August 5, 2013

Maine schools, DHHS in costly dispute over Medicaid

DHHS sends Medicaid overbilling notices to districts that thought they were following the rules, and taxpayers may end up with the bill.

By Steve Mistler
State House Bureau

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In a June 17 memo to the Legislature's Education and Cultural Affairs Committee, Nadeau cited examples of state guidance that was either promised but never provided, or was removed from agency websites after the transition from the Baldacci administration to the LePage administration.

Nadeau quoted an Aug. 2, 2010, response from the Department of Education and DHHS to school administrators' requests for a guidance manual. It read, "We hope to have a manual out before November 15th (2010). We had hoped to get it out before now," but agency officials said they were "a little busy" because DHHS was implementing a new Medicaid automated billing system.

Nadeau said the manual never arrived.

"There was a lot of concern about these changes when they were made under (Baldacci)," he said. "The LePage administration really had the chance to fix this and help the districts, but they've dropped the ball."

John Martins, a spokesman for DHHS, said he was prohibited by law from commenting on some of the violations because school districts are in the appeals stage of the state audit. Martins also couldn't provide the total number of school systems affected or how much money the state had requested be returned. He also would not name any of the districts being sent notifications of overbilling.

He did, however, provide a list of outreach efforts by either DHHS or the Department of Education regarding the 2010 revisions to Medicaid rules. The list showed eight outreach efforts in 2010, two of which included the public hearings required to be held on the reimbursement rule changes.

Other steps included a billing instruction notice for providers, Office of MaineCare Services training for districts, and a 50-page training document distributed statewide, followed by numerous Web conference presentations.

Martins also said a manual, "MaineCare Billing for School Based Services," was published in February 2011 and distributed.

The Department of Education, meanwhile, currently features a list-serve communications service on its website that allows providers of school-based medical services to query the agency. Samantha Warren, a spokeswoman with the Department of Education, said state officials "have always been just a call, email or site visit away to do our part in helping schools follow the rules."

"That said, no matter how diligent the state was in our communications about these changes, the responsibility is ultimately on schools to be compliant with the law," she said.

Nadeau argued that state auditors contradicted in 2011-12 the guidance that was provided in 2010. He cited examples in which special-education administrators completed the required "individual education programs" for students receiving treatment, but were penalized for not documenting a treatment plan. The treatment plan requirement, Nadeau said, was never communicated in guidance documents from DHHS or the Department of Education.

Nadeau had other issues with the 2011-12 state audit, but said a dropoff in Medicaid billings three years ago was proof enough that something was amiss.

According to Maine State Billing Services, which handles Medicaid billings, school districts received $37 million in fiscal year 2009. In 2010, the year after the rule changes, billings fell to $6.5 million.

Nadeau said the federal mandate to provide the services didn't disappear. The $30 million that once was covered by Medicaid is now paid by school districts and property taxpayers, he said.

That cost will continue to shift if the penalized districts lose their appeals with the state, Nadeau said.

Jill Adams, director of the Maine Administrators of Services for Children with Disabilities, acknowledged the school district complaints Thursday to lawmakers on the Education and Cultural Affairs Committee.

She said some districts have attempted to slog through the reporting bureaucracy. Others, however, are avoiding it altogether.

"Some districts are choosing not to bill because they don't feel like they're on solid ground (with the state's reporting requirements)," Adams told the committee.

Lemieux, with the Auburn district, said the Medicaid dollars are a significant portion of the budget. Without them, she said, costs could rise.

Lawmakers and Mayhew both noted that the state and school units are trying to revise the 2010 rule changes. The federal government will have to approve the changes, a process that Adams said could take "years." 

Steve Mistler can be contacted at 791-6345 or at:

Twitter: @stevemistler


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