I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
While environmental activists played their part yesterday during demonstrations at the capitol building, going so far as to dress up as solar panels and to sing the tune of “You Are My Sunshine,” their counterparts, the anti-cap-and-trade contingency who has…
Roughly one quarter of University of New Mexico students are unimpressed with the state’s flagship public school, according to a survey that questioned college students about their higher education experiences.
Just before the stroke of midnight on Wednesday, House Republicans tried to bring a dead veto override to life. Just as the House was getting ready to adjourn and discuss budget issues in committees, Rep. Paul Bandy, R-Aztec tried…
A rare veto override move came to a dead end Wednesday afternoon when the House Judiciary committee voted 7-4 to table a bill that would have forced state agencies to share financial data, including Medicaid spending, with the Legislative Finance…
Speaker Ben Lujan is trying to keep the House from voting on an open government bill that would override one of Gov. Bill Richardson’s 2009 vetoes, Rep. Paul Bandy, R-Aztec, charged Monday.
The Senate voted to override Richardson’s veto…
The U.S. Centers for Medicare & Medicaid Services (CMS)’s Medicaid Integrity Group intends to investigate allegations the Human Services Department (HSD) hindered Medicaid fraud and elder abuse investigations by the New Mexico Attorney General’s Medicaid Fraud & Elder Abuse Division, CMS spokeswoman Mary Kahn told The Independent.
“We plan on conducting an inquiry into this situation with the state Medicaid agency,” Kahn said.
HSD and the state Health Department administer New Mexico’s $1 billion Medicaid program.
The Medicaid Fraud Division reported that HSD and the Health Department had withheld, “filtered” and “sanitized” information and documents requested by investigators, hindering numerous investigations. The allegations were made in the Fraud Division’s 2009 annual report to the Inspector General of the U.S. Department of Health and Human Services. But the Inspector General’s office alerted the Medicaid Integrity Group to the 2009 allegations only last week, Kahn said, following inquiries by The Independent.
Similar allegations were also reported in the Fraud Division’s 2008 annual report, The Independent has confirmed.
“We have not heard from the CMS Medicaid Integrity Group, but of course if they contact us we will work with them to address any questions they may have,” HSD Spokeswoman Betina Gonzales McCracken said Monday.
HSD was “surprised by the allegations,” McCracken told The Independent last month.
But the Medicaid Integrity Group was “already aware of similar allegations related to the state’s relationship with its Medicaid Fraud (Division)” in 2008, Kahn said.
Following its May 2008 review of the state’s Medicaid program, the federal Medicaid Integrity Group ordered HSD to prepare a plan to correct violations of several federal regulations, according to a report obtained by The Independent.
“The State is not in compliance with federal regulations related to required disclosure and reporting requirements,” the report states. Among the violations described in the report was HSD’s failure to report fraud to the state Medicaid Fraud Division, “limiting the ability of the (Division) to prosecute fraud cases.”
The report also faulted HSD for failures to screen Medicaid providers for criminal convictions or to verify patients actually received the care for which Medicaid was billed by health care providers.
The HSD is required to track all cases of suspected Medicaid fraud and abuse, but was not doing so at the time of the 2008 review, the report states.
“HSD has implemented the Corrective Action Plan,” McCracken said Monday.
The concerns raised by the Medicaid Integrity Group’s 2008 review were addressed in the Plan and were different from subsequent allegations raised in the Medicaid Fraud Division’s 2009 report, McCracken said.
“We were unaware there were any further issues that needed to be addressed,” she said. “In light of the (Medicaid Fraud Division) report, we will work with the AGs office to address any issues that might still exist.”
On Monday, the state Senate voted to override Governor Bill Richardson’s pocket veto last year of a bill that would require state agencies to share Medicaid and other program data with the Legislative Finance Committee.
Sen. Keller
On Tuesday Senator Tim Keller (D-Albuquerque) introduced a motion to revive SB 531, a transparency bill that was unanimously passed by the Legislature last year only to be pocket-vetoed by Governor Bill Richardson.
Keller’s recall motion passed with unanimous consent. It was the first step toward a legislative override of Richardson’s veto.
“This was just the first step in a two-step process – recalling the bill to the Senate floor,” Keller explained. “It’s a totally arcane process. You can’t just move for an override. Vetoed bills go to the Secretary of State’s for a year in case they are recalled to the Senate for an override.”
Another motion will be required for an up-or-down vote by the full senate. A two-thirds majority in both houses is necessary for a veto override.
SB 531, which would have forced state agencies to share Medicaid spending and other financial data with the Legislative Finance Committee, unanimously passed both houses of the Legislature last year.
“We definitely have an issue with investigating Medicaid fraud,” Keller told The Independent, referring to allegations by the Attorney General’s Medicaid Fraud and Elder Abuse Division that the state Human Services Department (HSD) and Health Department have repeatedly “interfered” with investigations by not sharing data with investigators.
“This is not glamorous stuff, but it’s very important,” Keller said. “We cannot address the budget crisis without getting to the bottom of this. This year’s budget has $1 to $2 billion going through these Medicaid providers – 20 percent of our budget.”
SB 531 was intended to address state agencies’ failures to share several types of data with the Legislature, Keller said.
In a March 26, 2009 letter, Attorney General Gary King urged Gov. Richardson to sign the bill, saying it “resolves an ambiguity regarding whether existing law allows the Legislative Finance Committee to keep confidential non-public records it receives from agencies” and that the bill would “facilitate the exchange of information between government agencies and the Legislative Finance Committee.”
“Other (than Medicaid), areas where we have had these problems are in education, prison system and state investment funds,” Keller said.
Keller hopes to avoid a contentious fight, he said.
“We did not do this in a controversial way but the issue has come up again with the AG’s allegations, and we need to deal with it,” he said. “We need to keep things focused on the issue and avoid territorial disputes.”
Keller began meeting with officials from the AG and HSD today, he said, though he refused to discuss details.
“The next step is to talk with the agencies,” Keller said. “Then the full Senate will decide whether to move forward with the override.”
The Governor’s office has not yet responded to requests for comment. HSD Spokeswoman Betina Gonzales McCracken refused to comment on Keller’s efforts Tuesday, saying only, “the Human Services Department will work with the AG’s office to clarify any issues that may exist.”
The override motion is evidence of how frustrated legislators have become with the executive branch, according to New Mexico Foundation for Open Government Executive Director Sarah Welsh.
“It’s amazing that we would have to explicitly legislate checks and balances like this,” Welsh said Tuesday. “Basically, they want information and they feel thwarted. This latest move might seem like inside baseball, but it really points to a larger problem that I run into nearly every day – it’s very difficult to get information out of this administration. And it’s not just reporters who get frustrated. It’s legislators and candidates and activists of all stripes. It’s a baffling phenomenon until you remember: information is power, particularly in this new digital age.”
Feds “Aware” of Allegations
Last week, The Independent revealed, in an exclusive story, that an Attorney General’s report shows the state had hindered Medicaid fraud investigations.
Those allegations were forwarded to the U.S. Center for Medicaid and Medicare Services (CMS), the agency that administers federal Medicaid funding to the state, Inspector General spokesman Mark Wilson told The Independent Monday.
“We alerted CMS to the issue, based on the New Mexico Attorney General’s report,” Wilson said. “Now it’s up to them to contact the state and find out what’s going on there.”
CMS officials did not respond to emails and telephone messages requesting comment. McCracken would not comment on whether CMS had contacted HSD about the allegations.
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Come January, New Mexico could face a $300 million shortfall in its low-income health insurance program, and state officials are scrambling to figure out how to address a potential ocean of red ink. The state already has tried many cost-cutting measures—the “low-hanging fruit,” officials call them—to slow the cost growth in Medicaid. But now, because of the severity of the situation, they’re eying many previously off-the-table scenarios.
States across the country are responding to a funding crisis in Medicaid, the government’s low-income health insurance program jointly paid for by the feds and state governments, Laura Tobler of the National Conference of State Legislatures, told New Mexico state lawmakers at an interim legislative committee meeting this week.
Tobler’s message to lawmakers was simple: You are not alone.
California cut provider payments. Florida reduced funding for nursing homes by 10.5 percent. Massachusetts reduced adult dental services for 600,000 recipients of its low-income health insurance program.
Some states are taking several tactics, from fighting against Medicaid fraud to making care for high-risk, high-cost patients more efficient.
New York, a state with a history of Medicaid fraud, recently modified its management information system to better identify improperly paid claims. At the same time that state has created pilot projects with a focus on treating chronically ill Medicaid beneficiaries.
South Carolina, meanwhile, decided to post Medicaid payment information online to try to guard against fraud. It has also reduced—from 34 to 31—the amount of pills in each monthly prescription for Medicaid enrollees.
Utah, which has already cut optional services, created a preferred drug list. Such lists show what prescription drugs are approved for payment. In many cases, the lists limit the drugs to a certain number of drugs in each category of treatment.
The cutting has begun
New Mexico has already begun to make cost-cutting measures, such as starting with capping the amount of money managed care organizations can spend on administrative costs, New Mexico’s Human Services Secretary Pam Hyde said Wednesday.
“The good news is that we’ve already done many of these things,” Hyde said of the cost-cutting steps. “The bad news is that we’ve done many of these things.”
In other words, state officials are now looking for more ways to trim spending, including eliminating many, if not all, optional Medicaid services.
The potentially extreme measure is part of the mix this year because mandatory Medicaid services — such as hospital stays and physician services — are projected to grow to $550 million in early 2011. That’s compared to a projected $340 million for optional services.
If the state cuts $300 million to close the shortfall, very little money would be left for services that aren’t mandatory.
Cutting some optional services is a path Utah already has started down, Tobler said. That state eliminated vision, physical and speech therapy and chiropractic services, all optional under Medicaid, according to her presentation.
Spending cuts vs. tax increases
This tough economic situation has thrust legislators into the center of a fierce debate over spending cuts vs. revenue-side solutions like tax increases to fix the problem. Meetings have been planned around the state to collect public input.
The implications of such deep cuts are potentially dire for New Mexico, where one in four residents—more than 500,000 individuals—gets health coverage in whole or part through some form of public assistance. Medicaid provides the lion’s share of that coverage with more than 450,000 enrollees, according to Hyde’s agency.
“Some of these short-term cuts will create long-term problems” for people who receive these services, said Rep. Eleanor Chavez, D-Albuquerque.
Meanwhile, critics of raising taxes say the last thing a government should do during a deep recession is take money out of taxpayers’ pockets.
“We have to get back to core spending,” said House Minority Whip Keith Gardner, R-Roswell.
For many states, Medicaid is one of the biggest line items in their budgets. The program helps to underwrite a spectrum of services, from nursing home care and medications to vision and physicians visits.
But not all patients contribute equally to the cost of the program. Four percent of the Medicaid population is responsible for 50 percent of Medicaid spending, according to the Kaiser Commission on Medicaid and the Uninsured.
At the meeting, Rep. Dennis Kintigh, R-Roswell, wondered how many of those patients had those illnesses because of substance abuse. He also asked how much “life choices” contributed to the chances of people winding up on Medicaid rolls.
There is no silver bullet
Cutting optional services isn’t the only cost-saving measure under consideration. Another is the dismantling New Mexico’s State Coverage Insurance (SCI) program.
SCI helps pay premiums for thousands of low-income individuals, and small businesses take advantage of the program to insure employees, officials said.
Another cost-cutting option–and one generally considered to be one of the easiest to accomplish–is to reduce the rate of reimbursement to medical providers, such as physicians and nurse practitioners. Medicaid reimburses medical providers at various rates.
But even that can lead to unintended consequences like a diminishment in health care access, Tobler said.
”There is documented evidence that that reimbursement rate reductions leads to reductions in provider participation,” Tobler said.
How New Mexico will respond to the Medicaid problem, either in a special session scheduled for October or in the regular 2010 session in January — is not clear. But one thing is, say officials and state lawmakers. There is no silver bullet, a one-shot approach that fills the budgetary gap without parceling out some pain.
