K+10...What It Means To Remember Katrina

And by Remember, I mean remembering the sociopolitical circumstances that led to so much tragedy and loss...and not repeating them. People didn't suffer and die for us to forget, declare everything "OK," and merely move on and recreate the same conditions. (Yes, I'm looking at you, Mayor Landrieu.)

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?

Why Are We Buying What Donelon Is Selling?

Louisiana insurance Commissioner Jim Donelon explained last week on Angela Hill's radio show (at about minute 13:00) why our auto insurance is so high.  Auto insurance rates in Jefferson, Orleans, and a couple of other parishes are 40% higher than rates in the rest of the state because of a prolific "soft tissue" market, Mr. Donelon said.  That is, the proclivity of locals, aided by lawyers and doctors, towards seeking compensation for injuries resulting from auto accidents.  It pains me to agree with that characterization of the local citizenry.

It also leaves alot unexplained, in my opinion.  Seven years ago I paid about $74/mo. for a policy in Nashville with $100,000/$300,000 (100/300) limits and about $80/mo. for the same coverage in Chicago.  When I moved back to New Orleans, I had to slash my coverage limits to 50/100 just to barely afford auto insurance here.  Turns out I couldn't even barely afford it.  I just plain could not afford it, not even if I doubled my deductible.

With each passing year, I tacked on 365 more days to my flawless driving record *knock on wood*.  Still, my premiums continued to rise despite my car and me both being six years older and my having aged into an (allegedly) cheaper rating class; and five years into my move back home, I had to drop my coverage to the 25/50 state minimum.  

Commissioner Donelon's explanation does not even come close to explaining why I and every Louisianian shell out 50% more money for about 1/5th of the coverage that we would get in other major cities.  The WDSU report that ran last evening seems to confirm my hunch that the prevalent "soft tissue" industry is not to blame for much of this disparity in auto insurance rates because it only accounts for approximately 10% of the increased premium.  That news story also makes very fuzzy links between a national rise in auto insurance fraud and cell-phone caused driver distraction, but Louisiana's ridiculously high insurance rates long pre-date either of those phenomena.  

Even if auto insurance fraud accounts for 40% of our premiums in metro N.O., that does not satisfactorily explain why it's 40% more for WAY less coverage.  I am, in fact, now paying 40% more than I paid in Chicago and Nashville, but shouldn't I be paying 40% more for 100/300 coverage instead of 40% more for shitty 25/50 coverage?  Maybe there is an actuarial table somewhere that that backs up Mr. Donelon's explanation, but until I see it, I ain't buying it.

Senatron Vitter and The Talking Points

I think my Senator might be an automaton.

This past summer, I emailed Sen. Vitter what I thought were two simple questions: "Could you please explain your reasons for voting NO on the nomination of Richard Cordray for Director of the Consumer Financial Protection Bureau?  Who do you think would have been a more appropriate choice for this position, someone you could have voted for?" 

A little over two weeks later, he responded:

Dear Friend,
 
Thank you for contacting me in opposition to Majority Leader Harry Reid's planed "nuclear option" to change procedures in the Senate. I appreciate hearing from you, and I completely agree with you. 
 
As you know, Senator Reid was advocating ending the 60-vote threshold currently needed to confirm Executive branch nominees. He was considering a "nuclear option" to lower the threshold to 51 votes, which would have drastically changed the rules and norms of the Senate. I am vehemently opposed to this hypocritical idea that would severely hamper a minority party's constitutional right to advise and consent. A last minute deal was reached to defuse this current crisis, but Democrats could still attempt this maneuver in the future. 
 
If Senate Democrats insist on changing how the Senate operates, it will not be because Senate Republicans have forced their hand. Of the 1,564 nominations President Obama has sent to the Senate over the past four and a half years, only four have been rejected. Also, according to the Congressional Research Service, President Obama's cabinet nominees are, on average, moving from announcement to confirmation faster than nominees from the last two previous Presidents. Majority Leader Reid's plan is based on false premises, not on facts. Democrats would do permanent damage to the Senate for immediate and temporary political gain. Rest assured that I will hard to oppose this "nuclear option." 
 

Again, thank you for sharing your thoughts on this important issue. Please do not hesitate to contact me in the future about other issues important to you and your family.

__________________________ 

OOOOOOK, Take 2.  Although I should have been pleased over the personalized comment tacked onto the end of his email in a totally different font, I ungratefully wrote back:

Senator Vitter,

I do appreciate your taking the time to respond to my message.  It appears, however, that you responded to questions different from the ones I asked.  My questions were:

Senator Vitter, Could you please explain your reasons for voting NO on the nomination of Richard Cordray for Director of the Consumer Financial Protection Bureau? Who do you think would have been a more appropriate choice for this position, someone you could have voted for?

Could you please answer those questions?  Thank you.

_________________________

That was two months ago.  

Could the appropriate staffer please reboot the Senator in order to complete the installation of his most recent talking points?  It's not like y'all are doing anything else.  

An Open Letter to LA State Treasurer John Kennedy

Dear Mr. Kennedy,

I would like to begin by lauding your tireless efforts in ensuring that Louisiana's tax dollars are spent wisely and, specifically, your vocal advocacy for sensibly balancing the needs of our citizens with those of individuals and companies who contract with the state.  Because of the credibility you've established in addressing such matters, I urge you to ensure that the money received from pharmaceutical settlements finds its way back into the healthcare services budget from which it originated and to which it belongs. 

$38.8 million from Allergan, Covidien, United Research Laboratories, Merck, and Pfizer 

+

$258 million (+ $70 million for attorneys' fees) from Johnson & Johnson

+

$8.5 million from Watson Pharmaceuticals  
+

$45 million from GlaxoSmithKline (+ $7 million for attorneys' fees) 

_________________________________________________________________

= $350.3 MILLION DOLLARS FOR MEDICAID 

Attorney General Caldwell and DHH Secretary Kliebert acknowledge that these monies are "the result of Caldwell's office aggressively pursuing the recovery of Louisiana taxpayer's vital Medicaid dollars."  One of the attorneys for the state also stated that the money "will go directly to Louisiana’s Medicaid program."  By my estimate, at least $258 million of this money (from the J&J settlement) should specifically go back into the state's mental health budget.  

Mr. Treasurer, please make sure that happens.  

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

 A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/2013/03/07/anti-marketing-fraud-statute-used-to-prosecute-johnson-and-johnson-in-risperdal-case/#sthash.6ee2lzso.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/category/false-advertising/#sthash.VVI5MdXy.dpuf

A jury found Janssen’s marketing campaigns violated the state law 35,542 times at a cost of $7,250 per violation, resulting in $258 million in fines. It awarded the state another $70 million in counsel fees.  The Louisiana Supreme Court will decide whether the verdict will stand. - See more at: http://www.whistleblowerlawyernews.com/category/false-advertising/#sthash.VVI5MdXy.dpuf

K +8

Budgeting for Little Outcomes

The little things in life really are important, probably because those little things -- a child's smile or embrace, a joke told in passing by a friend that lifts your spirits on a shitty day -- eventually end up playing a big role in the quality of your life.

The same holds true for the little things that bring not joy but irritation, and eventually, high blood pressure if you're not careful.  Take light bulbs and dollar-store paint, for example. 

At 4:36PM yesterday during school zone hours, the school zone lights in front of KIPP Believe on S. Carrollton were not flashing, but I saw the speed camera flash on at least 5 different drivers who couldn't have been driving more than the regular posted speed limit of 30mph due to the volume of traffic at the time.  As was the case THREE MONTHS AGO when I reported this issue to my Councilwoman whose office then notified 311 and Dept. of Public Works Traffic Engineer Allen Yrle of the issue, the school zone lights were flashing on the opposite (lakebound) side of S. Carrollton, but not on the riverbound side.   New school year, same problem.  

Another little thing that bothers me in New Orleans are parking tickets, especially the ones for parking within however many feet ordained by city law from an intersection or crosswalk.  Now maybe it's just me hating on the meter maids for their amazing ability to eyeball distances with such pinpoint accuracy, but folks like me who were not blessed with that talent would appreciate a visible demarcation of the forbidden parking zones.  Every other city I've lived in has accomplished this through the modern miracle of painting white, sometimes yellow, lines on the pavement.  Yes, we are New Orleanians, and we pride ourselves on marching to the beat of a different drum; but maybe doing this one thing the way other modernized Western civilizations do it isn't so bad.  Just this once.  I SWEAR, just this ONE THING, and that's it.  And only temporarily, just until we come up with parking stripes more representative of our unique culture that have something to do with Mardi Gras Indians, or second lines, or the Saints or something.

It just so happens that we are once again upon that most wonderful time of year <*cue Johnny Mathis*> when the mayor requests citizen input regarding the next year's budget.   "Budgeting for outcomes," I believe he likes to call it.  Well, here's my advice, Mayor Landrieu: How about we start with budgeting for easily achievable, even cheap, outcomes like replacement bulbs for school zone signs and heavily discounted gallons of paint?  Nothing says RE-ELECT ME like a list of accomplishments!  Yes, even if it's just a list full of the little accomplishments. 

Where Is This on the Teacher Evaluation Form?

Just wondering...how many points is this worth when calculating a teacher's performance ranking?

Jindal: No need to expand Medicaid since Obamacare will be effective

There you have it, folks.  Gov. Jindal finally gives a legitimate reason for why he won't expand Medicaid eligibility.  You see, contrary to all of his previous arguments against healthcare reform, the Governor argues that Obamacare WILL be effective in reducing the number of uninsured Americans.  See Argument #4 in this article:

Without expanding Medicaid, and once eligible people are enrolled into healthcare exchanges set up by the federal government, there will be less than six percent of Louisianians without health insurance. That's why the state is focused on implementing public-private partnerships with charity hospitals across the state to expand access.

http://www.businessreport.com/article/20130422/BUSINESSREPORT02/130429997#ixzz2RpBwwhJF

Brown People Count -- and Other Election 2012 Lessons for Republicans

Early on during election night, even before President Obama was announced the winner, I watched a Fox News pundit soberly realize, as she put it, that Republicans need to realize they can no longer win many races without "brown people" and that they perhaps "overplayed" the whole Obama is a socialist thing.  Gee, you think? 

Grog's Gamut opened my eyes to a few other insightful take-home messages:  1) "All Obama lost from 2008 was Indiana and North Carolina which voted Republican even when Clinton was running in 1992 and 1996, let alone when George W won in 2000 and 2004. So it wasn’t a case of Romney making inroads, but more just getting back what the GOP used to take for granted"; 2) math and science rule; and 3) yes, the electoral map still looks like roadkill if you just look at land mass,

but the margins of victory at the county level may tell the more important story: 

 "Where Obama won big was in the big cities; where Mitt won big was in places that didn’t matter because they were never in play – such as Utah...

In Colorado for example Obama won big in and around Denver and Boulder. In Florida he won the Miami-Dade Country with 62% of the vote – that county had around 829,000 voters, next door in Broward County he won with 67%. It has around 719,000 voters. Together those 2 counties account for nearly 20% of the entire state’s vote.  In Ohio it’s the same story." [Grog's Gamut, 11-7-12]

Grog goes on to point out that radical Republican/Tea Party logic just will not win you votes in national and statewide elections in many states, nor will trying to appeal to (or trying not to piss off) that illogical segment of the population.  I think many Republicans fail to appreciate this. 

In a Facebook conversation I had with some local Republican friends hoopin' and hollin' about Scott Brown's loss to Elizabeth Warren, like they were born and raised in Massachusetts or something, I echoed that theory of flawed TEA (Taxed Enough Already) Party logic.  Especially in the MA Senate race, I believe it boiled down to this:  Republicans  underestimated how much people are hurting. People want health care and to not be raped by their credit card companies more than they want tax cuts. Tax cuts aren't bad, but what the hell am I going to do with a tax credit I have to spend money up front to take advantage of if I don't have any money in the first place?

For Mitt Romney's Health Plan, Look to Gov. Jindal

Want to know how Mitt Romney would fix America's healthcare problem?  Just look to how Gov. Bobby Jindal is reforming healthcare in Louisiana: by eliminating it.  If you think I am kidding, look at the Governor's travel schedule.  Louisianians already know that Jindal spends more time with Romney and raising money for him than he does at the state capitol.  Who else would Romney look to for advice other than the Republican-proclaimed healthcare guru?

Every time Jindal and his band of suck-up, "whatever you say, boss" state healthcare administrators have reassured us they are only cutting healthcare costs without sacrificing services, it has turned out to be a boldface lie.  Each time, they and Jindal have known exactly what the plan was all along, then proceeded to tell the public the exact opposite.  

It all started with mental health. Three years ago, the state's Medical Director clearly stated their intent to eliminate inpatient psych services for youths.   Remember New Orleans Adolescent Hospital? Remember how all those beds in New Orleans were moved to the northshore?  Isn't it convenient how NOAH was sold earlier this year just before the state decided publicly announced that Southeast Louisiana Hospital was closing and that those "psych beds" would be relocated back to the southshore?  I put "psych beds" in quotes because even though the state has already moved the patients out of Southeast Louisiana Hospital, it has yet to even identify where those "beds" will ultimately physically exist, which means they don't exist. And they likely never will.  Just like those more abundant outpatient services to replace the shuttered hospital units don't exist -- and in many cases never did. 

Using the loss of federal Medicaid funding as an excuse for decimating the LSU system is, in my estimation, Jindal and Greenstein being less than totally honest, to put it charitably.  The trip down that road has been underway since last summer when Jindal single-handedly and against the will of the legislature, and therefore that of the people, CHOSE to eliminate about $24 million in federal healthcare funds when he CHOSE to veto the renewal of the 4-cent cigarette tax.  The trip continued with the privatization of Medicaid with his brainchild the Bayou Health Program and with giving control of mental health services to the private insurer Magellan which slashed reimbursement rates to providers 30-40% before Jindal even learned of the federal Medicaid funding cuts, which of course led to even deeper cuts.

The latest outcry, which will of course be ignored by Jindal, is against his cuts to the LSU system that stand to cripple the training of future doctors.  Even his handpicked henchmen on LSU's Board of Supervisors weren't aware of the extent of Jindal's destructive plans:

"The shortage came as a surprise to members of the LSU Board of Supervisors, who recently approved a plan to cut $150 million out of operations of seven LSU hospitals in south Louisiana." -The Advocate 10/29/2012

Oh wait. Except they were lying about not knowing.  An article from six days earlier titled, "Medical Plan Caught Up in Cuts to LSU," noted:

"...the LSU budget cuts could jeopardize training programs’ accreditations and standards, threatening medical education in Louisiana and chasing away medical students needed to treat patients in a state that already has issues about access to health care and doctor shortages in rural areas.  LSU leaders and the governor’s health secretary, Bruce Greenstein, say they’re keeping all of that in mind and have graduate medical education at the forefront of their planning." -The Advocate, 10/23/2012

How are you surprised to learn of something you promised a week ago to keep in the forefront of your mind?  Seems to me that Jindal and his yes-men are lying about saving medical education too.  Why would they if they're getting rid of the places those doctors would practice?  

So if you're down with that, then by all means, cast your vote for Romney and roll out the welcome mat for incoming Secretary of the U.S. Department of Health and Human Services & new Cabinet member Gov. Bobby Jindal.

Mitt, Big Government, and the Deeply Confused Deep (Red) South

People living on the Gulf Coast, especially Louisianians, should be the last ones complaining about big government programs.  D-SNAP, FEMA, NFIP, USACE, National Guard, Road Home Program, etc.  Need I say more?

No I don't.  But I will.

Many local Republicans decry the amount of federal dollars spent on those no-income-tax-paying leeches living off the government dole, those same leeches who Mitt believes will never support him.  What many local Republicans seem unable to recognize, or at least admit, is that they are those leeches.

Source: http://cdn.theatlantic.com/static/mt/assets/politics/nonpayers.banner.taxfound.jpg

Such folks are either misled, uninformed, or disingenuous.  Either way, if they want the rest of us to start taking them seriously, Republican politicians and their local supporters need to walk their talk.  The ones living in St. John the Baptist, Plaquemines, and St. Tammany need to vote for enough new taxes to cover the full cost of the levees they want.

(Well OK, they don't have to hold that vote now.  We can wait until after they get out of the disaster food stamp line.)

Isaac Debris Picked Up?

Nope. Not yet. (taken 9/10/12)

Hurricane Isaac: A Post-Mortem Analysis

I was going to do a comparison/retrospective pre-storm post cleverly titled "Isaac Meet Gustav.  Gustav, Isaac" --  a flashback-flashforward piece, if you will, involving this post.  However, my detailed prep routine highlighted in that Gustav post prevented that.  

Folks getting their extra 2 inches of parking elevation pre-Isaac

Isaac, as irritating as he was, provided positive experiences I would not have otherwise had.  I learned that I have some very interesting neighbors.  Despite New Orleans' reputation for close-knit communities, I had never gotten to know these folks.  A lot of bonding can happen on a neighbor's front porch on the pitch black, windy, wet second night of a 'cane.  The cool Tulane college students who live next door and I finally had the opportunity to really hang out.  They even came over and made a delicious meal in my candlelit kitchen, complete with enthralling conversation that made me feel like a dope compared to their brilliance.  I, in return, provided some "radio action" during which Margaret Orr wowed them and, consequently, gained a new fan or two.  I experienced the kindness of my neighbor, about 7 or 8 years old, who swept the leaves off of my side of the porch in the heat of the morning without even being asked to.  

 

I learned that if you have older candles you haven't used in a while, you should make sure before the power goes out that the wicks aren't buried in the wax. 

I learned that my cat BoBo gets car sick. 

I learned that given the choice, I would pick air conditioning over cable TV, telephone service, and yes -- even Internet.

The bluish (some see more green, others more purple) glow given off by transformers in the pitch black darkness of a windstorm is eerily cool!

Tree down on Leake Av. - Wed., Aug. 29th, 2012

I learned that my what-to-cook-in-the-order-it-will-spoil-without-electricity strategy needs a great deal more refinement.

I learned that if it involves using the oven in an already sweltering house that I will most likely not cook it.  To hell with it spoiling!

Did Mayor Landrieu Just Say Chief Serpas Knows Jack About Reducing Murders?

The title of this CBS piece, "New Orleans Mayor Fights to End Culture of Violence," is the exact opposite of what I heard Mayor Landrieu say in this interview, which was that no one IN THE WHOLE ENTIRE COUNTRY knows how to stem the epidemic of young black males killing each other here in New Orleans.   

Based upon my grasp of the English language, population statistics, Venn diagrams, and if not A then not B logic, "Nobody in the Country" includes Landrieu's Police Chief Ronal Serpas.  So why did he hire this guy?

Other cities have brought down their black-on-black murder rates, so SOMEBODY SOMEwhere must know SOMEthing about how to do this.  Right?

UPDATED 8/14/12:

This seems like a far cry from nobody knowing what to do: http://publicspherenola.blogspot.com/2012/08/crime-prevention-in-new-orleans-value.html 

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. 

Jindal Will Sell New Orleans Adolescent Hospital

Gov. Jindal's current budget depends on the sale of New Orleans Adolescent Hospital (NOAH). 

In the spending plan for the LSU public hospitals, $35 million is tied to the sale of the New Orleans Adolescent Hospital, which hasn't yet been sold. [Alexandria Town Talk, 3/12/2012]

The state acquired the property through a Dec. 16, 1981 transfer agreement from the federal government. That deal specified that the property would used for "general health care" services for 30 years, a period that expires in December 2011. [Times-Picayune, 4/7/2010]

You remember NOAH.  

That's the safe place we used to have for our suicidal and homicidal kids before we routinely shipped them off to Shreveport. 

Is LA Medicaid Putting Fat Cats' Profits over Patient Health?

No, I don't mean the so-called "fat cat" doctors that people who aren't doctors think get rich off Medicaid payments.  I mean pharmaceutical companies.

I learned today that Medicaid patients need prior authorization for generic ADHD medications.  Name-brand (i.e., more expensive than generic) ADHD medications are on the current Louisiana Medicaid Preferred Drug List, but generic versions of those same medications are not.  This means that LA Medicaid will pay, no questions asked, for Adderall XR, Focalin, Focalin XR, and Concerta; but physicians must submit Prior Authorization forms for the less expensive generic forms of these medications.

That means that providers who prescribe these drugs to Medicaid patients must fill out additional paperwork, and may even have to call the state medicaid office, to justify why the state should pay for the CHEAPER  generic version.    

As if that isn't problematic enough, there is a shortage of stimulant medications used to treat ADHD, and many pharmacies only have generic versions.  They couldn't get the name-brand versions of the drugs if they wanted to.

I find this policy interesting, considering Governor Jindal's push to save healthcare dollars by privatizing Medicaid and his constant hootin' and hollerin' about how much Louisiana pays to fund Medicaid. 

Santorum, Risky Parenting, Heresy, and the Quran

Rick Santorum thinks President Obama is a snob for wanting Americans to go to college.



Santorum wants to create jobs so that people can remake their children in their own image.  While you do want your children to adopt your positive characteristics, everyone knows that trying to make your children grow up to fit some ideal persona that you have in mind for them can be disastrous.  For all of Santorum's questioning of the President's theology, what he just said is heresy.  Our children are made in God's image, not our own.


As for the violence over the military's destruction of the Quran, were these rare collectors' special edition Qurans or something? We apologized.  They do have more copies left, right?  I'm going to need the Afghans to simmer. 

New Orleans: Boldly Going Where We've Been Before

To reduce the murder rate, Police Chief Serpas is going to map crime hotspots, which I could swear he said he was going to do last year.  And the year before that.  Remember COMSTAT, anyone?  

The City Council pitched in today by voting to implement earlier curfews -- because law-abiding murderers and armed robbers will surely respect an 8pm curfew, and it's a no-brainer that crime will decrease if you limit the hours during which kids can commit them. Duh!  

And finally, to REALLY increase the quality of life in The Big Easy, the city's Health Department is improving the availability and delivery of mental health care by...drumroll, please...typing lists.