Wednesday, July 30, 2014

NYS's $1.3 Billion Medicaid Problem

Pasting in full story from today's Wall Street Journal since not everyone may have access.


The federal government has demanded that New York state pay back nearly $1.3 billion in Medicaid money distributed in 2010, prompting a rebuke from Gov. Andrew Cuomo's administration and a promise to appeal the decision.
At issue are the costs of caring for about 1,300 developmentally disabled people—about $2 million per patient in 2013—in nine state facilities from Staten Island to Rochester. New York's Medicaid program is among the nation's most expensive.
New York state and the federal government agreed on a payment plan in 1990. But after the Poughkeepsie Journal published a series of stories in 2010 about the extraordinary costs of the state's so-called intermediate-care facilities, the U.S. Centers for Medicare and Medicaid Services—the agency, often called CMS, that administers the program—started its own investigation. It found that New York was making exceptionally high Medicaid payments to the facilities, which are run by the state's Office for People with Developmental Disabilities.
A subsequent review by federal Medicaid officials found that New York couldn't justify some of its reported costs, lacked proper internal controls, didn't comply with federal reporting requirements and had an unreliable fiscal report from 2010-11, among other issues. A separate U.S. Department of Health and Human Services inspector-general probe in 2012 found the amount charged by New York to be excessive.
Medicaid spending in New York was roughly $52.5 billion in fiscal 2013, about half of which was borne by the federal government.
CMS told New York officials last week that it would seek nearly $1.3 billion from the 2010 fiscal year alone, and possibly more once further reviews of the 2011 and 2012 fiscal years are complete. New York officials have 30 days to respond with a plan to fix its Medicaid spending issues.
The request cuts against Mr. Cuomo's image as a Medicaid reformer, an issue he took on in his first year in office with a panel that made recommendations to save money that were ultimately signed into law.
It also comes after Mr. Cuomo's deal in May allowing New York to spend $8 billion in federal Medicaid savings over a five-year period, a pot of money seen as helping Brooklyn hospitals on the verge of closure. It isn't clear how the Medicaid office's request for reimbursement would affect that.
The New York State Department of Health said Tuesday it would appeal the federal demand, saying it would have "untold negative consequences on the state's health-care system."
"Under this administration, Gov. Cuomo proactively redesigned a wasteful and inefficient Medicaid program that was sanctioned by [the U.S. Department of Health and Human Services] and prior administrations," said Bill Schwarz, an agency spokesman.
The Medicaid review and request for repayment are part of the federal government's work to ensure proper Medicaid spending, officials at the CMS said in a written response to questions.
"We will continue to work with New York state officials to address issues outlined in this report in order to strengthen the financial management of the Medicaid program," said Courtney Jenkins, a Medicaid spokeswoman.
The request for repayment was welcomed by congressional Republicans on Capitol Hill, where New York's expensive Medicaid system has drawn attention.
"We applaud CMS's action, and we encourage CMS to recover the full amount due the federal taxpayer for both 2011 and 2012," said U.S. Rep. James Lankford (R., Okla.) at a hearing of the House Oversight and Government Reform Committee.
Federal auditors also said New York has used some of its share of Medicaid money each year for general spending for a broad number of state disability programs. A Republican-led congressional oversight panel accused New York of fraud last year, allegedly overcharging Medicaid $15 billion over two decades. New York officials have said the panel's conclusions were wrong.
New York has plans to close the state-run intermediate-care facilities for the developmentally disabled this year.


Tuesday, July 29, 2014

NY Phasing Out Sheltered Workshops

Janet Sugar's daughter, Rachel, used to work part time in a dress store, hanging up clothing."No one paid any attention to her. Sometimes she might eat, sometimes she didn't," said Janet Sugar, who lives in Mount Vernon. "My daughter is autistic so she can sit for hours staring into space."Since October 2009, Rachel Sugar has been in a sheltered workshop at the nonprofit C.A.R.C. Inc.-Keon Center in Peekskill, where she does piece work with other developmentally disabled adults and gets more help and nurturing, her mom said. She does tasks like packaging powder, assembling trophies, tagging clothes and helping in the cafe.

When Caregivers Need Healing

“This has happened before,” she tells herself. “It’s nowhere near as bad as before, and it will pass.”Robbie Pinter’s 21-year-old son, Nicholas, is upset again. He yells. He obsesses about something that can’t be changed. Even good news may throw him off.
Dr. Robbie Pinter and her
son, Nicholas.

So Dr. Pinter breathes deeply, as she was taught, focusing on each intake and release. She talks herself through the crisis, reminding herself that this is how Nicholas copes with his 
autism and bipolar disorder.

Monday, July 28, 2014

Balancing Special-Ed Needs & High Costs

Dylan B. Randall could not speak or stand. He never tasted food because he was fed through a gastric tube in his belly. He breathed through a ventilator; his own saliva would choke him unless a nurse cleared his throat every few minutes.
It was a daily struggle to keep Dylan alive, much less educate him. And when his public school could not deliver all the daily therapy the then 5-year-old was supposed to receive, his parents asked that New York City pay for what they believed was the kind of education Dylan needed: a private school for disabled children.

Conn. Parents Fear Cuts' Impact on Lives of Their Adult Children

GREENWICH, Conn. – Dozens of parents filled the front room of Greenwich residents David and Lynn Arezzini on Saturday morning to speak out about the state's failure to fund the Department of Developmental Services, which provides services that so many of their adult children depend on.
The group met to hear stories from parents who are finding out that their adult children with mental disabilities such as autism may not be getting any more state assistance for independent living. Many were told that their adult children, who have been living independently, would have to move back home.

Friday, July 25, 2014

NYC Council Passes Law To Install Door Alarms In Public Schools

NEW YORK — After several highly publicized incidents where children slipped unnoticed out of school buildings, the New York City Council passed legislation on Thursday to install door alarms in public schools.“Avonte’s Law” — named for Avonte Oquendo, an autistic teenager who died in October after slipping through an unattended exit door in Queens – would require the city and NYPD to study and prioritize the installation of exterior door alarms in school buildings.

An Unexpected Use of Google Glass

A Westfield woman has demonstrated that Google Glass has a use that even Google did not foresee — improving the lives of those with disabilities.Ashley Lasanta, 23, was among the first people to test Google Glass through Google’s Glass Explorer Program. Lasanta has cerebral palsy, which limits mobility in her arms and hands.