Hollyrod's fundraising campaign to give away iPads to people on the autism spectrum is a great idea

I reprinted a press release over on the CDREA news page, that the Hollyrod Foundation is taking applications to give away iPads to qualifying individuals on the autism spectrum.

The other side of this is the fundraising campaign to pay for the hardware as well as the special applications that will be needed.

The more money the Hollyrod Foundation can raise, the more iPads they will be able to give away.

My daughter Hannah has just started with using a Dynavox, but I got her an iPad to see what else it could add to her learning experience.  I have been absolutely amazed at the variety of games, stories, puzzles, and other activities that are available for children like Hannah.  If you've never met a child who is physically incapable of communicating with you verbally, it can be hard to imagine the pure joy they get on their faces when they start to "get it". 

This is a great idea, and I hope it catches on.  From the standpoint of a mom, I don't think there's ever been a greater gift I could give my daughter than the ability to communicate with us.

According to the Hollyrod Foundation's website,

Inspired by a father and son, actress, author, philanthropist and co-host of "The Talk", Holly Robinson Peete and retired NFL quarterback, Rodney Peete founded the HollyRod Foundation in 1997. The HollyRod Foundation provides medical, physical and emotional support for those living with Parkinson's Disease and Autism.

Hawaii DD Division apparently admits to defrauding federal government and state taxpayers

According to a November 16 letter from the Hawaii Department of Health's Developmental Disabilities Division, the program has apparently been caught by federal authorities defrauding Medicaid.  The DD division established new reporting guidelines that went into effect on December 1, and the letter emphatically tells recipients to comply with ongoing federal and state audits.

The news was quietly inserted into a letter that went out to DD waiver participants and providers with a headline of "documentation requirements" that was a bit misleading.

The Fray letter states "as a result of the recent Payment Error Rate Measurement audit conducted by CMS, the Med-QUEST Division is implementing new documentation requirements for PAB services."

Last April I reported that CMS was unable to deny rumors that Hawaii's Payment Error Rate Measurement could be as high as fifty percent (it's legally supposed to be between three and five percent).  

(paraphrased from then)  What would a 50% Medicaid payment error rate mean?  It could mean that half of all Medicaid claims are paid twice:  once by either Evercare or Ohana through their capitation payments, and the second time by Medicaid's fee for service program.

Here is how it might happen:

1.  ACS, as the fiscal agent for Hawaii's fee-for-service Medicaid program, charges a fee for every claim they submit.

2.  Hawaii receives matching funds from the federal government to pay these fees for ACS's services, just as they do for the state's aged and disabled program operated by Evercare and Ohana.

3.  ACS could be billing the state for claims incurred by patients served by Evercare and Ohana.

4.  ACS would then be receiving federal (and state) funds for claims that are the responsibility of Evercare and Ohana and which are included in the calculations for the monthly per person payments (capitation payment) they receive.  Evercare (UnitedHealth) and Ohana (Wellcare) are retaining their full capitation payments, hence the double payments.

What that means for Hawaii is that suddenly our Medicaid budget could be half of what it should be.  For example, since the state's total Medicaid budget for FY2010 is about $1.4 billion, then suddenly the state might have only $700 million to spend.

Out of that comes the fifteen-to-twenty percent net operating profit UnitedHealth and Wellcare skim off the top of their state capitation fee payments.  That's at least another $92,000,000. 

So from the original annual budget of about $1.4 billion,  only about $608 million is left to spend on actual services for Hawaii's Medicaid population.

When services are cut, the Medicaid profits aren't cut, and the capitation fees not only are not reduced, at least here in Hawaii they've been increased several times by means of "contract amendments".    The Medicaid company cries poor and that it is a victim of rising medical costs, to justify increases in the capitation fees paid by the states.

This is why Hawaii's Medicaid waiver program for our aged and disabled population experienced a thirty-six percent increase in the death rate of participants within its first year of operation.

NPR series starts today on "the new civil right" for people with disabilities

 Copied from an email forwarded to a group I belong to:

NPR will run stories that look at the new civil right, after the Olmstead decision, to get care at home.

The first story-about that right--runs today, Thursday, December 2nd (4:30 and 6:30 Eastern time) on All Things Considered on your NPR station. (Or you can find it by going to http://npr.org . You can listen to the radio story there. Also at our Web site, you'll find additional stories, a data base of every nursing home in America and the levels of independence in each one, a map t hat shows how much each state spends of its long-term care dollars on home and community based care, photos, and a chance for you to comment on the stories.

A second story runs tomorrow, looking at federal enforcement since the Olmstead decision. Also on All Things Considered, probably at the same time.

Next week, two more stories will run. The first-which has just been moved from Monday to Thursday-will run on Morning Edition, December 9th. It looks at the surprising group that is a growing percentage of the nursing home population: 31 to 64 year olds. This is built around the story of Michelle Fridley, at an ADAPT action in Washington in the spring.

That night on All Things Considered, we'll run a story on the Children's Freedom Initiative, an attempt to find alternatives to nursing homes for young people with disabilities.

Thanks.

Hawaii Medicaid office takes responsibility for coordinating interdepartmental services, including DOE, for children covered by Medicaid

On November 23, Dr. Kenneth Fink, State Medicaid Director for Hawaii, sent me a letter.  The letter began:

The Department of Human Services/Med-QUEST Division (MQD) is committed to assuring that your daughter, Hannah, has coordination of medically necessary Medicaid services that are being provided through multiple State agencies......To facilitate this, we are requesting your consent to allow the Department of Education (DOE) to release to us a copy of Hannah's most recent Individualized Education Plan (IEP).

I haven't heard whether any of the other hundred-thousand children receiving Medicaid, or even the twenty-thousand some kids in Special Education, have received the same letter.

This letter, while addressed only to my daughter, opens up a tremendous opportunity for all Hawaii's children with special health needs.  The DOE no longer has the final say in the services provided to your child enrolled in Medicaid.  The state Medicaid office is essentially assuming responsibility for ensuring your child's medically necessary services are provided, if not through the school, then through either Evercare or Ohana.

For instance, if your child's doctor prescribes five hours a week of occupational therapy and the school is only willing to provide two, you can count on Medicaid to handle providing the other three.

It inadvertently brings up the related question of why Hawaii DOE doesn't appear to be actively enrolling kids in special ed into Medicaid.  Once they do, the federal Medicaid budget (administered out of Dr. Fink's division) picks up 75% of the cost of all that kids' services that are provided by the school.  The budget savings that could be realized by transferring that 75% from state coffers to federal ones are enormous, and why it's being ignored by our local school district is beyond my comprehension.

Whether that issue is related to the fact that Evercare and Ohana are becoming aware of  requirements that EPSDT funds be paid out of the capitation fees they receive, I can't say.  Paying for school therapy services could dig into the $15 million profit they make off the monthly $100 million or so in capitation fees Hawaii pays them.

For parents and advocates, MQD admitting this responsibility for service coordination opens an alternative for receiving services DOE either can't or won't provide.  Federal Medicaid EPSDT regulations and laws provide more protection and additional means for winning disputes than can happen with IDEA alone.

Was threatening letter from Evercare retaliation for blog stories?

The last time I posted on here was November 4.  I wrote two articles that day, one of them on how UnitedHealth Group in Hawaii had been under a "Corrective Action Plan" since April for violating grievance and appeals rights.

On November 6, I received a threatening letter from David Heywood, Executive Director of UnitedHealth's Evercare for Hawaii.   The letter had been sent out by certified mail on November 5.

They wanted me to stop emailing federal officials, and to push all the care services I've been fighting for since September 2009 under the rug.  Let's just start over again from scratch.

Here is the letter from Heywood.
110510 Cert Letter f Heywood

Here is the email I sent him in response on November 21.
My Email to Evercare Re Hannah