Auditor’s report found payments to dead people, other UHIP problems continued last year

April 05-- Apr. 5--PROVIDENCE -- State Medicaid administrators are chasing nursing homes across the state for the repayment of $60.8 million they were advanced to hold them over while the applications of scores of prospective nursing home patients were snagged for long periods by the state's balky "UHIP" computer system.

The immediate problem: most of that money represents double payments to nursing homes which are not responding now to the state's entreaties to pay the money back, state Medicaid Director Patrick Tigue told the House Oversight Committee on Thursday night.

He did not name the nursing homes. He declined to even state the number of nursing homes ignoring the state's requests for repayment of the double payments. "There's been not so much a dispute, but simply that there has not been a response," Tigue told the lawmakers.

"Don't these nursing homes have any responsibility for paying us back?" a stunned state Rep. Patricia Serpa, the House Oversight Committee chairwoman, asked Tigue.

"I don't have to tell you that this is a very bad budget year, and in plain English," she said. "This is money out there somewhere that I am sure the [House] Finance Committee would love to use to fill in holes. You seem to be taking a rather lackadaisical attitude. You know, 'we're working on it. We'll get it.' That's good. I'm glad. But we need it now."

"We absolutely agree," Tigue assured her. "We have taken a voluntary approach to the recoupment to date. [But] we do recognize now because of those fiscal pressures that you are citing, that we do need to take a more aggressive posture."

The state's battle to recoup $60 million of the $130 million given the state's nursing homes since early 2017 marks the latest in a series of direct and indirect problems that have dogged the state -- and its residents -- since the September 2016 launch of the $617-million, not-ready-for-prime time public assistance computer system known as UHIP.

The chief lobbyist for the nursing home industry had no immediate response to the financial cat-and-mouse chase that Tigue described. And he said there is no effort contemplated to change current laws or practice that require "interim" payments when applications for Medicaid-financed nursing home stays are not processed in 90 days, and the subsequent -- and duplicate -- payment of actual claims.

But the tale unfolded on the same night the lawmakers were confronted with a newly released audit that shows, despite some improvements, "significant" problems remain in Rhode Island's programs for the poor and the elderly last fiscal year as a result of UHIP shortcomings.

Among the findings by the legislature's auditor general, Dennis Hoyle:

* The state made $11.6 million in managed-care payments last year for dead people, of which only $6.6 million had been recouped.

* It failed to remove more than 2,500 names from a children's health-insurance program after they turned 19.

* It failed to accurately calculate the amount parents are required to pay, based on their income, for subsidized child care, resulting in underpayments in some cases and over payments in others.

* It also failed, in 53 percent of sampled cases, to recertify within a year the eligibility of people on Medicaid.

The millions of dollars in questioned costs during the fiscal year that ended on June 30, 2018 were all blamed on shortcomings in the design and operation of UHIP.

Hoyle's summary: "This has resulted in application backlogs, delays in delivering timely benefits, and advances to providers impacted by delays in eligibility which prevented claims processing. Control deficiencies relating to the ineffective eligibility system have also resulted in known duplicate capitation payments for Medicaid managed care enrollees, continued Medicaid eligibility for deceased individuals, and extended backlogs for establishing eligibility for newborns."

Against this backdrop, more than one member of the House Oversight Committee questioned the wisdom of Governor Raimondo's recently announced decision to extend to June 2021 the state's contract with Deloitte Consulting, which produced UHIP. The system touches the lives of the 305,127 Rhode Islanders on Medicaid, 155,099 receiving food stamp benefits (now known as SNAP), 9,581 receiving cash assistance under the "Rhode Island Works" program, and 9,715 receiving child-care subsidies, according to the Department of Human Services.

Rep. Anastasia Williams, saying she has no confidence in Deloitte, called the extension of the contract a "grave mistake."

But Department of Human Services Director Courtney Hawkins told the lawmakers she personally recommended the contract extension over hiring a new operator based on her belief that "a transition right now would put all of the progress we've made at risk."

"You heard the auditor general say, 'we are just moving out of a crisis. We're just getting into a regular operation.' To bring in a new team now, in my estimation, would have been potentially really problematic ... putting benefits at risk for Rhode islanders. It would have also cost money."

Lawmakers also had questions about an unannounced $727,720 contract that Governor Raimondo's team awarded International Consulting Acquisition Corp. (dba ISG Public Sector) last May to advise the state on "development, vendor selection, negotiation and transition planning" for the ultimate award of a new contract for the operation of UHIP.

___

(c)2019 The Providence Journal (Providence, R.I.)

Visit The Providence Journal (Providence, R.I.) at www.projo.com

Distributed by Tribune Content Agency, LLC.