As the state continues to phase in its new privatized Medicaid system, which contracts five private insurance companies to manage the health care of 1.2 million of Louisiana’s poorest residents, the horror stories from health care providers trying to adapt are plentiful.
New Orleans Gambit reports this week on just one sector that’s suffering — mental health — through the story of the McNeils, who own and operate a mental health clinic in Chalmette. Medicaid patients account for 95 percent of the McNeils’ business:
Clinical Advisor, a Medicaid reimbursement computer program built by state contractor Magellan Health Services, is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It’s not working. As a result, providers — many of which ... serve Medicaid clients — haven’t been able to submit Medicaid claims. What’s more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid.
Magellan is engineering and installing a massive database that will allow clinics to share information on treatment, patient prescriptions and medical history. While the state is paying the company per-patient fees for management services, individual providers get the software without charge.
Under the LBHP, he says, providers are no longer being paid for Medicaid claims for services provided over the phone. Some phone services, such as scheduling calls, were never covered ... Other phone services — such as calls to other clinics or to patients’ parole or probation officers — are now being handled by LBHP, and thus are not billable.
Having many previously billable claims denied under the new rules leaves clinics with several choices, none of them good. They can ask their staff members to work for free. They can refuse to take calls and risk possible malpractice charges. They can submit a claim for phone care as another, approved service — such as counseling — and possibly be charged with attempted fraud. Or they can pay for phone care out-of-pocket and cover those costs by cutting back elsewhere.
But the problems with implementing the new system extend far beyond what the McNeils are facing, as evidenced by a report from The Advocate on a recent legislative hearing where state Department of Health and Hospitals Secretary Bruce Greenstein addressed tough questions from lawmakers who remain skeptical about the new plan:
The state started phasing in the program in Livingston, Tangipahoa and the New Orleans area in February. Providers complained about having claims routinely rejected and long lag-times in payments on others. The complaints were mainly directed at what are known as “shared savings” plans operated by United Healthcare of Louisiana and Community Health Solutions of America.
Greenstein said problems in getting physicians, hospitals and other providers paid in areas where the program started won’t delay the April 1 expansion of the Bayou Health program into the Baton Rouge and Acadiana areas.
Greenstein’s comments came during and after a House committee meeting at which state Rep. Katrina Jackson, D-Monroe, asked whether Greenstein would consider delaying further expansion of Bayou Health.
“Before this plan is implemented in a new area, we need to have a real discussion on where the (health) plans are,” Jackson said.
“When physicians don’t get paid, they don’t treat Medicaid patients. If this hits Baton Rouge ... and it’s still not worked out, it’s going to discourage physicians in my area from accepting Medicaid patients,” Jackson said.
JUNE 19 Former Saint Steve Gleason, who is paralyzed by ALS, released a statement Tuesday in response to the Atlanta radio station's skit making fun of him and the disease, this Picayune post reports. What did he say? He said he'd accepted the apology of the DJs who did it, notes that at least the incident has got people talking about ALS, and asks anyone who is burning to take action about it to do so -- by helping him fight ALS.
JUNE 19 Blogger Ian McGibboney takes a look at the Gleason incident in this post. He makes a good argument about the difference between having free speech and being free from consequences for your speech (which none of us is). He also admits that many of us got upset before we listened to the skit -- but lets us know that the reality is far worse than we can imagine. It was the incredibly bad judgment, even more than the actual speech, that probably got those DJs fired, he opines.
JUNE 19 Washington Post blogger Aaron Blake writes about Sen. Guillory's switch to the GOP in this post. He writes what most political watchers in Louisiana know: Guillory was a Republican before he decided to run for the senate seat in a mostly-D St. Landry district, and has switched back now that he plans to run for Lt. Gov. in a mostly-R state. But how come Blake missed Guillory's appearance on a TLC pageant show? Now that is a video we'd like to see. (Again).
JUNE 19 Here's another Washington Post blog post about a Louisiana politician, and it's just plain scathing. Ezra Klein says Jindal's Politico post was "insulting" to the intelligence of voters, and adds that Jindal is personifying the "stupid" he's railed against, by being an "elite" who convinces GOP activists of "things that aren't true." Me-ow.
JUNE 19 Here's Gov. Jindal's post in Politico, in which he asks the GOP to get over losing to Obama (again) and stop "the bedwetting." (Uh, what?) He gives his Republican buddies what is probably a nerd's idea of a coach's motivational talk, which starts with a list of accomplishments that they can't seem to exploit and ending with an absurd description of liberals that sounds like a character treatment for a Fox "News" movie scripted by Gordon Liddy. Sure, he's preaching to the choir, but even the choir's not this gullible.
JUNE 19 Lamar Parmentel read Gov. Jindal's post on Politico, but thinks it was so dumb it probably was published in the wrong paper. This post by Lamar on the Daily Kingfish opines that possibly Jindal's post was destined for the Onion -- because the governor couldn't possibly be serious here. If you listen closely, you can hear the staff of the Kingfish giggling.
JUNE 19 Blogger Robert Mann posts from Turkey, a country he has visited several times in the past few years. Mann gives an interesting overview of the current political and societal climate of the country, which -- if you're living under a rock and don't know -- is experiencing protests and turmoil these days. Mann promises to post as much as he can during his trip, which should be fascinating reading.
JUNE 19 Blogger CB Forgotston says the legislature is keeping the vicious cycle going with its funding of new buildings for the community college/technical college system. Universities across the state need maintenance and improvement on existing buildings, and the solution is to build new buildings at other schools? By the time the bonds are paid off, those buildings will be falling down, too, CB says.
Frank’s Casing Crew, now doing business as Frank’s International, will make its final appearance on ABiz’s list of the Top 50 Privately Held Companies in Acadiana this year, and once again it will likely be at the top with more than $1 billion in annual revenues. The 75-year-old company specializing in tubular fabrication and installation services to the oil and gas industry plans to offer shares of its stock to the public for the first time.
The defeat, or rather highjacking of House Bill 420 in the final days of this year's Legislative Session, say Reps. Vincent Pierre and Terry Landry, is the result of the propaganda spread by one unidentified local media outlet and an unnamed former state Representative, but nothing to do with the original legislation's lack of checks, balances or details.
He’s a singer. A songwriter. A piano man. A family man. He’s even got his own Wikipedia entry. He’s David Egan. And he knows ancient secrets about the monolithic stones of Stonehenge that he’s not willing to share.