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Mo. lawmakers ignore own demands for Medicaid accountability

Sunday, January 6, 2008 | 4:43 p.m. CST; updated 6:59 a.m. CDT, Friday, July 18, 2008

JEFFERSON CITY — Lawmakers who sought to inject more accountability into the state’s Medicaid program have failed to live up to their own demands.

Others are doing a little better.

When lawmakers gave the government health care program for the poor a new name and new emphasis last year, they wanted to keep their fingers on the pulse of the program instead of just turning it over to bureaucrats.

So lawmakers mandated various entities to report to the legislature by Jan. 1 on certain aspects of MO HealthNet (the program previously known as Medicaid).

Half of those reports have yet to be made, including the one over which legislators have the most personal control.

The lack of progress on the reports highlights an important reality about state laws: Just because something is required by law does not mean it occurs, particularly if there is no penalty attached to inaction.

In this case, the MO HealthNet law that took effect Aug. 28 required six separate reports covering 25 specific points, ranging from efforts for combatting Medicaid fraud to physician payment rates to the program’s projected future enrollment.

The Associated Press requested copies of each report on Dec. 31.

Only the report from the attorney general’s Medicaid Fraud Control Unit was provided before the New Year. It said the office obtained orders for medical providers to pay more than $14.2 million to the Medicaid program in 2007.

The Department of Social Services said it submitted two reports — one on Medicaid waste, fraud and abuse investigations; the other on payment rates to medical providers — on Jan. 2.

One report noted its Division of Legal Services investigated and closed 280 cases of alleged fraud by Medicaid recipients, recovering nearly $2.1 million for the state.

The other report described the disparity in Medicaid payments to medical providers. Depending on the service, they receive anywhere from just 8 percent to the full amount of what they would be paid by the federal Medicare program.

Legislative budget office director Dan Kowalski said his wide-ranging report on projected costs and enrollment in the MO HealthNet program won’t be complete until the end of this week or early next week. Part of the reason, Kowalski said, was that he had to wait on figures from the Department of Social Services before he could make his projections.

“I appreciate their putting guidelines in there for us to get it done,” Kowalski said of his bosses in the legislature. “But the first one is a little hard.”

Kowalski is doing well compared with two other committees.

The new law created an 18-member MO HealthNet Oversight Committee consisting of several lawmakers and numerous gubernatorial appointees representing consumer and health care interests.

Gov. Matt Blunt did not appoint members to the committee until Oct. 31. When the panel met for the first time on Dec. 4, there was no discussion of its requirement to make recommendations on how to spend the money in a health care technology fund.

The oversight committee is not scheduled to meet again until Feb. 5, said Jan Carter, an assistant to Department of Social Services director Deborah Scott. Needless to say, that report will be late.

But at least the oversight committee exists.

As part of the new law, the legislature also created the Joint Committee on MO HealthNet, consisting of five House and five Senate members. That committee was supposed to report by Jan. 1 on the expected growth in the program, its needed expenses, needed improvements and ways to structure the state budget to meet the program’s future needs.

But the committee has not met. In fact, House and Senate leaders have not even made the required appointments. Staff for House Speaker Rod Jetton offered no explanation. Senate President Pro Tem Michael Gibbons said he hadn’t viewed the committee’s formation as urgent and didn’t realize it faced a Jan. 1 deadline until after The Associated Press contacted his staff.

“We will be taking care of our end,” Gibbons, R-Kirkwood, said. “I don’t think there’s really that much to report.”

Just four months have passed since the Medicaid revisions became law. And the legislative oversight committee largely would duplicate the work of others.

The new law, for example, requires both the legislative committee and the legislative budget officer to report on the projected budget needs of the MO HealthNet program — something which the Department of Social Services provides each year anyway to the governor, who in turn makes budget recommendations to lawmakers, who then hold their own budget hearings.

Gibbons acknowledges that legislators may have gotten a little carried away in their quest for oversight and accountability.

“Generally speaking, you try to avoid creating multiple interlocking bureaucracies,” Gibbons said. “But apparently, through the legislative process, that’s what we achieved.”


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