Sunday, February 23, 2014

Don't Tread On Me

Sadly, the NC General Assembly agreed last year to withhold 3% of the Medicaid funds from hospitals, nursing homes, physicians, assisted living, etc. Nursing homes have not had a Medicaid rate increase since 2008. The "withhold" was sold to health care providers as a quality and efficiency incentive. If we could prove quality and efficiency, then we could get that money back. Since then, the NC Department of Health and Human Services has determined that this is a cut, not a withhold. If we can save money beyond the 3% cut, then it might be shared with us providers. I serve on the NC Medical Care Advisory Committee, which is to advise the state Medicaid program. They asked us to discuss and advise on the savings beyond 3%. Finding savings beyond the 3% when we haven't seen an increase since 2008 is a farce. We were to discuss this in a meeting on Feb. 10, 20114. Instead I offered a resolution that was greatly improved by the Committee members and unanimously adopted. It's a shame we are only advisory and have no authority! But at least we took a stand to "Don't tread on me!" The resolution encourages the state to reconsider the 3% cut as it harms the most vulnerable people in our state. The resolution is printed below. I am non-partisan. But I can talk about issues, and about harm to the people we serve. We have got to stand up for the people we serve, since they cannot stand up for themselves! North Carolina Medical Care Advisory Committee Resolution Adopted 2-10-14 Whereas, states are required by Federal rule to establish a Medical Care Advisory Committee (“MCAC”); and Whereas, the purpose of the MCAC is to advise the Medicaid agency on health and medical services that may be covered by Medicaid; and Whereas, 42 CFR 430 and 42 CFR 447 require states to adequately reimburse providers for quality services and to not limit access; and Whereas, the MCAC has reviewed the Division of Medical Assistance (“DMA”) Shared Savings Plan and have found the following to be true: 1. The MCAC, along with various groups, including those representing providers and beneficiaries, and a variety of other health care policy makers believe a well-designed, jointly-developed shared savings program can be an effective way to reduce costs and improve quality and access, and 2. North Carolina lawmakers mandated in Section 12H.18 of Session Law 2013-360 requiring a 3% withhold of Medicaid payments for certain Medicaid providers and instructed DMA to implement a plan whereby providers subjected to the withhold could earn back all or a portion of the withheld funds (“the earn back plan”), and 3. DMA has begun to implement the withhold effective January 1, 2014, and 4. DMA does not currently have an approved state plan amendment for the withhold; such an amendment may take in excess of a year or more, possibly causing uncertainty about when providers could be eligible to receive incentive payments under the earn back plan, and 5. DMA has not established the earn back plan as required by S.L. 2013-360, and 6. Since DMA is currently withholding 3% of provider payments without having adopted ways to measure savings for subsequent incentive payments to providers, it is risking violation of Federal rules by potentially restricting access to care, and could cause cost increases if less community care is available for routine problems that could become more emergent or urgent. Therefore be it resolved, that the North Carolina Medical Care Advisory Committee asks DMA to implement its earn back plan by developing incentives for effective and efficient care that result in positive outcomes for Medicaid and NC Health Choice recipients, and that payments under the earn back plan be paid to providers from funds currently being withheld (3%) during the 2013-15 fiscal year, and not by any other means or additional requirements to achieve savings above three percent being withheld as of January 1, 2014, and prohibiting withheld funds from being transferred to the General Fund; and Further be it resolved, that the MCAC requests that the 3% withhold be suspended immediately until such time as an agreed-upon shared savings program can be developed and any subsequent state plan amendments are approved by CMS; and Further be it resolved, that the MCAC asks the Division of Medical Assistance to keep it fully informed of all activities associated with implementing the requirements of Section 12H.18 of Session Law 2013-2-360 and any other shared savings plans that may be considered.

Friday, February 7, 2014


It was my job to provide devotions this morning for the Lutheran Services in America Disabilities Network. We talked about vision, Proverbs 29:18, and gifts, Corinthians and Timothy. I used a picture of Cheryl on her pottery wheel to demonstrate vision, and a picture of our grandchildren to demonstrate gifts. Lutheran social ministry has a vision to serve God and serve those in need. We do that with and through gifts. Dorothy is a gift to me. She works at our Trinity Living Center, in the same building I work it. She comes by the office once in a while to check on me, or we meet in the parking lot. She expresses genuine concern for me, worries about me, and thanks me for all I do. Dorothy inspires me to work harder to provide for those we serve, for her, and for all of our teammates. What a gift! Lutheran Services Carolinas is full of gifts like Dorothy. Who and what are your gifts?

Wednesday, February 5, 2014

Overhead is good!

Nonprofits often get beat up over their administrative overhead cost. Overhead is not a dirty word; it's certainly not waste. Waste is wrong in any setting. Lutheran Services Carolinas' overhead is low, which looks attractive, but may be too lean to get the job done. Nonprofits would not exist without overhead. Let me introduce you to some of LSC's overhead. None of us teammates would get a paycheck if it weren't for the Tammys at the LSC Administrative Office. Joyce Hathcock in accounts receivables brings home the bacon at Albemarle, collecting from Medicare, Medicaid, and private pay. What she brings in as revenue, we use for salaries, supplies, and food for the people we serve, the power bill, etc. If Matt Hembree wasn't the Quality Management Director out of the Charlotte Office, LSC wouldn't be COA accredited. If not accredited, which is required, child and family services would be out of business. IT is overhead, but we would all be out of a job today without our computers and technology! Marketing at Trinity Oaks is considered overhead, but if prospective residents don't hear about us and ultimately move in, then we won't be able to provide the desired services for residents or jobs and benefits for employees. The list of essential overhead is long. Some people think overhead is bad. It is not. It's really just a way to distinguish between those people and services who directly touch a person we serve, and those who don't. Neither can live without the other. As in everything in LSC, it takes all of us to get the job done.