Volume 13 Issue 3

RCOMO  NEWS

August 2006

Parent Power

Parent Power

Parent Power

Jefferson City— Two proposals to reduce Medicaid fraud died Friday under pressure from medical providers, who convinced House leaders that the penalties for stealing from taxpayers were too severe.

In the process, House Republican leaders also killed a plan that would have softened last year’s dramatic cuts in Medicaid eligibility by allowing about 3,200 disabled people back on the Medicaid program.

Democrats, who generally supported both the crackdown on fraud and the restoration of Medicaid benefits, and Republicans sold out to the health-care industry.

“We have plenty of legislator health-care providers supplemented by fat-cat lobbyists who choose to tread lightly on their fellow providers who have bilked the system because they don’t want to spoil or soil their alligator slippers,” said Senate Minority Leader Maida Coleman, a St. Louis Democrat.

But House Speaker Rod Jetton, a Marble Hill Republican, said House Republicans believed the penalties in the bill would scare off medical providers who are often in short supply in rural areas. A house version of the bill was significantly softer on fraud than the Senate version, he said, but it still increased penalties and contained a small incentive for whistleblowers to come forward.

Sen. Chris Koster, the Harrisonville Republican who championed the crackdown, said lawmakers missed a chance to rein in rogue medical providers who steal up to $600 million a year from a system that provides medical care for the poor.

“The Senate version of the Medicaid fraud bill was tough,” Koster said. “It was drafted with law enforcement in mind. It appears to me the House version of the bill was crafted largely by the folks in the provider community. Between those two versions it was hard to find common ground.”

When it became clear that the House was not going to take up the Senate plan, senators made a last-ditch effort shortly after midnight Thursday. Koster softened several provisions and attached his plan to a bill that restored Medicaid coverage to about one-third of the disabled people who were dropped from the Medicaid program last year.

The Senate sent the combined bill to the House five times throughout the day Friday. House leaders refused to accept the message.

Rep. Carl Bearden, a St. Charles Republican and second-ranking member of the House, said the House was too busy to consider the Senate plan. House leaders intended to send their more moderate plan to the Senate, but didn’t get to it.

The House plan had been written by a special House committee whose 11 members included three doctors and two optometrists. Bearden said there was nothing unusual about lawmakers who work in a profession helping craft rules on how that profession is regulated.

House Republicans said the Senate bill could penalize people for simple billing errors. Low fees paid by Medicaid make such stiff penalty provisions even more unreasonable, they said.

(The bills were SB1210 and HB1742. For the full text of the bills, go to www.moga.mo.gov, click on “Joint Bill Tracking” and type in the bill number.)

Jefferson City— Governor Matt Blunt said Thursday that if House and Senate leaders reach agreement on toughening laws against fraud by health care providers, he would call them back into session to pass that and to restore government health care for some disabled workers.

Blunt has said previously he didn’t intend to call a special session for any issue. But Wednesday, the governor said he would be willing to call a special session if both issues can be addressed.

“We’re not going to come back here and spend taxpayer money until we know we’re ready to pass those two bills,” he said Thursday.

On the final day of their session, which ended May 12, senators passed a measure combining restoration of a trimmed-down disabled workers program with various measures to punish health care providers who cheat the Medicaid system. But House leaders refused to take up the bill for debate.

House Speaker Rod Jetton, attending a news conference with the governor for a separate bill signing Thursday, said he asked certain House members to work with the Senate sponsor of the provider fraud legislation to try to find a compromise. They set no time frame for reaching agreement.

“We are excited about doing that, happy to come back in September and knock those two issues out,” he said. “I, like the governor, think there’s too much fraud going on, and if we can get it stopped we’re definitely happy to do that.”

But Jetton, R-Marble Hill, said in an interview that he heard concerns form representatives who also are doctors.

“Can we pass a Medicaid fraud bill to stop fraud, save us money, but not open up every doctor to a lawsuit from a trial attorney that could then make them not want to take Medicaid,” he said.

Sen. Chris Koster, R-Harrisonville, who handled the anti-fraud measure, said his main goal is to preserve elements modeled after the federal False Claims Act, which would allow the state to keep more of the money it recovers in fraud cases. The federal government pays about 60 percent of Medicaid costs, so it usually takes about 60 percent of the money recovered.

The Senate version of the bill allowed people, such as company employees who suspect wrongdoing, to sue on behalf of the state to recover money. If the attorney general pursued the case and recovered

money, the whistleblower could receive up to 35 percent of the award. The House version removed the ability for people to file suit themselves, and if the attorney general acted based on their tips, whistleblowers could receive up to 10 percent of the recovered money.

If agreement is reached, a session likely would happen in mid-September, when lawmakers already must be in Jefferson City to consider any vetoes by the governor. Blunt hasn’t vetoed any bills, other than a few spending items within budget legislation.

The Medical Assistance for Workers with Disabilities program provided Medicaid coverage in its last year to nearly 17,000 disabled people who earned too much to qualify for traditional Medicaid but who worked at least a minimal amount each month. It cost about $250 million in state and federal funds.

Republicans argued the program had grown out of control and eliminated it during their 2005 session. But more than half the participants continued receiving Medicaid by transferring to another prong of the program and, in many cases, paying out of their own pockets.

The bill that ultimately failed this year was projected to cover 1,800 people under the revised program and would have restored or improved Medicaid coverage to 1,337 sheltered workshop employees. The state budget included funds to restore the program, and Blunt did not veto that money. The measure was expected to cost $19.7 million in state and federal funds this fiscal year.

House Minority leader Jeff Harris, of Columbia, said Democrats would support a special session for anti-fraud legislation and to reverse Medicaid cuts made last year.

David and Taylor Crowe just can’t sit still.  Whenever the father and son have a spare moment, they are always doing something productive.

David, an orthodontist who lives in Cape Girardeau, and Taylor, his autistic son, are currently involved with projects aimed to educate people about autism.

Not only are they working on bringing to life The Tailor Institute, a not-for-profit organization dedicated to autism research, but they are also putting the finishing touches on a new DVD that will help people understand autism.

Autism is a spectrum disorder. It can range from the low-functioning, which can include mental retardation, all the way to genius-level intellect with social difficulties consistent with autism, according to David.

The Tailor Institute, which received a $200,000 grant from the Missouri Department of Economic Development, is attempting to advance the systems of care and services for high-functioning autistics. The organization has conducted interviews with parents, physicians, therapists and educators. They are currently developing educational materials and will begin conducting more research in the fall.

In 2000, the Crowes finished “Growing Up With Autism,” a 20-minute VHS tape that shows Taylor’s development growing up and ways to cope with the disorder. The DVD is a new, extended version of “Growing Up With Autism” and it runs about an hour with bonus materials.

The old video showed Taylor up to age 19. The new version incorporates how the 25-year-old lives with his disorder as he attends the California Institute of the Arts in Valencia, Calif.

“The target audience is educators, families, parents, siblings and people that either are new to the diagnosis of autism or want to learn more about it,” David said.

Taylor said that the video was important because autistic people can misinterpret things like teasing and joking.

“Some of the teachers I had as a kid would say stuff to me that made me think they wanted to kidnap me,” Taylor said. “One said if I didn’t get my work done, I’d never go home. They were teasing. I didn’t know that.”

Taylor said for this and several other reasons, educators need to educated on autism.

He also said all autistic people should have a “circle of friends” - which encourages them to have a variety of friends, all of whom are familiar with autism.

“Autistic people need friends, too,” Taylor said. “I have a friend with Asperger syndrome who says I’m his chief number one friend. The reason is because he never had a circle of friends.”

The first version was produced by Showcase Productions (now Showcase Technologies) and began being distributed in 2003 by the Council for Exceptional

Children’s Division on Developmental Disabilities. More than 3,000 copies of the video have been sold.

Tom Emmendorfer, who works at Showcase Technologies, is the producer and editor of the DVD project and has spent more than 100 hours shooting footage, editing and conceptualizing ideas. Emmendorfer said they aim to have the project finished by early September.

“I see the potential Taylor has to offer the world,” Emmendorfer said. “I see the gift he has and it’s neat to be a part of that.”

Taylor, who is high functioning, is studying animation at CalArts and intends to graduate in May 2007. He aspires to work at Dreamworks Animation.

When Taylor isn’t studying or painting, he gives speeches at autism conferences. His next speech is at the 2006 Texas State Conference on Autism in September.

“I don’t enjoy rehearsing and all,” Taylor said. “But I know it’s something I have to do to help other people with autism.”

Reprinted from "Monday Morning in Washington DC" (The Arc of the United States and the

Over 100,000 people with developmental disabilities across the U.S. live in Medicaid funded Intermediate Care Facilities for persons with Mental Retardation (ICFs-MR). ICF-MR residents can benefit significantly from opportunities to take periodic overnight absences to spend time in the community with family and friends. Each state sets its own policy to determine how often its Medicaid program will pay ICFs-MR to hold a bed when a resident is absent. Because ICFs-MR are not required to hold beds without payment, state leave policies control ICF-MR residents’ ability to take overnight leave.

The Arc of DC reviewed state ICF-MR leave policies in response to requests for help by parents of adult DC residents with developmental disabilities who were concerned about the limits of DC’s current policy. While DC only allows up to 18 absences per year for either home visits or hospital stays, most states either place no annual limits on home visits, or allow an average of up to 44 “therapeutic leave” days per year. Twenty-nine states provide hospital leave and typically reimburse for up to 14 days in a row when an ICF-MR resident is hospitalized, with no annual limits.

——————————————————–—

Editor’s Note: The complete report can be found on the ARC of DC site http://www.arcdc.net/State%20ICF-MR%20Leave%20Policies.htm.
In this report, Missouri ranked 37th out of the 50 states and District of Columbia for therapeutic leave policy.

Below is a reprint of Missouri’s Medicaid State Plan, Attachment 4.19-C, “Payment for Reserve Beds,” on the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Service web site:

Reserve Bed Days –The State provides for coverage of a maximum of twelve reserve bed days for the first six calendar months and 12 days for the second six calendar months of the year for recipient residents of Title XIX nursing facilities for the purpose of therapeutic home visits. The absence must be specifically provided for in the patient’s plan of care and physician prescribed.

The state provides for coverage of reserve bed days for days that a recipient resident of a Title XIX nursing facility is in a hospital if certain criteria are met. The maximum number of days that are covered in one hospitalization period is three days.

If you are a Medicaid recipient and have lost a service that is medically necessary, you can apply for a Medicaid Exception. The Medicaid Exception Request form along with a Certificate of Medical necessity requires a physician’s statement of medical need. The physician must indicate if the request is an emergency or non-emergency. Mail forms to Exceptions Unit, Division of Medical Services, PO Box 6500, Jefferson City, MO 65102-6500. The Exceptions Unit obtains a decision from the appropriate medical or pharmaceutical consultant &/or administrative official and informs the treating prescriber, provider of service and recipient of all approved decisions. In the event of a denial, only the prescriber and recipient are notified.