Mid-June 2009:  DHHS response to a Public Information request brought another surprise. Over six weeks before the request, DHHS notified Senate Fiscal Research Staffer, Melanie Bush that the CCME review Berger is referencing - showing that 45% of the Medicaid Home Care patients were ineligible, was inaccurate. Read the email below:

 

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DHHS to Senator Doug Berger:  The review does not show that home care patients are ineligable. Because the 'reviews' did not include a physical examination of a single patient.  Read the email below:   

From: Gray, Craigan [mailto:craigan.gray@dhhs.nc.gov]
Sent: Fri 6/12/2009 1:31 PM
To: Sen. Doug Berger
Cc: Cansler, Lanier; Feezor, Allen
Subject:

June 12, 2009

Senator Berger:

The first two attachments are the requests and responses.  The last three attachments include the summary of the CCME survey where ~41% of surveyed were out of compliance.  Keep in mind that of that percentage, some came back in to compliance with proper documentation, some got better and left the program, others moved to other programs, died, or in fact some did not qualify.  We are breaking each category down for further analysis presently.  The PCS group is anticipating an electronic surveillance tool in the future; however, all metrics are currently manual.  I am asking the PCS management group to implement an enhanced metric-based surveillance program as a result of the most recent inquiry to improve the standard of performance from all parties.

I appreciate your interest in the PCS program and we remain available for further questions as needed.

C. Gray, MD

Craigan L. Gray, MD, MBA, JD
Director, Division of Medical Assistance
2501 Mail Service Center
Raleigh, NC 27699-2501
(919) 855-4101 phone, (919) 733-6608 fax
craigan.gray@dhhs.nc.gov

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From: Tim Rogers 
Sent: Monday, June 15, 2009
To: NC Legislators
Subject: E-mail from Tim Rogers to Legislators

Dear North Carolina Legislator:

I want to share with you new information I have received since my last note (about the misleading chart HHS gave legislators, claiming 45% of the Medicaid patients receiving home care were ineligible). 

That chart was based on reviews by CCME, a vendor to HHS.  Friday, I had a note from Secretary Cansler stating he was informed several weeks ago – in a meeting with Senator Clary – the CCME percentages were wrong. 

In addition, Thursday, we received information (attached) from HHS that the Department had decided, after receiving the study, not to notify even one of the 899 patients CCME said were ineligible that they would no longer receive care; it is also clear from the records we have received most of the patients continue to receive care with the Department’s approval.

HHS paid the vender (CCME) $1.29 million dollars for this study.  As part of the study, HHS paid CCME a fee of $360 for every patient it reviewed.  ($360 equals one-half the average cost of a month’s home care for a patient of $750.)

So, per the attached, HHS paid over a million dollars for the study, almost all of the patient reviews were reversed by the Department, then the Department gave the study to legislators knowing it was inaccurate.

As ever, thank you for allowing me to keep you informed.

Sincerely,

 

 

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