January 23

OUR OPINION: DHHS needs to fix payment system

Computer program upgrades, additional staffing are necessary to help nursing homes.

Maine’s nursing homes, assisted-living and residential care facilities are overcrowded and underfunded, and their residents are sicker than ever before.

So it’s not like our state’s long-term care system needed another challenge — but it has one.

The Maine Department of Health and Human Services has lost track of millions of Medicaid dollars that it’s overpaid to long-term care providers. They keep repaying the funds while the DHHS continues to make more overpayments, setting up a cycle of accounting headaches for the already-overburdened providers.

In response to a state auditor’s report, an ad hoc panel on long-term care concerns has proposed legislation calling on the DHHS to fix its computer systems. The auditor’s office also recommends dedicating additional permanent workers to overseeing reimbursements to one sector of the state’s long-term care system.

Both proposals are critical. The state can put in place new technology, but without trained, qualified people to implement it, the change that’s urgently needed in this situation won’t happen fast enough.

The scope of the problem is massive: In fiscal 2013, which ended June 30, the DHHS made an estimated $29 million in overpayments to all long-term care providers. From September 2010 through June 2013, private nonmedical institutions — Medicaid-funded assisted-living and residential care facilities — received $36.4 million in overpayments. The total of overpayments is always growing, and at any given time, the overpayments take $35 million to $40 million out of the Medicaid system (known as MaineCare here).

Meanwhile, long-term care facilities are underfunded by at least $39 million a year — unwelcome news in a state where the proportion of people age 65 and older is second only to Florida’s. What’s more, long-term care providers are serving more residents who have several chronic illnesses or are dealing with mental health disorders like chronic depression and schizophrenia.

Given all of these issues, it would seem that the state would make it a priority to address concerns over tracking and recovering overpayments. But although the problems were discovered in 2006, they’ve never been addressed. Instead, the DHHS has implemented strategies that circumvent computer systems’ defects without solving them. This inaction not only helps ensure that the overpayments continue but also forces care providers to record and return overpayments using time and staff they don’t have to spare.

It’s also staggering to note that one “temp” worker oversees reimbursements to the 100 or so private nonmedical institutions in Maine. Needless to say, the state auditor’s office is on solid ground with its recommendation to transfer this responsibility to additional, qualified permanent staff.

The state has pledged to focus and act on the concerns of Maine’s senior citizens. If Augusta wants to make good on its commitment, it can — by mandating computer fixes and additional staffing at the DHHS — free up funds to better meet the needs of this growing population.

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