Arizona Adopts Michigan Child Medicaid Revenue Maximizing Fraud Schemes

Here is a terse op-ed by Barbara A. O'Brien commenting on Arizona's Child Protective Services Governor Task Force.

From what I have gathered, Arizona has done absolutely nothing in the areas of Continuous Quality Improvement for almost 6 years.

Couple that with the fact that the state is expending billions to snatch children of undocumented immigrants to shove them in foster care instead of promoting family, you have just found the underlying reason why Arizona has created a CPS task force.

So what other reasons exist for Arizona to revamp its Child Protective Services at this particular time?  I found the reason here, as stated by Cindy Mann:

Under Brewer's plan, parents earning between 75 percent and 100 percent of the federal poverty level would have remained on AHCCCS, but no new parents would be eligible and those who fell off the rolls for any reason could not get back on.

AHCCCS estimated that about 30,000 people, or half of the 60,000 parents in that category, would lose benefits in the first year, for savings of $17 million.

Mann said U.S. Health and Human Services Secretary Kathleen Sebelius did not believe eliminating coverage for low-income parents furthered the Medicaid mission.

Sebelius and the CMS also denied a plan to require AHCCCS members to re-enroll every six months, instead of annually. The proposal would have saved an estimated $15 million, primarily because people would fail to sign up in time or become ineligible.

Cindy Mann, is the Deputy Administrator Center for Medicare & Medicaid Services Director Center for Medicaid, CHIP, and Survey and Certification.

To better understand the motivation of Arizona to establish barriers for its citizens to this federal program, one may look no further than of the Michigan's working model, designed by Maura Corrigan.

Here is how it works.

CPS task force needs real experts

Gov. Jan Brewer labels the task force she appointed to improve Child Protective Services as comprised of "the best child-safety experts in Arizona."

However, I don't believe there is one member who has psychology, counseling or child- and family-development credentials and experience.

Given the severe lack of effectiveness of CPS over the years, why does anyone believe that yet another gathering of the same "experts" (legislators, police and other assorted businesspeople and child-welfare agency administrators) will be able to produce miraculous reform?

Why doesn't the task force include a licensed child psychologist, counselor, family therapist, or social worker who works with children and families?

Someone who not only understands abuse, neglect, mental illness and substance abuse, but who works directly with these phenomena.

Someone skilled in conducting interviews in a way that gleans honest answers and instills motivation to seek help. Our children deserve better!

-- Barbara A. O'Brien, Phoenix

Legally Kidnapped was triggered to address by a surprisingly malicious comment.

I responded in my traditional fashion.

In order to improve the functioning and image of Child Protective Services experts must represent all facets of the industry, not solely under the lens of the objective of removal of children based upon the codification of poverty being the crime of abuse and neglect. A key area when approaching the improvement in delivery and quality of services is in the administrative structures of transparency and accountability. 

Arizona has not demonstrated a very credible track record when it comes to properly administrating its child welfare services, documented in this federal report of more than $21 million in false claims. 

http://www.scribd.com/doc/3...

If Arizona has a pervasive issue with drug usage within its communities which deems removal of children, it would behoove society as a whole to identify and deliver remedy to ameliorate it. This is called, from a basic economic perspective as investment in human capital, or rather investment in the best interests of the children so they may mature for society to reap the profits of a productive, tax paying citizen. 

As it stands, the use of perjorative statements such as "bottom of the dung heap" presents, not only a lack of substance in your argument, but reduces it to an ad homenin fallacy. 

Simply put, you have been reduced to throwing sticks and stones as you have no logical retort to this op-ed. 

GOPinNOV, if your daughter, who is a representative, contractual arm of the State of Arizona, feels that its citizens and the clients of her employer are "bottom of the dung heap", then it would behoove her to find a new profession for the greater good of the State. In posting this response, you have exposed the bias when it comes to case recommendations for referral of services and reunification, which should be construed as a hate crime, calling for intervention of the State Attorney General to investigate possible civil rights and false claims violations. 

State Attorney General Tom Horne must also be included in this task force as it is the duty of his Office to investigate Medicaid fraud, waste and abuse in child welfare. At this time, I shall commend Governor Brewer for the creation of this task force and graciously offer my expertise to provide the omitted voice in the area of administration oversight and federal compliance. 

Beverly Tran 



In the end, these Child Protective Services Task Forces will only be hand picked by those individuals who are willing to coddle the whims of those who want to rebuild their economy of the backs of the poor and their children, the oldest form of survival.

Arizona Medicaid cuts: Key portions of plan rejected by U.S. officials

Arizona Medicaid cuts: Key portions of plan rejected by U.S. officials

Thousands of low-income Arizonans will keep government-funded medical coverage but face new co-payments and fees under a decision that federal officials announced Friday.

The Centers for Medicare and Medicaid Services OK'd some of Arizona's proposals to reduce the state's financial burden. But federal health officials rejected other key pieces: The state will not be allowed to impose a smoking fee or cap enrollment for low-income parents, a move that would have left an estimated 30,000 people uninsured in the first year.

Agency director Cindy Mann said the state failed to show that freezing enrollment for poor parents would do anything more than save money, which is not reason enough to allow an exception to Medicaid standards.

"It's not sufficient justification to depart from federal law because there are cost pressures on the state," Mann said in a conference call from Washington, D.C.

The agency will finalize the decisions next week, Mann said.

The rejected proposals amount to $52 million in savings the state had been relying on to help reduce a budget shortfall.

Gov. Jan Brewer and lawmakers cut the Arizona Health Care Cost Containment System, the state's Medicaid program, by about $500 million to help balance the fiscal 2012 budget. Another $40 million in planned savings has been delayed indefinitely.

Brewer spokesman Matthew Benson said the governor never expected federal officials to accept all of her proposals and is pleased the "big-ticket items" have been approved.

"We recognized that some of these were long shots. The governor is quite pleased that most of what she's requested has been approved," he said.

But health-care advocates said any more cuts to Medicaid are too many.

"I don't know how much more the health-care system in this town and this state can take," said Janice Ertl, clinic director for St. Vincent de Paul.

Cost-saving plan

Brewer, lawmakers and AHCCCS officials said cutting benefits and eligibility was the only way to keep the burgeoning program afloat. AHCCCS currently covers more than 1.3 million Arizonans.

Arizona, the last state to join Medicaid, must renew its program every five years. Any changes the state makes must be "likely to further the objectives" of Medicaid. This renewal plan was unusually complex, with more than a dozen new proposals, and the state and the CMS have negotiated since the proposal was submitted in March.

The state dropped two proposals during those negotiations: A $50 fee for overweight patients who fail to follow treatment and limiting hospital reimbursement for emergency-room visits.

The state is still waiting to see whether the federal government approves another planned cost-saving measure, a 5 percent cut to reimbursement rates for hospitals, physicians and other health-care providers, worth $95 million.

Monica Coury, an assistant AHCCCS director, said she expects the agency will make up the difference between what lawmakers cut and what federal officials denied and not require supplemental funding this year. For example, she said, there may be extra savings from a freeze on childless-adult enrollment and higher federal reimbursement for prescriptions.

State health officials view the changes as a bridge to 2014, when most of those who lose coverage in the next two years are expected to be picked up under Medicaid's expansion through federal health-care changes.

Rejected proposals

Friday marked the first time that federal health officials had rejected any of the governor's cost-cutting proposals.

Under Brewer's plan, parents earning between 75 percent and 100 percent of the federal poverty level would have remained on AHCCCS, but no new parents would be eligible and those who fell off the rolls for any reason could not get back on.

AHCCCS estimated that about 30,000 people, or half of the 60,000 parents in that category, would lose benefits in the first year, for savings of $17 million.

Mann said U.S. Health and Human Services Secretary Kathleen Sebelius did not believe eliminating coverage for low-income parents furthered the Medicaid mission.

Sebelius and the CMS also denied a plan to require AHCCCS members to re-enroll every six months, instead of annually. The proposal would have saved an estimated $15 million, primarily because people would fail to sign up in time or become ineligible.

As many as 10,000 people churn off and on the AHCCCS rolls every month because they get jobs, move, fail to provide sufficient paperwork or miss their enrollment deadlines.

Mann said a proposed $50 annual fee for smokers who fail to quit was too high and could discourage people from getting the care they need. Besides, she said, the state has other options it hasn't tried.

Coury said Arizona had applied for a grant to pay people to quit smoking, with gift cards or free classes or other incentives, but didn't get the funding.

And as expected, the CMS said Arizona's request to eliminate state emergency-services funding for people who could not prove citizenship was not within their authority. It would require a change in federal law. The state had projected a $20 million savings this year.

Accepted proposals

Brewer previously won federal approval to eliminate a program for people with costly health emergencies and cap enrollment for adults without dependent children, expected to save $260 million this year and leave about 110,000 people without health coverage.

On Friday, federal officials also approved:

- A $4 copayment for taxi rides to non-emergency medical appointments in Maricopa and Pima counties, applied to childless adults only. Brewer had asked that all non-emergency transportation be eliminated in urban areas, and copays imposed in the rural counties. The state must study whether access to care or patients' health is compromised.

- A $3 fee for parents and childless adults who fail to give 24-hour notice for missed appointments in Maricopa and Pima counties. Brewer wanted a $25 fee applied statewide. The state also must evaluate this program.

- Sixty days of health benefits for people who have lost federal disability coverage in the past month.

Sebelius already OK'd two AHCCCS reductions.

In July, federal officials approved the enrollment cap for childless adults, preventing new people from being eligible as well as those who fall off the rolls for any reason. AHCCCS estimates that 100,000 people will lose coverage this year.

They also approved elimination of the "spend-down" category. About 6,000 people were receiving AHCCCS benefits because medical bills had reduced their income to 40 percent of the federal poverty level. Enrollment in the program was capped in May and it ended Oct. 1.

Coverage for childless adults and the spend-down population is considered optional because it goes beyond minimum Medicaid requirements.

The childless-adult freeze is being challenged in court. Voters in 2000 agreed to expand AHCCCS coverage to everyone earning below the federal poverty level. Attorneys argue that the cuts violate Proposition 204 as well as the state Constitution, which voters amended in 1998 to prevent legislative meddling with ballot measures.

CMS Does Not Report All Medicaid and Medicare Fraud

How is it the Centers for Medicaid and Medicare do not report all violations of its program to its exclusionary database? It is either incompetence, lack of resources, fraud, kickbacks, or basic stupidity. Ask Cindy Mann. I am going for all of the above.

What about reporting child welfare entities which engage in Medicaid fraud?

Here is my Central Registry of Child Welfare Fraud. CMS, feel free to use it as a template.


CMS Reporting to the Healthcare Integrity and Protection Data Bank (OEI-07-09-00290)

Initiating Empirical Research in Children's Health Care

Sebelius Awards $100 Million to 10 States to Test Innovations in Children's Health Care

Health and Human Services Secretary Kathleen Sebelius today announced $100 million in federal grant funds to 10 states to improve health care quality and delivery systems for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

The grants, which will be awarded over a five year period, were funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The money will help states implement and evaluate provider performance measures and utilize health information technologies such as pediatric electronic health records and other quality improvement initiatives.

“We all have a stake in the health of our nation’s children,” said Sebelius. “Exploring new technologies and initiatives will help ensure our kids get the high quality care they need and deserve.”
The grants are totally federally funded and are designed help establish a national quality system for children’s health care through Medicaid and CHIP.

“These grants will test the most current theories of how to improve the quality of care delivered to children,” said Cindy Mann, director of the Center for Medicaid and State Operations within CMS.  “These awards will help create the foundation for a more responsive and effective national system of high quality health care for children.”

Awardees represent both single-state projects and multi-state collaborations.  Grantees working in multi-state partnerships will share award funds with those partners with funding ultimately distributed among 18 states in total. The awards were granted to:

Lead State	Partner(s)	First-Year Award	Five-Year Total Award
Maine	Vermont	$2,030,721	$11,277,362
Oregon	Alaska, West Virginia	$2,231,890	$11,277,361
Pennsylvania		$1,934,754	$9,777,361
North Carolina		$2,210,712	$9,277,361
Florida	Illinois	$880,371	$11,277,361
Massachusetts		$1,496,542	$8,777,542
Colorado	New Mexico	$1,722,161	$7,784,030
Utah	Idaho	$2,877,134	$10,277,360
South Carolina		$2,214,263	$9,277,361
Maryland	Georgia, Wyoming	$2,401,467	$10,993,171

Eight of the 10 grantees will test a new set of child health quality measures, and seven of the ten states will use the funds to implement health information technology (HIT) strategies with two states specifically planning to develop a new pediatric electronic health record format.

More information about CHIP can be found at www.InsureKidsNow.gov.

More information about health information technology initiatives and experimental methodologies on state levels can be found at http://beverlytran.blogspot.com/2010/01/there-was-no-nebraska-compromise.html.

Every state is participating in this initiative.  The ones that received nothing are the observed.  There are more than 18 states that are to receive treatments, and the treatments vary.

Looks like I owe Cindy Mann an apology...but we shall wait and see.  I'm watching you, girl.  This is absolutely brilliant.

XOXO