White House. State legislators have wised up to the notion that they should question ICF's contract, and are finding some questionable allocations. Democrats and Repubs from LA and MS may actually unite to take on the insurance companies, now that they've even screwed Trent Lott. The Saints (need I say more?). Hell, who knows? Maybe Nagin will miraculously wake up mute next week!

Whatever the case, or however down I feel today (and I must keep emphasizing that this is how I feel today, right now), I have no choice but to keep going because at this point the alternative is an even less acceptable option. It's not like anyone promised any of us blissful holidays for eternity anyway, and who are we to demand such?

ICF International Wouldn't Lie to Us, Would They?

Today's Times-Picayune featured an article on the slow progress of the Road Home Program stating: "In its proposal, ICF boasted that [it] would provide the kind of 'surge capacity' that would enable the company to quickly process applications and get relief to weary homeowners." However, "while more than 90,000 homeowners have applied for a Road Home grant in the past four months, as of last Thursday just 94 families had received money."

Michael Byrne, an ICF senior vice president and chief program executive defended the company, saying the state's demands changed after the job began:

"We had enough people for the model we built, based on what we thought we needed to be doing," Byrne said. "But the perception of what we needed to deliver changed." [Times-Picayune, December 24, 2006]

Really?
In that case, I think ICF should explain the discrepancy in the above statement with their June 30, 2006 Press Release:

"The Road Home housing registry already exceeds 90,000 applicants, with more than 30,000 additional applicants who have not yet registered but are expected to qualify."

Oh and this one one too, from October 19, 2006:

"The State estimates that nearly 123,000 residents are eligible for the rebuilding grant monies allocated for homeowners. In the second and third phases, we expect to double local hiring and team with an even greater number of local firms."

OH, annnnnnnd this one:

"We met or exceeded the deadlines established for the first phase of the Program and are pleased that we were able to accomplish our goals..." October 19, 2006

Not to nit pick, but that sounds a little different from the state's view of things: "By not having enough advisers, ICF was unable to reach its goal of conducting 1,000 initial interviews per day by Oct. 31, Jones [state official and mayor of Franklin, LA for 23 years] said. That goal wasn't reached until Nov. 16, records show." T-P December 24, 2006

Don't Listen to Me!

OK. In my previous post when I said local merchants should play the big money game so they can get them some big FEMA contracts...I was kidding. I didn't mean for y'all to go and do it -- like these suspects did.

Judge overturns fine against trailer dealer

By James Varney
Staff writer, Le Times-Pic
"A state judge in Baton Rouge has determined that Bourget’s — the politically connected custom motorcycle shop that has sold almost $120 million of trailers to FEMA — does not have to pay a fine for selling travel trailers without a license, according to attorneys who have read the judge’s unsigned ruling. The decision also appears to let Bourget’s off the hook for potentially hundreds of thousands of dollars in Louisiana sales tax, the attorneys said."

Why waste time going after these guys when we could keep stickin' it to those Blac -- I mean those people who used their $2000 FEMA voucher on foolishness?

Big Fat FEMA Contracts to Big Fat National Companies Waste Big Fat Money

Vitter says nearly half of debris clearing cost was wasted

By Jenny Hurwitz
St. Tammany bureau, The Times-Picayune

"The Army Corps of Engineers will have spent $2.4 billion clearing the staggering mounds of hurricane debris left behind by Hurricanes Katrina and Rita by the year’s end. But taxpayers could have saved $1.1 billion of that amount — an estimated 45 percent — if they had gone through local channels instead of federal ones, U.S. Sen. David Vitter, R-La., said Friday."

Is it fraud to waste money like this, or just a by-product of big bureaucracy? Granted, smaller local companies couldn't tackle debris removal from this disaster without outside help, but it sounds like local folks could have handled a bigger piece of the pie. But see, that's the problem with ignorant Louisianians -- if they wanted big government money, they should have been giving alot more $ to the GOP!
No wonder our state's schools are so bad; too much focus on shaping ethical behavior!


And what the hell does the Corps mean by this?
"The corps requested that Vitter not disclose individual contract prices, which they contend could drive down competition. "
SHHHHHH!!!! hey y'all!! Be quiet! Public information is now SECRET!!!! shhhhh!!!!

And one last quote from the article:
"Officials from the corps would not comment, deferring inquiries to Federal Emergency Management Agency, which is overseeing debris removal. Officials from FEMA were unavailable for comment Friday evening.""

Get the F*** Outta here!! You mean they couldn't find nobody from FEMA? How unlike them! I hope they're OK...OK, now I'm worried.

Seriously, though, props to Vitter for bringing this to light.