Families to Hawaii's governor: Yes, you have failed

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Families of children with disabilities have reacted strongly to the August 22 meeting with Governor Abercrombie. The letter below was written the day following the meeting.

Dear Governor Abercrombie:

We are families whose lives have benefited from Hawaii’s Insurance Commission external review system.
The format of yesterday’s conference did not enable all of us to speak. Many of us made the extraordinary effort to meet you in June, but you did not attend.

You said yesterday that:

“I think it’s fair to say that people felt that the review panel process in place kept the insurance companies in check, and on the whole they were able to get services that they wanted to have.

The two avenues available, the Department of Human Services hearing process or the 3-person panel, and I think most people went for the 3-person panel, and felt that was satisfactory. Nobody was arguing with that, least of all Suzie or Roz or myself or for that matter the professionals at DHS, that is to say those that were left after the ranks had been decimated over the last years.”

Please explain to us: if this is so, why did you sign a bill that deprives everyone on Medicaid of this process? The U.S. Dept. of Health and Human Services did not disapprove our existing process for Medicaid members, which is not an issue with the ACA. In fact, it expressly approved the inclusion of the 3-member panel option in the RFPs for QUEST and QExA (and we have not seen anything showing that DHHS approved revoking this option).

You said the denials of services that threaten the lives of our families are just “glitches.” You said the on-going regulatory violations we are experiencing are to do with the contractor. You said that if we needed a lawyer to dispute a denial, that means you are failing.

I regret to inform you that you are failing. Based on Insurance Division statistics, the number of cases filed since you took office nearly equals the number filed in the last 10 years. In fact, since you took office, over 20 cases have been filed in the external review and won by QUEST or QExA members against Evercare and HMSA QUEST. Some of those cases were previously denied by the Administrative Appeal and even had Legal Aid assistance. Apologies for failing, promises to do better, and an uncertain plan of assistance, will not help those more than twenty families as certainly as the external review did. The health plans are the only winners under SB1274.

Most of us are, right this minute, depending on a lawyer for our lives, and the lives of our children. We are in the midst of “glitches” that have spanned months, if not years. We have all experienced the failure of the DHS review system, including their failure to monitor the contractors for federal compliance.

We appreciate your intentions, but your proposals on Monday did not meet our concerns. In fact, they left us terrified for our futures and angry that you could belittle our life-and-death battles with the insurance plans as mere “glitches.” We will not rest our efforts until we have a system we can count on to prevent health plans from running over us and our children.

UnitedHealth's Hawaii operation under monitored "Corrective Action Plan" since April 2010

UnitedHealth Group's Hawaii operation has been under a DHS-imposed and monitored "Corrective Action Plan" (CAP) since April 2010.  The following was contained in an email I received from CMS on October 20, responding to a complaint I had filed earlier.

CMS and DHS reviewed your September 9, 2010 complaint about Evercare and the lack of oversight by DHS‐Med‐Quest (MQD) Division. You have reported that Evercare is out of compliance with CFR 438, subpart F: Sec 438.400.438.410 in meeting the needs of your daughter, Hannah Harrison. In reviewing your complaint the Med‐QUEST Division (MQD) found that Evercare is out of compliance with some of the required timeframes for both Notice of Adverse Action (NOA) and processing of appeals. MQD identified on April 5, 2010 that Evercare was not consistently compliant with both timeframe and required information for NOA as well as grievance and appeal regulations. MQD placed Evercare under a Corrective Action Plan (CAP) in April 2010 to assure they are meeting the required timeframes. CMS has assurance that MDQ continues to monitor Evercare in its CAP to assure they are meeting the required timeframes.

Apparently, at some point in time prior to April, federal Medicaid regulators and Hawaii DHS agreed that Evercare (UnitedHealth) had violated my daughter's legal rights.

The obvious question is how many of the other twenty thousand or so medically needy people enrolled under Evercare also had their rights violated? 

And why haven't any of us been notified officially?

In a related issue, CMS told me on May 24 that MedQuest told them Evercare had not denied any services for Hannah, and there were no outstanding complaints.  

All I could do was respond that I had a record of 33 complaint emails I had sent to Evercare over denied services and sixteen emails directly to Patti Bazin.  One of the biggest outstanding issues, I said in my email to CMS, was Evercare's refusal to follow medical recommendations for how to teach Hannah to talk with us using assistive technology.

I didn't have a chance to respond to the October 20 news that Medquest once again was telling federal regulators there were no outstanding complaints for Hannah until November 1. I reported to CMS that it appeared the reports they were receiving from DHS regarding Evercare's adherence to the specified timeframes could be in error.  I had emailed Patti Bazin on June 30 that Evercare had never responded to prescriptions received for medically necessary services received on May 21.  Emails I received from Bazin as recently as October 12 consistently ignored Evercare's failure to approve therapy that would teach my daughter how to talk.

The public deserves to know about this so-called Corrective Action Plan.  The elderly and disabled adults as well as children who have had their rights violated deserve to know.  If the state manages to keep losing my complaints, knowing I blog about it, who else's complaints have disappeared?

Hawaii Medicaid, UnitedHealth and DC law firm Covington & Burling

Yesterday I reported that DC law firm Covington & Burling had received another extension of their contract with the state, with part of the purpose being to contribute to the 'reprocurement' of Hawaii's Medicaid contract for services for the state's aged, blind and disabled population.

C&B had already been paid for "legal and consulting services relating to the drafting and issuance of the RFP", to "facilitate the evaluation of the proposals in response to the RFP in Hawaii" , to "assist Med-QUEST in negotiating with health plans",  and to "assist Med-QUEST with developing answers to questions submitted by bidders".

The two companies awarded this contract are UnitedHealth and Wellcare.

Covington & Burling on their website notes they represented UnitedHealth "in federal criminal, SEC enforcement, and Congressional committee investigations."

Charles Miller, of Covington & Burling, has served as Special Deputy Attorney General to the state of Hawaii for issues related to the Department of Human Services and Med-QUEST.  He served in this position from November 2004 until at least June of 2008 (that's only per the records I've been able to find online).


As the mother of a child with disabilities, I find it worrisome that the same company that has represented UnitedHealth in federal criminal and SEC complaints is helping Hawaii redraft the contract for services to our disabled community.  David Heywood of UnitedHealth already told me that his company is in discussions with the state on how to reconceptualize EPSDT's definition of case management services, in response to my request for these services on my daughter's behalf.

I'm not a lawyer, but it seems to me that there might be a conflict of interest here someplace.