Weekly Medicaid RoundUp: Week of October 23rd, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2y9t7L7

For optimist readers-  http://bit.ly/2y8BeaQ


A LITTLE LONGER THIS WEEK- Sit a spell. Let’s catch up.


STATES TO GET EASIER TIME ON WAIVER REVIEWS- CMS head Verma was at a conference this week in Ohio and let attendees know the agency is moving towards an
“unprecedented level of flexibility” for states to operate Medicaid the way they want to (v.s. being told what to do by the feds staring down the barrel of an FMAP). Sounds good to me, and should sound good to any freedom-loving person who thinks local autonomy is a good thing. Will of course ring alarm bells for lefties who want to continue using the feds to impose their views.

BADGER STATE STRUGGLES TO GET LEAD TESTS FOR KIDS- Guidelines require that kids get lead testing at 1 and 2 years of age. But it ain’t happening in Wisconsin. Less than 2/3rds of Medicaid kids there receive them according to a new report. Especially concerning since Medicaid kids have a 3X risk of lead poisoning.


… BUT APPROVES MORE SUBSTANCE ABUSE TREATMENT— The Good Guvnr Walker announced pay raises for mental health and substance abuse professionals treating Medicaid members this week. All in all, the state will spend about $17M on the rate increases, with the hopes it will entice more providers to offer more treatment.


SUNSHINE STATE TIGHTENS TIME AND DISTANCE STANDARDS TO INCREASE PHARMACY NETWORK- Florida changed requirements on MCOs to now have to have a pharmacy within a 10-mile drive of all patients this week. The move added thousands of pharmacies to the overall managed care network, with Staywell adding 1,400 alone (Molina added nearly 900). There were not a lot of rx access complaints before the change, so some analysts are left scratching their heads. Based on what I am reading it may be related to an ongoing independent pharmacy v.s. PBM lobbying scuffle, but not sure. Please write in or call with any intel if you are there on the ground.


… ALSO MOVES FORWARD WITH PLANS FOR NEW DENTAL PROGRAM – FL is rolling out a stand-alone dental program March of 2019. The RFP (technically and Invitation to Negotiate, or ITN) was released last week. Bids are due April next year. Considering bidding? Give me a ring. This is one of the ones we are tracking.



EMBOLDENED DEMS GEAR UP FOR TROTTING OUT “PUBLIC OPTION” – After the multiple nothing-burger attempts at repeal died on the garbage piles of our Congress and Senate, “progressive” Dems (I love that adjective and how its used – what is the corollary- indeed is one allowed in modern discourse?- for Republicans whom journalists want to give them linguistic halos? I digress) are now trotting out the revolutionary (think Che) idea of selling Medicaid to the masses via the exchange. This is the “public option” that ACA footsoldiers dreamed of nearly 10 years ago. Senators from HI and NM are leading the charge. Let’s do a poll – would you buy Medicaid if you had a choice? Assume: no changes to benefits or network compared to Medicaid in your state today; you pay a similar percentage of the total costs as you do for your commercial coverage today; and there are no subsidies. Please do comment or write in on this one.


NM BUDGET GROANS, PARTLY DUE TO CHIP RE-AUTH UNCERTAINTY- $82M short for Medicaid this year. $31M is being pinned on CHIP, which is still currently in the air in The District. $15M is tied to the ACA expansion bill coming due (states like NM who expanded start paying more of the costs of that decision this year).


AZ GOP NOT GIVING UP ON FIGHTING EXPANSION, DESPITE D.C. GOP FAILURES TO REPEAL/REPLACE— If you’ve been following this, you know its been a long road. If you are pro-expansion, you view these guys as the zombies that just won’t die. If you are pro-taxpayer, you admire their stick-to-it-ness. After being denied at the state appeals court, the AZ lawmakers get their day in the AZ Supreme Court this week. Recap: Good Guvn’r Brewer expanded unilaterally. State GOP said it’s a tax passed without their consent, which is against AZ laws.


GOOD GUVN’R USES CHIP FUNDING CRISIS TO RENEW PUSH FOR EXPANSION- The state that brought us the Batman-Villain-Eyebrows VP Candidate, continues to grace us with current Good Governor McAuliffe (Virginia). The Good Guvn’r insists that the way to deal with CHIP uncertainty is to expand Medicaid. Can someone please let him that’s so 2015? The hip thing now, Terry, is to sell Medicaid on the exchanges, under the “public option.”


CONVERT YOUR NURSING HOME TO BE “COUNTY-OWNED” IN THE HOOSIER STATE, GET 30% HIGHER RATES FROM MEDICAID— All you have to do is lease your nursing home to a county health system and you get higher rates. Pretty much every facility in Indiana knows about the loophole now, so 90% of them lease themselves to county hospitals. No big deal though. Spending over past 5 years on IN nursing homes has only increased a paltry $1B. That’s less than 1% of a typical pay-off-Iran-in-the-middle-of-the-night-with-a-ship-load-of-cash scheme. Seems legit.


DIRECTORS SAY CAID SPENDING WILL INCREASE 5.2% IN FY 2018, V.S. 3.9% IN FY 2017— This is even with slower enrollment growth. Seems most states are resolved to pay most providers more (except hospitals). 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Isaiah Bongham, owner of Dynamic Visions (a home health agency in D.C.) has been ordered to pay back $2M he stole from Medicaid. Actually he stole $480k, but the Fraudulent Claims Act triples it (that’s cool). Santila Terry of Morgan Park, IL stole $1M using her speech therapy operation. She kept billing for services provided by an employee long after the employee left her firm. Christina Benson of Orlando was sentenced to 4.5 years for her role in a scheme that enticed homeless Medicaid members to get services at her psych rehab center. Mrs. Benson’s kickback scheme cost FL about $200k. Charline Brandon of Little Rock is accused of billing Medicaid nearly $300k for hospice care for patients without a terminal diagnosis. Jerrold Rosenberg of Jamestown, RI plead guilty this week to accepting $180k in kickback payments in exchange for prescribing a version of Fentanyl called Subsys. He was conspiring with AZ-based Insys Therapies. Cesar Tavera of Cherry Hill, PA was sentenced this week for embezzling $1.5M from the community mental health center he ran. His wife plead guilty to Medicaid fraud earlier this year.  Mr. Tavera – you win on sheer volume alone! Congratulations! This weeks total taxpayer tab: $3.5M.


That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (make a bonfire) and keep running the race (you know who you are).


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