Mississippi Division of Medicaid

Our Letter to the Editor 9/23/10

2010-09-23T11:39:00.000-07:00

Recently, the Division of Medicaid discovered too many young children were undergoing therapy far in excess of their medical needs. Beginning Oct. 1, Medicaid will begin requiring young children who need day treatment services to obtain a medical professional’s permission to enroll in such programs. This will help assure parents their child is receiving appropriate mental health care.

Currently, there are fewer than 200 children impacted by the state policy. No child will be denied unless a physician deems day treatment as medically unnecessary. As always, Medicaid will work with parents to find the appropriate path of treatment for their children.

Unlike pre-school or day camp, the day treatment program provides intense therapy for children with severe mental illnesses. Day treatment is the most intensive service available on an outpatient basis and should not be the first treatment option considered. Therapists and doctors believe few young children require the intensity of day treatment.

Medicaid has at least ten mental health services for children and teens below the intensity of Day Treatment. Placement in the programs should begin with an initial assessment to determine the strengths and weaknesses of each child and family. Potential services available should include family therapy to equip parents with the tools to help their children and group therapy to teach social skills.

The Division of Medicaid will work with parents and families to ensure their children are receiving the correct medical services to lead healthy lives. Please phone 1-800-421-2408 and ask for the Bureau of Mental Health if you have any questions.

Robert L. Robinson

Executive Director

Division of Medicaid

Federal Health Care Will Cost State Millions

2010-09-13T13:52:00.000-07:00

Federal Health Care Will Cost State Millions

Expanded Federal Poverty Limit Would Add 400,000 More To Rolls

JACKSON, MS.- (September 13, 2010) – Basic requirements of federal health care reform could push as many as 400,000 new Mississippians onto Medicaid rolls in 2014 at an annual average cost between $225 to $250 million to state taxpayers, Division of Medicaid officials stated today in a joint meeting of the state Senate and House public health committees. In 2020, if States pick up the full cost of the newly enrolled, the cost to Mississippi taxpayers will be $438 million per year.

The new law grants new categories of coverage to families and childless adults between 100 percent and 133 percent of the Federal Poverty Limit, Richard Roberson, Special Assistant to the Executive Director, told legislators. Compared to other states, Mississippi has one of the largest percentages of its population within these limits.

“We struggle to pay for the program that we have now, said Medicaid Executive Director Dr. Robert L. Robinson. “With federal health care reform we will soon need more than $1 billion from Mississippi taxpayers annually to pay for this program. In 2014, our Medicaid program will cover approximately one out of three Mississippians and consume 20 to 25 percent of our state budget.”

The law will also impact Mississippi hospitals by reducing the Disproportionate Share Hospital (DSH) program which provides supplemental payments to hospitals that serve a high volume of uninsured patients. Last year, Mississippi paid more than $200 million to Mississippi hospitals through its DSH program.

# # #

Mississippi Medicaid and Dentists

2010-06-30T08:13:00.000-07:00

I am disappointed that Dr. Mark Donald, president of the Mississippi Dental Association, took offense to my recent comments regarding Medicaid reimbursement to providers. My offensive comment was that “We currently overpay all Medicaid providers except physicians.” Dr. Donald also said that he would like to work collaboratively with DOM. This is an interesting comment considering that a few years ago, rather than working with DOM, the Mississippi Dental Association lobbied and persuaded the Mississippi Legislature to force DOM to pay Mississippi dentists serving Medicaid beneficiaries a 10% increase in reimbursement for each of three years—a total of a 30% compounded increase in reimbursement rates. Including this compounded rate increase, inflation and an increase in beneficiaries, Mississippi dentists serving Medicaid received a 108% increase in payments from Medicaid over a three year period—while the number of dentists billing Medicaid decreased.

Let me explain why I think dentists are paid well by Mississippi Medicaid. There are 585 procedure codes for the practice of dentistry. Mississippi Medicaid pays 158 of these codes; Alabama Medicaid pays for 64 of these codes; Georgia Medicaid pays for 79 of these codes; Florida Medicaid pays for 67 of these codes; Louisiana Medicaid pays for 63 of these codes; and Arkansas Medicaid pays for 50 of these codes. We feel certain this will never happen, but if one Medicaid beneficiary were to receive services for all the codes paid by Mississippi Medicaid, it would cost Mississippi Medicaid $103,556. If one beneficiary received all dental services paid for by Alabama, it would cost Alabama Medicaid $7,737. The same event in Georgia would cost $19,934; in Florida $4,467; in Louisiana $10,044; and in Arkansas $9,735.

When one compares Medicaid payments by codes for these six southern states, Mississippi pays highest on 73 codes; Alabama on 2 codes; Georgia on 26 codes; Florida on 0 codes; Louisiana on 27 codes; and Arkansas on 19 codes.

As Director of Mississippi Medicaid, I repeat my much used statement that Mississippi Medicaid overpays all Medicaid providers except physicians. And, in case we have forgotten, physicians are the heart and soul of health care in Mississippi—and around the world.

Robert Robinson

Executive Director

*All data used in this letter was taken from each respective states’ website on June 22, 2010.

Medicaid’s reimbursement for Medicaid pharmacy providers

2010-05-14T08:54:00.001-07:00

There has been recent publicity regarding the Division of Medicaid’s reimbursement for Medicaid pharmacy providers. Although Mississippi is the poorest State in the nation, Medicaid’s reimbursement for generic drugs is one of the highest in the nation. Medicaid needs the ability to adjust generic reimbursement so that it is equitable to pharmacy providers and to Medicaid for all generic drugs.

Medicaid prescriptions compromise between 10 to 15% of the average Mississippi pharmacy’s business while other payers, such as Medicare Part D and private companies, compose the remainder of their ‘pharmacy book of business.’ The question begs to be asked “if Medicaid represents only 10-15% of their business, what about the other 85-90% of payers?” How is Medicaid going to force a pharmacy into bankruptcy with a 2% annualized cut on 10-15% of the pharmacist’s business for one year?

There are two components of pharmacy reimbursement: drug costs and a fee to dispense the drug. According to the 2009-2010 Pharmacy Benefit Management Institute’s Annual Survey, the national average dispensing fee among all payers for brand named drugs was $1.57; MS Medicaid pays a $3.91 dispensing fee for brand drugs or 2.5 times the national average. In the same article, the national average dispensing fee among all payers for generic drugs is $1.63; MS Medicaid pays a $4.91 dispensing fee or over three times the national average. It is Medicaid’s stance that the pharmacy community’s reimbursement woes are the result of other third party payers who for the past ten years have been systematically decreasing reimbursement to the pharmacy community rather than the result of Medicaid’s actions.

For the past several years, some pharmacies have advertised prescription generic drugs at a flat rate price for consumers. If some pharmacies can offer these prices as their usual and customary charges, why can’t others do the same and pass those savings on to the taxpayers of Mississippi?

Here are some examples of drugs advertised on the flat rate prescription program and below are actual reported costs on other drugs with the corresponding Medicaid reimbursement:

Brand name

Common use

Flat rate plan cost

Medicaid payment Percentage Reimbursement over cost shown

Foxamax osteoporosis $9/4 tablets $61.47/4 tablets 683%

Paxil depression $4/30 tablets $15.64/30 tablets 391%

Ortho-Tricyclen contraceptive $9/28 tablets $34.40/28 tablets 382%

Reported provider cost

Prilosec indigestion $4.91/30 tablets $109.91/30 tablets 2,238%

Zofran ODT nausea $6.00/12 tablets $339.21/12 tablets 5,654%

Flonase Spray congestion $15.58/1 bottle $64.91/1 bottle 417%

Medicaid’s goal is to reimburse all our providers fairly. We currently overpay all Medicaid providers except physicians. We underpay physicians.

Robert L. Robinson, Executive Director of Mississippi Medicaid

Our Response to the recent Lawsuit

2010-03-11T07:11:00.000-08:00

We have received a copy of a lawsuit alleging, "Mississippi forces mentally ill children through a lonely cycle of restrictive psychiatric facilities when community-based programs would better serve their needs", but have not had an opportunity to review it with legal counsel. It appears that Plaintiffs’ lawyers have overlooked the thousands of Mississippi children who do receive mental health services in the community setting. The lawyers also fail to point out the recognition that Medicaid’s MYPAC program, (a program that serves children in need of mental health services), has received for serving children in the community setting. In fact, earlier this year, MYPAC won an award for its outstanding service to children, so to ignore this important point seems a little disingenuous. We look forward to aggressively defending our position.

Updated Medicaid Speech Therapy Now In Effect

2009-09-10T07:38:00.000-07:00

JACKSON, MS.- (September 9, 2009) – Division of Medicaid Executive Director, Dr. Robert L. Robinson, recently confirmed that after discussions with federal officials, the Centers for Medicare and Medicaid Services (CMS) had no objections or revisions to the Division of Medicaid’s proposed policy for speech therapy services. He went on to say, "As a general rule, Medicaid has provided speech therapy services for individuals when such services are 'medically necessary,' and the policy that is now in effect will not change that. Our benefits in this area continue to be some of the most robust in the state when compared with other health insurance payers."

“Federal regulations require us to only pay for those speech therapy services that are medically necessary. We cannot change federal law. But, we are pleased to better clarify our policy regarding this requirement.”

The policy outlines multiple criteria considered to determine the medical necessity of requested speech therapy services. Robinson stated this as a reminder, “Because each individual is unique, each case is reviewed by a medical professional – nurses, therapists and doctors - on a case by case basis and the medical necessity is determined by combining the information submitted for each individual with evidence based research and the clinical judgment of our independent medical professionals. These medical services can be provided in schools, clinics or outpatient hospital settings provided that the services are medically necessary.”

Not all Medicaid beneficiaries require speech therapy services. For August 2009, only 728 beneficiaries requested prior authorization for speech therapy benefits. Out of the 728 requests, 711 were approved for speech therapy services. That's about a 98% approval rate under the policy that was heavily criticized as it existed in July.

For a copy of our policies, go to www.medicaid.ms.gov and click under “Publications” on the home page and then scroll down to “Provider Policy Manual”.

Feds Approve Increasing Medicaid Demonstration Grant

2009-08-21T06:44:00.001-07:00

Feds Approve Increasing Medicaid Demonstration Grant
Home-based alternative to Psychiatric Residential Treatment Facilities lauded

The Centers for Medicare and Medicaid Services (CMS) has approved increasing participation in the Mississippi Division of Medicaid's Mississippi Youth Programs Around the Clock (MYPAC) demonstration grant program. According to CMS, "We thank you for your dedicated efforts in participating in this project. We recognize your early success in implementing this demonstration waiver and will remain steadfast in our commitment to provide the technical assistance and support you may need to fully accomplish the goals of this demonstration program."

MYPAC Program Director Kristi Plotner said, "MYPAC is transforming the way mental health services are provided for our state's youth and their families.
The program 'went live' in November of 2007, and has now been approved for larger participation due to favorable performance." She went on to say, "We wanted to make sure our children and families have better choices to access services at home of the same level and intensity as they would have had available to them from a psychiatric residential treatment facility.

Medicaid Executive Director Robert L. Robinson added, "Our MYPAC program is truly a 24/7 program that gives unique guidance that makes a difference for the child and for the child's family. Absent this waiver, these services would be limited exclusively to psychiatric residential treatment facilities." He went on to say, "Kristi Plotner is the engine driving this program. She and her team work long, hard hours because they care about those they serve!"

For more information on the Mississippi Medicaid MYPAC program call 1-800-421-2408.

Medicaid "planners" fraud

2009-08-04T12:10:00.000-07:00

We are advising seniors, their families, and caregivers there is no fee associated with applying for Medicaid benefits.

Avoid so-called Medicaid "planners" who charge to fill out Medicaid applications. When one applies for benefits at the Division of Medicaid there is never a charge. Call 601-359-6050 in Jackson, or 1-800-421-2408 to find out how you can make a no-cost appointment at your local Medicaid Regional Office. To report Medicaid fraud please call 601-576-4162 in Jackson, or 1-800-421-2408.

Respnse to Bill Minor's most recent column, "Barbour's heavy-handed tactics on Medicaid worrying"

2009-07-13T07:34:00.000-07:00

Bill Minor's most recent column, "Barbour's heavy-handed tactics on Medicaid worrying", brings to mind what Germany's former Minister of Propaganda Paul Joseph Goebbels once said, “If you tell a lie big enough and keep repeating it, people will eventually come to believe it."

Bill wrote, "In his June 30 statement, the MHA's [Sam] Cameron made a point that got no attention: that the existing Medicaid Division 'has yet to demonstrate its ability to plan, project and administer any budget.'" The aspersion cast concerning the capability of this (or any other) Medicaid administration's ability to balance the books is a lie by omission. What's omitted are indisputable facts.

Fact #1: When any given manager is prevented from having control over revenues or expenditures there is no way to accurately "plan, project, and administer any budget."

Fact#2: State law and Federal law control the funding of Mississippi Medicaid as well as the rates paid to providers.

Fact#3: Beneficiaries and Providers control the amount of Medicaid products that are utilized.

Fact #4: Providers control rate setting through state legislation.

Fact #5: Because Medicaid is an entitlement, if you're eligible, you get coverage. This adds another layer of difficulty to estimating the Medicaid budget.

Fact#6: Medicaid Rates X Medicaid Utilization = Medicaid Expenditures. Mississippi Medicaid has no control of either. Medicaid is usually intentionally underfunded or funded with some degree of smoke and mirrors.

Fact#7: Mississippi Medicaid budgets are projected two years in advance which makes it difficult to accurately predict the degree and direction of movement of a host of variables.

The columnist goes on to say, "I remember when public health director Alton Cobb and Clinton Smith headed the division with no political interference, it ran well. Maybe that's where Medicaid reform should start."

Fact#8: In 1970, Dr. Alton B. Cobb reported to the State Medicaid Commission and was given control over the program. He could make all cuts necessary to stay within the budget, and he did just that. By doing this he had the total support and backing of the then Mississippi Legislature to do what was necessary to stay within his $38 million budget. Alton Cobb was and is a good administrator and a fine person.

Fact#9: Today's Medicaid program is a $4 billion program which has the future potential of financially devouring us all.

Fact#10: On many occasions Medicaid Executive Directors have been sternly reminded by the Mississippi House of Representatives Leadership that political control over the program was not only favored but a matter of pride.

Fact#11 Most Mississippi Medicaid programs have been designed through the political "squeaky wheel" approach and are highly inefficient.

Fact#12 Ninety-six lobbyists are working on legislators both day and night for more money to be paid to their clients through Mississippi Medicaid.

Perhaps the real reason "that we hear no outrage in the Mississippi news media about "[Governor] Barbour's heavy-handed tactics" is Mississippians are finally getting both sides of the story and can see through this columnist's spin.

MHA's pressure on the Medicaid issue

2009-06-30T10:17:00.000-07:00

At today's Mississippi Hospital Association's morning press conference, their President/CEO stated, ""While the current Division of Medicaid is yet to demonstrate its ability to plan, project, and administer any budget, we accept and endorse the tax amounts and assessment methodologies contained in the bill." C'mon Sam Cameron, even you know when you are prevented from having control over revenues or expenditures there is no way to accurately "plan, project, and administer any budget." Isn't that the way MHA designed it in the first place?

Letter to Providers in Response to MHA's letter

2009-06-27T12:50:00.000-07:00

Medicaid letter to Providers

2009-06-19T13:18:00.000-07:00

STATE OF MISSISSIPPI

OFFICE OF THE GOVERNOR
DIVISION OF MEDICAID

DR. ROBERT L. ROBINSON
EXECUTIVE DIRECTOR

June 19, 2009

Dear Medicaid Provider:

To date, the Legislature has failed to reach an agreement on the budget for State Fiscal Year 2010. Unfortunately, it appears that the Legislature has left approximately a $34 million deficit in the Division of Medicaid’s budget in FY 2009.

The current year deficit is due, in part, to a significant increase in the number of beneficiaries since March 2009 and a similar increase in benefit utilization. We notified the Legislature of our budget situation for FY 2009, but they have not appropriated any funds to cover this deficit. As a result, the Division of Medicaid is unable to make any more provider payments for the remainder of FY 2009.

Once the Legislature funds the program, clean claims will be paid. We ask that you continue to serve our Medicaid beneficiaries and that you continue to file your claims with ACS. Again, when funds are available, providers’ clean claims will be reimbursed.

Thank you for your cooperation in this matter and for your service to our beneficiaries. We will update you as this budget situation develops.

Sincerely,

Robert L. Robinson
Executive Director

Letter from Executive Director Dr. Robert Robinson in response to the MSMA alert

2009-06-16T07:56:00.000-07:00

STATE OF MISSISSIPPI

OFFICE OF THE GOVERNOR
DIVISION OF MEDICAID

DR. ROBERT L. ROBINSON
EXECUTIVE DIRECTOR
June 12, 2009

Randy Easterling, MD, President-Elect
Mississippi State Medical Association
408 West Parkway Place
Ridgeland, Mississippi 39158

RE: MSMA Legislative Alert

Dear Randy:

Those of us in healthcare know the MSMA is a powerful influence at the Mississippi State Capitol and in Washington DC. MSMA speaks for physicians on a wide range of topics and certainly understand the needs of our beneficiaries. That's why I am especially pleased with your June 11, 2009 "Legislative Alert" where you conclude, "The bottom line is there will have to be some form of hospital assessment reinstated before Medicaid can be fully funded. Exempting hospitals from cuts would result in physicians taking a deeper cut if the budget falls short." I couldn't agree more.

We at the Division of Medicaid appreciate MSMA understanding the importance of properly funding this vital program. With physician's, the heart and soul of healthcare, speaking out on our behalf, we are now reinvigorated. On behalf of our beneficiaries, the Governor, and the Division of Medicaid, we wish to thank all of you for standing up for what's right.

As I have said on numerous occasions, if we could get the physicians and patients in charge of healthcare, we will have better quality healthcare at lower cost. .

Sincerely,
Robert L. Robinson
Executive Director

Mississippi Hospital's CEO's Salaries

2009-06-16T07:48:00.000-07:00

Ineligible beneficiaries have still received Medicaid for Medicare Part B premiums.

2009-06-10T12:57:00.000-07:00

The Division of Medicaid confirms that certain former Mississippi Medicaid beneficiaries have been receiving letters concerning the payment of their Medicare Part B premiums. During our ongoing internal control effort to reconcile file data, individuals who had been previously determined as ineligible for Medicaid, and had been properly notified by the Division of Medicaid, continued to have their Part B premium payments paid by the State. Although terminated, these individuals continued to have their premiums paid.

As soon as this discrepancy was detected by Medicaid, action was taken to stop the premium payments. A file was sent to the federal government to remove the former dual eligibles, thus prompting a letter to be sent by the Social Security Administration. These individuals have the option to contact their local Medicaid office to be evaluated to see if they can reestablish eligibility. According to Executive Director Robert L. Robinson, "Medicaid has and will always pay for individuals eligible for Medicaid benefits, but these individuals are no longer eligible and we cannot pay for those who do not qualify."

The Division is continuing to analyze all aspects of this issue, including the fiscal impact.

Former Mississippi Medicaid beneficiaries have been receiving letters concerning the payment of their Medicare Part B premiums.

2009-06-10T12:53:00.000-07:00

Medicaid does not intend to move ARRA money into the “Working Cash Stabilization Fund”

2009-06-08T14:25:00.000-07:00

The Division of Medicaid does not intend to move ARRA money into the “Working Cash Stabilization Fund” (which is considered to be a “rainy day fund” by the state and will be subsequently referred to as the Rainy Day Fund). To be clear, our state law does not allow the Division of Medicaid this discretion. ARRA money for Medicaid will result in state general fund savings and the Mississippi Legislature, not the Division of Medicaid, is responsible for determining how the general fund money is spent.

We pay medical service claims on a weekly basis. For medical service claims that qualify for the enhanced match rate, we put up the non-federal share and draw down the regular federal share plus the enhanced federal share each week. This money is deposited into a bank account for less than 48 hours before it is paid out to providers. These medical service expenditures are recorded in the “Medicaid Special Revenue Fund” #3328. The end result is that MS Division of Medicaid does not have access to the increased matching funds to deposit those funds into another account or fund, including the Rainy Day Fund. The result of the increased match rate for Medicaid is that less money is needed from non-federal (state) sources to fund the total program expenditures.

The State understands that ARRA money cannot be directly or indirectly deposited or credited into a reserve or rainy day fund for use in a future period and remain eligible for the ARRA increased FMAP, and we do not intend to do so. In that regard, we understand in particular that it would not be permissible for the state to directly or indirectly deposit general fund savings resulting from the increased federal match rate in the rainy day fund in State Fiscal Year 2010 (7/1/09 to 6/30/10) in order to use those funds in State Fiscal Year 2011 (7/1/10 to 6/30/11).

Medicaid is projecting an estimated $300 million deficit in non-federal (state) funding for State Fiscal Year 2011 based on funding sources authorized under current state law and expected program growth. In order to address the significant projected state deficit in future periods the State is considering setting aside state dollars from other available state funds for future periods particularly after ARRA funding is exhausted on 12/31/10. However, based on our conversations, it would be permissible to delay the use of Tobacco Settlement payments received in the “Healthcare Expendable Fund” in State Fiscal Year 2010 until State Fiscal Year 2011. These funds have no connection to ARRA stimulus savings, and as indicated, the State could allocate these funds to State Fiscal Year 2011.

Ultimately, the Mississippi Legislature, not the Division of Medicaid, will determine how state funds are allocated in the budget once the budget for State Fiscal Year 2010 is completed.

We also believe that the questions related to moving ARRA funds to a rainy day fund raised by the third party sources were likely generated by the MS Hospital Association (MHA). We note that MHA has openly lobbied the MS Legislature to delay reinstating a $90 million hospital tax because they have indicated there are sufficient ARRA savings to allow hospitals to receive a tax break for the fifth year in a row.

Hospitals in this state can afford to pay a $90 million assessment

2009-06-03T07:58:00.000-07:00

You’ve heard the saying, “It’s as sure as death and taxes.” Well, perhaps it’s time to put a 21st Century spin on that cliché - “It’s as sure as death, taxes and a Medicaid deficit.” For the better part of this decade, Mississippi has experienced deficits in its Medicaid program – sometimes as the result of unforeseen events, but most of the time as the result of intentional underfunding.
Until State Fiscal Year 2006, hospitals, more specifically, government funded public hospitals, paid an additional $90 million into the Medicaid program. When this non-federal money was matched with federal money, the $90 million generated $360 million for the Medicaid program. When the federal government disallowed this funding methodology, it left the State with a hole in the Medicaid program. This recurring hole has been filled with one time money for the last four fiscal years. There is no more one-time money. Given the downturn in the economy, resulting in increases in service utilization and in the number of beneficiaries, costs for the Medicaid program are projected to increase dramatically. Although the State is realizing a savings because of the federal stimulus money, the money is not enough to fill the void. The State must find additional non-federal money to fund the program.
A hospital assessment is not a new concept; other states have recently enacted provider assessments to help generate the revenue necessary to fund the non-federal share of its Medicaid program. Recently, Colorado, with the support of a Democratic Governor and the Colorado Hospital Association, passed a $600 million assessment on hospitals. Colorado’s relatively low match rate means that the assessment is expected to generate about $1.2 billion total dollars for healthcare providers. A 2 to 1 benefit overall. Wisconsin and Illinois, with support from their state hospital associations and Democratic governors, have also recently passed hospital assessments. The Illinois assessment is a $900 million assessment.
In Mississippi, we can’t pay for the program we currently have. A $90 million assessment would generate nearly $600 million in total program dollars for Mississippi providers – a 6 to 1 overall benefit – with a $5 net gain. The assessment is not a partisan issue; it simply makes good sense by promoting sound fiscal policy.
Some will call this a tax on sick people. For the last four years, hospitals have benefited from not having to pay the $90 million that was paid for the previous thirteen years. That’s a savings of $360 million over the last four years. If you’ve gone into a hospital during the last four years, you may have noticed that these savings were not passed along to patients. The cost of hospital services has continued to increase – hospitals can’t attribute that to a $90 million assessment.
Hospitals in Mississippi are reimbursed very well for treating Medicaid patients. On average, Medicaid reimburses hospitals 123% of their costs of treating Medicaid patients. None of the three states mentioned above (Colorado, Wisconsin or Illinois) pay their hospitals as well as Mississippi – yet Mississippi is one of the poorest states in the nation. In FY 2009, Mississippi hospitals will earn a profit off Medicaid of $194 million – excluding a Disproportionate Share Hospital (DSH) payment of $202 million.
To be fair, hospitals do pay an assessment to the Division of Medicaid. For State Fiscal Year 2010, hospitals are estimated to contribute approximately $14 million in assessments to fund medical service payments. Hospitals will receive approximately $1.5 billion in total payments from Medicaid. Again, even considering the net effect of these assessments, Medicaid still reimbursed hospitals, on average, at 123% of their Medicaid costs in FY 2009. As a percentage, hospital assessments amount to 2% of their Medicaid medical services revenue. By comparison, nursing homes contribute approximately $90 million in assessments – approximately 8% of their total Medicaid medical services revenue.
Not only can hospitals afford to pay this assessment, it is imperative that they do so. Based on calculations by Families USA using the old federal match rate, without the additional $90 million from hospitals there will be an adverse impact on business activity in the state by at least $550 million and a negative impact of over 5,600 jobs and $197 million in salaries and wages. Our economy currently needs these wages and jobs. With the enhanced match rate, the impact is even more pronounced. It is fiscally irresponsible not to reinstate the hospital assessment in order to avoid disastrous consequences to the State’s economy. When faced with a $90 million shortfall last year, the Division of Medicaid proposed reimbursement changes which maximized the UPL contributions from hospitals in order to harness additional non-federal funds and avoid a disastrous loss of total program dollars.
The bottom line is that hospitals in this state can afford to pay a $90 million assessment. It is not a tax on sick people any more than the $360 million hospitals saved the last four years was a tax refund to patients; it is good policy enacted by many other states and Mississippi needs the stability that such a revenue source would bring.

2009-04-06T11:24:00.000-07:00

Publications from Center on Budget and Policy Priorities (Mississippi’s “face –to-face” rule blocks coverage of eligible people, not fraud"), and the Center for Justice ("Losing Ground: Declines in health coverage for children and families in Mississippi"), continue to criticize the Division of Medicaid (DOM) for our payment error rate measurement (PERM) data and our face-to-face eligibility policy.
It is crucial to know and understand that the DOM is held to a much higher standard in our data reporting than are these two organizations. Our PERM data was compiled by the independent, nationally recognized CPA firm of Clifton Gunderson LLP. Clifton Gunderson, ranked as one of the nation’s largest certified public accounting and consulting firms, provides a wide range of assurance, accounting, tax, and consulting services to clients in a variety of industries. Founded in 1960, Clifton Gunderson has a staff of more than 2,000 professionals serving clients from 45 offices across the country.
In contrast, the Mississippi Center for Justice and the Mississippi Center for Budget and Policy Priorities are advocate organizations staffed by lawyers . Both organizations have every incentive to create the false perception that weak eligibility standards do not cause fraud. DOM strongly disagrees and continues to await credible, standard -sourced data to show otherwise.[1] The DOM is mandated by federal and state law to be good stewards of the tax-payer dollars that are allocated to our program. This is especially critical given our current economy's impact on our taxpayers. In contrast, these two "attack" organizations appear to be in favor of universal health-care coverage with total disregard for how to pay for it.
[1] Center for Justice ("Losing Ground: Declines in health coverage for children and families in Mississippi") data was produced by one person driving from Memphis to the Mississippi Gulf coast while interviewing DOM employees on a hit -or-miss manor along the way. When DOM asked for their research data, this same single source would not provide it.

In a recent Associated Press offering, "Mississippi Medicaid rule unfair to poor, advocates say", paraphrased my direct quote and inserted it into their article to give it a much different meaning by virtue of context. Paraphrasing "You cannot quantify the results of how face-to-face determination prevents Medicaid fraud much in the same way you cannot quantify how increasing police patrols in a high crime area deters crime" to " Medicaid spokesperson Francis Rullan said the policy has helped the program maintain solvency by removing people not eligible for benefits, but he noted that there is no way to tell if the rule has reduced fraud," and syndicating it world-wide, is neither correct nor a fair representation of my meaning. Here's what the AP failed print even though I submitted it to them..."From the end of May 2007 to the end of March 2009, our CHIP enrollment has increased by 6,674 and over this same period enrollment for full Medicaid benefits has increased by 58,538. Since July 1, 2008 alone, Medicaid enrollment has increased by 34,383.We began enforcing existing policy that required verifying income and other critical factors of eligibility (identity, age, relationships). DOM increased supervisory reviews of each case. This increased accountability for the outcomes of eligibility decisions resulted in the removal of those who were not eligible for benefits from our rolls. It also prevented new applicants who were not eligible for benefits from getting on our rolls in the first place! A vital benefit of our face-to-face interview component includes providing us the opportunity (and therefore bettering our ability) to communicate with our applicants. To be sure, we make the most of this opportunity to personally appraise applicants of their rights, their responsibilities, and the many services they could be entitled to receive if they qualify. Equally important, viewing the applicants' documents brought to the face-to-face interview, (rather than mailing them back/forth), saves valuable time. Mail-in eligibility slows eligibility determination since it would be more difficult to gather required information from the applicants, many of whom are challenged by printed forms and letters.States may have to rethink their position on in-person interviewing when federal audit findings are released. Just because we are the only state that has this process in place does not make it wrong. It shows that DOM is very serious about ensuring only those who are qualified for Medicaid or CHIP are the ones who are enrolled in these programs." Additionally, "We feel having this process in place acts as a deterrent to fraud much in the same way increasing police patrols is a deterrent to crime. And, these costs are part of our admin costs which represent one of the lowest of any Medicaid program in the United States. Changes in our current face-to-face policy such as requiring personnel to man their out-station sites 40 hours a week or returning to mail-in determination/redetermination would only increase our admin costs. Just to man our 103 outstations eight (8) hours per day will require sixty (60) additional employees. Finally, our medicaid facts come from Medicaid experts and CPA's all of whom are held to very high standards. Advocate data comes predominantly from lawyers and they are not audited for their validity as are ours.

[1] Center for Justice ("Losing Ground: Declines in health coverage for children and families in Mississippi") data was produced by one person driving from Memphis to the Mississippi Gulf coast while interviewing DOM employees on a hit -or-miss manor along the way. When DOM asked for their research data, this same single source would not provide it.

A good and proper reason for the decline in our SCHIP beneficiaries

2009-03-02T08:59:00.000-08:00

During my past 10 years at Medicaid, I have had the privilege of serving on the primary SCHIP steering committees under two governors and six Medicaid Executive Directors. I was one of the first on-board when we grew our SCHIP population from less than 5,000 to well over 50,000 beneficiaries; this in a very short period of time. I directed the SCHIP television commercials and wrote and produced the radio ads. I designed many of the print advertising that was published and distributed statewide. This background has given me the perspective to refute much information from Dr. Ed Ivancic's February 22nd opinion letter, "Face-to-face Medicaid interviews harmful."
We at the Division of Medicaid appreciate our providers and what they do to help us afford the blessings of good health to all of our qualified beneficiaries. When Dr. Ivancic stated, "We pediatricians often find ourselves advocating on behalf of our patients, since so many are too young to speak on their own behalf" he was preaching to the choir. This is the position the Division of Medicaid shares with our provider partners and with our beneficiaries. So once again, in an effort to clear the air on this issue, I will be even more accurate with the facts and try not to mislead by omission.

The enrollment process as it exists currently ensures that only qualified individuals are certified for coverage. This was not the case in the past. In report #431(June 24, 2002), the Joint Legislative Committee on Performance Evaluation and Expenditure Review (PEER) stated on page 42, "The Mississippi Department of Human Services does not verify income for all Medicaid applicants before awarding benefits. According to Department of Human Services county workers, departmental policy does not require verification of a Medicaid applicant's income prior to awarding benefits. The five Department of Human Services workers interviewed by PEER from Bolivar, Hinds, Jones, Lauderdale, and Washington counties stated that the main goal, as told to them by management in the state office (in Jackson), was to enroll as many people in Medicaid as possible and to simply accept whatever income the applicant reported on the application form." That's why healthcare advocates and state legislators pushed to move the determination process from the Department of Human Services to Medicaid. To implement this mandatory policy, the Division needed to bring more Regional Offices on line as well as hire and train new employees.

Did you know that Medicaid now has over 100 outstationed sites in addition to our 30 Regional Offices? These sites are located in 80 of the 82 counties within Mississippi and this has increased our administrative budget. This should not be surprising, especially when the "$48.5 million dollar cost" (as mentioned) included the transitioning of eligibility determination from DHS to DOM covered a 33 month period (as not mentioned) from 04/01/05 – 12/31/07!

Dr. Ivancic stated, "The Division of Medicaid has testified before the Legislature that 87 percent of the children being enrolled in the program had been kicked off the rolls because of the face-to-face requirement." Kicked off the rolls? The truth behind this accusation is that 87percent of the applications that were eventually approved were for individuals who initially failed to do what was required by law, but when those same individuals complied with the review process, they were approved with no break in their healthcare coverage!

In the past, the Department of Human Services had a 60 percent closure rate using their mail-in process. They also posted a 90 percent approval rate with little or no supervisory reviews. The Division of Medicaid also had a 60 percent closure rate for our "Families and Children" and SCHIP programs utilizing our in-person interviews and requirements. The big difference is that we do have supervisory review of these same cases! Additionally our closure rate is improving; in calendar year '07 it was 55 percent, and in calendar year '08 it was 40 percent. Lower closure rates mean higher beneficiary satisfaction and a higher level of overall process efficiency. The in-person interview has more to do with healthcare education, thoroughly working each application, and assisting the beneficiaries with the enrollment process. It certainly is not "a way to save the state money" as claimed by Dr. Ivancic.

As a direct result of our face-to-face interviews the number of referrals mailed to our providers concerning qualified beneficiaries requesting medical screening services for state fiscal year 2008 was 98,794. Would these referrals have taken place with just a mail-in process? Most probably not.

Since our Medicaid program exists primarily for the benefit of our beneficiaries, shouldn’t we all be on the same team? Why must we go round and round, year after year, about the administration of this program? One of my Executive Directors, former State Representative Bobby Moody, once told me that he thought he knew most of what needed to be known about our Medicaid program…until he came over to administer it! He discovered that being an outside expert was not enough to run this program.

We encourage and evaluate the input of all of our outside partners. In this case however, it is demonstrable that our current enrollment process ensures only qualified individuals are certified for coverage, thus protecting the program for the greater good of all of our beneficiaries, and for the state of Mississippi.

Please support Senate Bill 3044

2009-01-31T08:06:00.000-08:00

The Senate Appropriations Committee will vote on SB 3044 this week. The Division of Medicaid urges hospitals and all Medicaid providers to support this bill.
Steve Dixon, a representative of the Mississippi Hospital Association (“MHA”), is requesting that the Division consider using the language from SB 2013 from last year’s Special Session. As you will recall, that was the language that was agreed upon between the Division and MHA and was approved by the Senate. It was lobbied against and killed in the House.
Although SB 2013 would generate the $90 million in needed assessments to cover the shortfall, the Division believes that the two models recently developed by the Division and its consultant are better for hospitals. All three models generate the $90 million in needed assessments, but SB 2013 results in higher bed day assessments and more losers. The two models recently proposed by the Division result in no losers and lower bed day assessments. We think these options are better. Please let us know whether you prefer the assessment model proposed under SB 2013 or the models recently proposed by the Division.
Not only does SB 3044 provide better results for hospitals, it provides better results for other providers. For example, SB 3044 deletes the language requiring the Division to reduce reimbursement rates to certain non-institutional providers by 5%. This results in a 5% increase in reimbursement to providers such as physicians, dentists, and ambulances. We think these increases are necessary to continue to attract our primary care physicians and first-line providers .
We ask your support for SB 3044. Please talk to your Senator and urge them to pass SB 3044

2009-01-23T13:00:00.000-08:00

Click on the above sheet that shows what Mississippi provider hospitals receive for each dollar invested in funding our Medicaid program.
This shows what we have done for the last three years and what we propose for SFY 2010. Please see below and attached.

Wonder if the MHA ever thinks about the Medicaid beneficiaries or the taxpayers?

2009-01-22T08:19:00.000-08:00

This quote is from The blog created by the Mississippi Hospital Association to keep their members updated about pertinent health care issues during Mississippi's legislative session

"Some lawmakers are just realizing that the entire Division of Medicaid is due for reauthorization this session. The importance of this 'sunset' is critical for MHA as this fight will be THE ultimate battle over who controls Medicaid.

While federal law rests authority for Medicaid in the Governor’s Office, Mississippi lawmakers have tightly regulated the program by statutes. Provider groups have benefitted from legislative 'control' of the program since its inception. Rates and services, for example, are set by statute and can’t be changed except by the Legislature (and CMS).

Governor Barbour wants total control of the program, without any legislative oversight or intrusion into his executive authority. He and his appointments at the Division of Medicaid claim over-regulation by the Legislature prevents them from administering the program efficiently.

If no reauthorization bill is passed, the agency can be run by Executive Order. All the 'protections' put in the law by MHA and others across the years die with the statute."

Wonder if the MHA ever thinks about the Medicaid beneficiaries or the taxpayers?

Is our Medicaid program's costs impacted by hard economic times?

2009-01-21T12:04:00.000-08:00

Is our Medicaid program's costs impacted by hard economic times? Judge for yourself. As of April 30, 2007 there were 551, 893 beneficiaries qualified for Medicaid. As of December 31, 2008 there were 578,135 beneficiaries qualified for Medicaid. That's an increase of 26,242 beneficiaries qualified for Medicaid. From July1, 2008 to December 31, 2008 alone, there was an increase of 8,841 beneficiaries qualified for Medicaid. (This increase is part of the total increase of 26,242 from April 30, 2007 through December 31, 2008.) Our Mississippi Medicaid budget is directly correlated to factors beyond the Division's control. Those factors are program "Utilization" and "Provider Rates." Stated in this simple formula, Utilization X Rate = Expenditure!

Response to Sam Cameron (Hosptal Association)

2009-01-20T12:58:00.000-08:00

Sam Cameron's carefully crafted statement appearing in the Jackson Clarion Ledger's 'SUNDAY MORNING WITH' this past January 18th, certainly gave new depth and meaning to the definition of "spin". His remarkable remark that, "Currently, we disagree with the governor's belief that it is the responsibility of health care providers to fund a state/federal entitlement program. Grocery stores don't fund food stamps." What a specious argument!
Facts show grocery stores are "for profit organizations". As such they pay taxes. Since taxes fund food stamps, they do contribute to food stamp funding! Here's another flash. Our farmers who benefit from the food stamp program also pay taxes.
Sam would like to divert you from knowing the major Mississippi hospitals (who contribute to his generous salary), do not contribute to our general fund through income taxes or property taxes. Therefore, one can correctly deduce that an assessment on hospitals in his association would level the playing field primarily with other providers who do contribute to Medicaid, like doctors, nursing homes and other categories of Medicaid providers.
His argument that "Even though our hospitals currently provide more than $150 million in funding to the Division of Medicaid, it is the governor's belief that we should provide $90 million more", is another clever misdirect. Don't fall for it because the hospitals do put up their share for their Disproportional Share and Upper Payment Limit payments. In this case, for each quarter the hospitals put up, they get back one dollar in return. That is not the case for any other Medicaid provider. All of this begs the question, does the Medicaid program exists to benefit the beneficiaries or Sam Cameron's providers?

Mississippi Medicaid follows the law - It does not make the law.

2009-01-16T13:01:00.000-08:00

Many of you have seen (and will continue to see) headlines that may give you the impression that the Division makes the laws that control our program. Nothing could be further from reality! Truth is, Mississippi Medicaid has more laws to govern almost every aspect of the program than any other Medicaid program in the United States. The Division is bound to follow these laws, both on the federal and state level to remain in compliance with both legislative bodies. This situation results in stifling program flexibility to the point where Medicaid managers cannot be nimble enough to meet the ever-changing program demands. Though targeting "Medicaid" in 18 point bold headlines may be a convenient way to create reader interest, it is far from being truthful. A more accurate headline would be the "Federal or State law dictates (whatever)" , not "Medicaid."

Medicaid Spending

2009-01-14T11:42:00.000-08:00

Medicaid funding creates a $4 billion cash-flow annually for our state. Some argue that Medicaid is not as much for the beneficiaries as it is for the providers. That $4 billion yearly is a large part of our state's economy and this dollar amount is driven by a simple formula: Program Utilization X Provider Rates = Expenditures. Therefore the incentive to decrease the number of those who suffer in poverty has a direct correlation to the dollars this health care program draws down from the federal government that eventually contributes to our economy. On the Gallo radio show yesterday morning, D. Stephen (Steve) Holland (Chairman of House Public Health) said, "Medicaid can't be controlled; it is driven by utilization…" According to our Executive Director Robert L. Robinson, " It is simple. The MS legislature should appropriate what the state can afford to spend on Medicaid then give the Governor and MS Medicaid the authority to make those cuts necessary to stay within budget. This is the way other states control Medicaid expenditures. Mr. Holland prefers growing Medicaid through deficit appropriations."

Francis Rullan
Director of Medicaid Communications