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.

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.

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.

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.

Tech Startup Hires People with Autism

Mark Leslie is a capable computer programmer who speaks four languages, but until recently the latest entry on his résumé was a retail job he held for six years at a Barnes & Noble in New York City.Like many of the estimated 1.5 million Americans on the autism spectrum, Leslie, who has Asperger's syndrome, is at a disadvantage in traditional office environments. There, he could run into unplanned social interactions that can cause anxiety or risk reporting to a boss ill-equipped to communicate with someone on the spectrum. 

But a year and a half ago, Leslie found a better work situation at a software-testing firm, ULTRA Testing, a company that not only accommodates his condition but was created with the specific intention of hiring people on the autism spectrum.

Read more: http://www.businessinsider.com/startup-hires-people-on-autism-spectrum-2014-7#ixzz38O7hVeg7

NYC Council to Vote on 'Avonte's Law'

NEW YORK —

The New York City Council's Education Committee voted unanimously Wednesday in favor of a law designed to prevent a repeat of the Avonte Oquendo tragedy."Avonte's Law" requires the Department of Education and the NYPD to compile a list of public schools that should have audible door alarms.
The entire council is expected to vote on the law Thursday.

People with Autism Prone to Obesity

Even at young ages, individuals with autism are far more likely to be obese or overweight than their typically-developing peers, a new study finds. 

In a review of medical records, researchers found that more than 23 percent of children with autism and 25 percent of those with Asperger’s syndrome were obese. Meanwhile, another 15 percent of kids with autism and 11 percent with Asperger’s were overweight.

Staff Working to Keep Individuals Safe At Special Needs Center Near Gaza

Going to the volatile Middle East. Am certain that a similar story exists on the Gaza side. Hoping for some sort of agreement soon to end the bloodshed.

In Ofakim, a sand-choked, barren community minutes from the Gaza border, residents have just 30 seconds when they hear a red-alert siren to run and find cover. For able-bodied members of this impoverished community, that’s precious little time.But what about those who can’t run?At ALEH Negev, a state-of-the-art rehabilitative village for Israeli citizens with severe disabilities, it’s a serious question. Most of the residents at ALEH Negev, which gleams like a spaceship in the middle of Ofakim’s brown desert, are wheelchair-bound and cannot walk on their own. Many cannot speak, use their limbs or practice motor functions without assistance.

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Peer-Led Intervention Effective In Helping Parents, Study Finds

Peer-led interventions that target parental well-being can significantly reduce stress, depression and anxiety in mothers of children with disabilities, according to new findings released today in the journal Pediatrics.

In a first-of-its-kind study, researchers from Vanderbilt University examined two treatment programs in a large number of primary caregivers of a child with a disability. Participants in both groups experienced improvements in mental health, sleep and overall life satisfaction and showed less dysfunctional parent-child interactions.

Robert Kennedy, Jr.'s Mission to End Use of Thimerosal in All Vaccines

Not trying to cause any more panic, but found this intriguing.
Sen. Barbara Mikulski listened impassively as Robert Kennedy Jr. made his case. He had to talk over the din in the marbled hallway just outside the Senate chambers, where he was huddled with Mikulski, two of her aides and three allies of his who had come to Washington for this April meeting.

Kennedy, a longtime environmental activist and an attorney for theNatural Resources Defense Council, had thought Mikulski would be receptive to an issue that has consumed him for a decade, even as friends and associates have told him repeatedly that it’s a lost cause. But she grew visibly impatient the longer he talked.A mercury-containing preservative known as thimerosal, once used widely in childhood vaccines, is associated with an array of neurodevelopmental disorders, including autism, Kennedy told her, summarizing a body of scientific research he and a team of investigators had assembled. Thimerosal, which is an antifungal and antiseptic agent, was taken out of those vaccines in 2001, but it is still used in some flu vaccines. If it was dangerous enough to be removed from pediatric vaccines, Kennedy contended, why was it safe at all?

Telemedicine Providing Access to Doctors

To get the best care for her three autistic children, Mandi Larkin would drive three hours from her family's home in Tifton, Ga., to Marcus Autism Center in Atlanta. The drive to and from Atlanta was exhausting. Missed work, missed school and the long drive were constant sources of stress.
"The accessibility to the doctors in Atlanta is the big thing," Larkin said. "Not everyone has the means to make that kind of a drive. Telemedicine gives us access to the doctors that we normally wouldn't have access to."Today, Larkin's children receive world-class medical care at her local hospital via a state-of-the-art telemedicine link to Marcus Autism Center. The recently improved telemedicine system was optimized by scientists at the Georgia Tech Research Institute (GTRI) and Cisco Systems, Inc. Marcus Autism Center's telemedicine room is now a showcase for providers of telemedicine, where improved video capabilities and an ergonomic suite allow patients in rural Georgia to meet face-to-face with medical specialists in Atlanta.

Feds Clarify Autism Coverage Rules

In what advocates are calling a major win, federal officials are for the first time telling states that Medicaid coverage must include treatments like applied behavior analysis for children with autism.

Medicaid programs nationwide must offer “medically necessary diagnostic and treatment services” to kids with autism, the Centers for Medicare and Medicaid Services told states in abulletin this month. That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.

The Arc Urges Government to Hire More People with Developmental Disabilities

WASHINGTON, D.C. — The Arc submitted comments to the U.S. Equal Employment Opportunity Commission (EEOC) on Wednesday, calling on the federal government to become a model employer of people with disabilities, including individuals with intellectual and developmental disabilities (I/DD).“While the last few years have seen some modest increases in the numbers of people with disabilities employed by the federal government, The Arc remains deeply concerned that many people with the most significant disabilities, including jobseekers with intellectual and developmental disabilities, are being left behind,” said Peter V. Berns, Chief Executive Officer of The Arc.

Can Running Help Children with ASD?

At a time when people more often reach for the remote than for their running shoes, finishing a five-mile race is a commendable achievement for anyone.What if we told you that among the runners crossing these finish lines are children with autism? And that running is actually helping with the symptoms of autism?

Owner of Tim's Place Gets Reality Show

ALBUQUERQUE, N.M. — Tim Harris, the owner of Tim's Place restaurant, will be getting his own reality show, and the show is casting.
Harris, who was born with Down Syndrome, has made several TV appearances, including a recent trip to "The View." Harris lives by this famous Walt Disney quote: "If you can dream it, you can do it."

Tech Firm Helps Teens with Autism Build Skills and Confidence

Sixteen-year-old Mason Dimock can focus intently on one subject, thinks visually and spatially, and is interested in technology — skills that have helped him land a summer job designing for a construction company.

He and nine other Salt Lake City teens were selected for a pilot project by NeuroVersity, a company that aims to give students with autism or similar disorders the training they’ll need for careers. The students work with 3-D imaging software called SketchUp Make, developed by Google.

Connecticut Medical Homes Improving Medicaid Care Coordination

The use of nationally certified medical homes to coordinate the care of Connecticut's Medicaid patients has led to improved quality, a 2 percent cut in per person costs, and a 32 percent increase in the number of participating providers during an 18-month period.
The news comes as the state moves forward with plans to jumpstart the medical home movement in Connecticut with an expanded "Glide Path" program that would assist all practices – not just those that accept Medicaid patients – working to become medical homes. The program, still under development, would require practices to meet national standards.

Editorial: NYS Should Pay Up Now

Of the 126,000 New Yorkers with developmental disabilities, about 110,000 of them are serviced by nonprofit organizations, most of which depend on state funding.

That's just one reason why a recent audit by state Comptroller Thomas DiNapoli is so troubling. Of the 5,946 contracts the state has with not-for-profit entities, state payments were late 87 percent of the time in 2013. That's an increase from 78 percent in 2012.

Advocates Say Thousands Banned From Voting Based on Cognitive Disabilities

LOS ANGELES — At a time when election officials are struggling to convince more Americans to vote, advocates for the disabled say thousands of people with autism spectrum disorder, cerebral palsy and other intellectual or developmental disabilities have been systematically denied that basic right in the nation’s largest county.A Voting Rights Act complaint to be filed Thursday with the U.S. Justice Department goes to a politically delicate subject that states have grappled with over the years: Where is the line to disqualify someone from the voting booth because of a cognitive or developmental impairment?

Child, Home and Conscience

Noam Bramson, Mayor of New Rochelle, N.Y., (a suburb of NYC) reveals his troubled conscience following a community meeting where residents voice strong objections to a proposed group home.  

Let me tell you a little about Matthew.  Next fall, Matthew will enter fourth grade.  His favorite food is pizza.  He’s always happy to jump on his trampoline or go for a swim.  He can’t wait to return to Disney World.  And he loves riding horses.

As the school year was wrapping up, Matthew and I, along with his classmates, had lunch together.  Their teacher had made the winning bid on “lunch with the mayor” at a Special Education PTA auction.  I could not have asked for a warmer, friendlier greeting from the kids, although — let’s be honest — the McDonald’s happy meals that I brought with me may have accounted for just a bit of the excitement.

Tenn. Guidelines Confuse Agencies

Tennessee agencies that care for people with intellectual and developmental disabilities are struggling to help those they care for achieve life goals, according to a court-appointed review panel.Each of the 19 service providers evaluated in the latest round of biannual quality reports published at the end of May was rated noncompliant in helping people meet goals such as doing dishes or checking the mail.But the panel’s results don’t mean these 19 agencies are doing a bad job in the state’s eyes. All were found partially or fully compliant with individual planning standards in the most recent quality reports from the state Department of Intellectual and Developmental Disabilities.

NYS Faces Growing Special Ed Challenges

ALBANY, N.Y. — The Department of Education faces a daunting challenge in accommodating a large and growing population of special needs students, statistics in an Independent Budget Office report released Tuesday revealed.

The report found there were 183,850 special education students, constituting 18.1 percent of the total student population in D.O.E. public schools during the 2012-13 academic year, the most recent year for which data is available.

The percentage of special education students has risen every year since 2009, when the I.B.O. started collecting information on public school demographics.

Study: iPads May Aid Children with Autism Develop Verbal Skills

Adding access to a computer tablet to traditional therapy may help children with autism talk and interact more, new research suggests.

The study compared language and social communication treatment -- with or without access to an iPad computer tablet -- in 61 young children with an autism spectrum disorder (ASD) and found that the device helped boost the effect of the treatment.

Asking Children with Special Needs to Clear the Same Bar

Jackson Ellis will soon head to fourth grade. Diagnosed with autism spectrum disorder, he's been receiving publicly funded services since he was 15 months old. Jackson's mother, Rebecca Ellis, a single parent, has made education advocacy her career. She's fighting to make sure her son gets the help he needs at his Mandeville, Louisiana public school. That's always been an uphill battle. But, since the state adopted the Common Core State Standards, Ellis says, it's become even harder.

"There's always been a gap — academically, socially — between what he could do and other kids could do," she says. "When the standards changed, the gap grew into this canyon overnight."