Friday, April 1, 2011
Yesterday the Senate Republican Caucus offered a series of Medicaid reform amendments to the Supplemental Budget, H.3318, designed to crack down on waste and abuse in the state’s Health Safety Net program that was uncovered and outlined in a recent report by Inspector General Gregory Sullivan.
Earlier this week, the Boston Herald reported that the state’s Uncompensated Care Pool – which is funded through contributions by taxpayers, health insurers and hospitals – paid out $414 million in 2009 for 1 million emergency health care claims. According to the Inspector General, $7 million was used to provide health care for non-Massachusetts residents, $17.8 million was spent on “medically unlikely” or “medically unnecessary” claims, and $6 million went towards payments on 13,000 duplicate claims.
Although the Health Safety Net was intended to be limited to Massachusetts residents only, the Inspector General’s report found the state does not even require individuals to provide a Social Security number to help verify their assets and eligibility. As a result, the fund was used to provide health care for residents of 48 other states and even other countries.
The Senate amendments would:
• require applicants to provide a Social Security number on all medical benefits request forms, require verification of an applicant’s eligibility prior to payment, and prohibit payments for individuals who have other insurance coverage;
• require the Office of Medicaid to develop regulations to improve record-keeping and minimize the likelihood of paying for duplicate or invalid claims; and
• authorize the Inspector General to conduct a comprehensive audit of the state’s Medicaid program and report back to the Legislature with his findings by April 1, 2012.
The caucus was able to force a roll call vote for the required verification amendment but unfortunately all three proposals failed during yesterday's debate. To view the votes taken by the members of the Senate and the actual language of the bills please click the read more tab below. To read the Inspector General's report please click here.
MEDICAID VERIFICATION FOR COVERAGE Roll Call Vote:
Roll Call Votes: Yea/Nay
Steven A. Baddour: Nay
Frederick E. Berry: Nay
Stephen M. Brewer: Nay
Gale D. Candaras: Nay
Harriette L. Chandler: Nay
Sonia Chang-Diaz: Nay
Katherine Clark: Nay
Cynthia Stone Creem: Nay
Sal N. DiDomenico: Nay
Kenneth J. Donnelly: Nay
Eileen Donoghue: Nay
Benjamin B. Downing: Nay
James B. Eldridge: Nay
Susan C. Fargo: Nay
Barry Finegold: Nay
Jennifer L. Flanagan: Nay
John Hart: Nay
Robert L. Hedlund: Yea
Patricia D. Jehlen: Nay
Brian A. Joyce: Nay
John Keenan: Nay
Thomas P. Kennedy: Nay
Michael R. Knapik: Yea
Thomas M. McGee: Nay
Mark C. Montigny: Nay
Michael O. Moore: Nay
Richard T. Moore: Nay
Senate President Therese Murray: Did Not Vote
Marc R. Pacheco: Yea
Anthony Petruccelli: Nay
Michael Rodrigues: Nay
Stanley C. Rosenberg: Nay
Richard J. Ross: Yea
Michael Rush: Did Not Vote
Karen E. Spilka: Nay
Bruce E. Tarr: Yea
James E. Timilty: Yea
Steven A. Tolman: Nay
James Welch: Nay
Daniel Wolf: Nay
MEDICAID VERIFICATION FOR COVERAGE
Mssrs. Tarr, Hedlund, Knapik and Ross move to amend the bill (House, No. 3318) by inserting at the end thereof the following new sections:-
“Section X. The office of Medicaid shall, within six months of the passage of this act, take any and all necessary actions to ensure that social security numbers are required on all medical benefits request forms and that social security numbers are provided by all applicants who possess them.
If for any reason the office determines that it is or will be unable to accomplish the foregoing within six months of the passage of this Act, it shall submit a detailed report of the reasons for such inability to the clerks of the house of representatives and the senate within three months following the passage of this act.”
Section X. The division of health care finance and policy shall, within six months of the passage of this act, ensure ii) that the identity, age, residence and eligibility of all applicants are verified before payments are made by the Health Safety Net Trust Fund; and iii) that no payment is made for any expense which is otherwise covered by third party liability, private insurance, or other governmental coverage, including Medicare and MassHealth.
If for any reason the division determines that it is or will be unable to accomplish the foregoing within six months of the passage of this Act, it shall submit a detailed report of the reasons for such inability to the clerks of the house of representatives and the senate within three months following the passage of this act.”
Mssrs. Tarr, Hedlund, and Ross move to amend the bill (House, No. 3318) by inserting at the end thereof the following new sections:-
“Section X. The division of health care finance and policy shall, within eight months of the passage of this act, develop regulations to ensure the following: i) that Medicare-like claims editing is fully and effectively implemented and used to determine reimbursements from the Health Safety Net Trust Fund; and ii) that claims editing is effectively used to reduce the occurrence of payments for medically unnecessary services, medically unlikely events, and duplicate services.
Section X. The office of Medicaid shall, within eight months of the passage of this act, develop regulations to ensure that incentives or regulations are implemented to increase competition among MassHealth managed care organizations, reduce the size of some provider networks offered by managed care organizations, and/or to reduce cost of managed care organizations.”
INSPECTOR GENERAL AUDIT OF MEDICAID
Mssrs. Tarr, Hedlund, Knapik and Ross move to amend the bill (House, No. 3318) by inserting at the end thereof the following new section:-
“Section X. Notwithstanding any general or special law to the contrary, in hospital fiscal year 2012, the office of the inspector general may expend funds from the Health Safety Net Trust Fund, established by section 36 of chapter 118G of the General Laws, for the costs associated with conducting an audit of the Commonwealth’s Medicaid program. The inspector general may examine the practices utilized in all hospitals including, but not limited to, the care of the insured receiving health care services reimbursed pursuant to the Commonwealth’s Medicaid system. The inspector general shall submit a report to the house and senate committees on ways and means containing the findings of any audits so conducted and any other completed analyses not later than April 1, 2012. For the purposes of such audits, health care services shall be defined pursuant to said chapter 118G and any regulations adopted there under.”