Medicaid

A network of 11 community health centers across the state will be a 50-50 partner with Johns Hopkins in a new managed care organization created to enroll Medicaid patients, the parties announced yesterday.The new organization, to be called Priority Partners, expects to enroll 30,000 to 35,000 members during the first year, said Jerome H. Gotthainer, chief operating officer of Johns Hopkins HealthCare.During a six-month period beginning in February, the state will move about 300,000 Medicaid patients -- mostly welfare mothers and children and some categories of disabled people -- into managed care plans.

Either County Councilman David Marks and county Chief of Staff Don Mohler are untruthful or they are sadly misinformed about the Baltimore County budget ("Balto. Co. Council poised to adopt 'bare-bones budget,'" May 17). The county is laying off the entire staff of the Medicaid Waiver Program. This is a program committed to keeping the elderly who qualify for nursing home care in their own homes or those of relatives. Instead of retaining the current staff, the case management responsibilities will be farmed out to temp agencies.

Uncompensated care at Maryland hospitals indeed drives up the health care costs for us all ( "Maryland hospitals struggle with uncompensated care," Jan. 12). We're fortunate to have community leaders who understand that improving access to care drives down these costs. Mercy Hospital CEO Thomas Mullen long has helped us save money by ending the homelessness of our clients, and Gov. Martin O'Malley has shown true leadership by expanding Medicaid for low-income parents well before national reform efforts.

Baltimore County's dental clinics can now accept Medicaid, and patients will find better equipment when they visit. The county - which has clinics at the Eastern Family Resource Center in Rosedale and the Liberty Family Resource Center in Randallstown - can take Medicaid for children and pregnant women. Officials including County Executive Kevin Kamenetz and Del. John Olszewski Jr. visited the Rosedale clinic this week to see the dental program's new digital X-ray equipment. The machines expose patients to a third of the radiation that a traditional X-ray machine does, health officials said.

I am writing to speak up for amputees and persons with chronic limb impairment. Several states have taken the extreme steps of trying to modify Medicaid benefits so that the state would deny access to artificial limbs. I am asking you to keep this from happening in Maryland. Recent studies such as the "Prosthetic and Orthotic Adult Benefit" by the Colorado Department of Health Care Policy have concluded that providing this essential health benefit saves money by helping patients avoid costly co-morbid medical conditions.

Some people continue to debate the impact of the economic stimulus package passed by Congress and enacted by President Barack Obama in 2009. However, in my opinion, there is no debate that the parts of the law that protected the health and long-term care of people most in need made a profound and positive difference in many lives. That positive difference may soon turn into damaging and painful reductions in the resources that our elders, families and people with disabilities depend upon.

Dava Pharmaceuticals Inc. will pay about $11 million to settle federal claims that it misreported drugs prices so it could charge more of the state-federal Medicaid program, according to U.S. Attorney for Maryland Rod J. Rosenstein and others in the U.S. Department of Justice and U.S. Department of Health and Human Services. The settlement, under the False Claims Act, resolves allegations that Dava and corporate predecessors knowingly bucked the Medicaid rebate program between Oct. 1, 2005 and Sept.

Several states have taken the extreme step of trying to modify Medicaid orthotics and prosthetics benefits in order to deny patients access to artificial limbs. I hope Marylanders will oppose allowing this to happen in our state. Opposing cuts to benefits is an appeal to both fairness and fiscal responsibility. Studies have shown that providing this essential health benefit saves money by helping patients avoid costly co-morbid medical conditions. O&P care permits patients to return to gainful employment and end their dependency on federal and state assistance programs.

A growing backlog of requests for state medical assistance has Maryland's nursing homes picking up the tab for millions of dollars and patients facing months of uncertainty over the status of their claims. In one case, an Ellicott City nursing home did not receive a payment for a 59-year-old patient with debilitating multiple sclerosis for about a year, between December 2008 and last month. During that time, the patient, Barbara Sherman, her husband, Winston, and their elder-care lawyer repeatedly called and wrote the state Department of Human Resources.

The state health department announced a plan yesterday to reduce spending on the relatively small number of people who account for more than half of its yearly Medicaid budget. The patients will be identified, health care will be found for them and the expenses will be monitored.Article, Page 2B.

Good Samaritan Hospital agreed to pay $793,548 to settle allegations that it submitted false claims to federal health benefit programs for four years ending in December 2008, federal Department of Justice officials reported Wednesday. The hospital denied any wrongdoing, but federal officials say the MedStar Health System hospital listed some patients admitted to the hospital as suffering from malnutrition when they were not diagnosed or treated for that condition. It was marked as a secondary condition in each case.

Dava Pharmaceuticals Inc. will pay about $11 million to settle federal claims that it misreported drugs prices so it could charge more of the state-federal Medicaid program, according to U.S. Attorney for Maryland Rod J. Rosenstein and others in the U.S. Department of Justice and U.S. Department of Health and Human Services. The settlement, under the False Claims Act, resolves allegations that Dava and corporate predecessors knowingly bucked the Medicaid rebate program between Oct. 1, 2005 and Sept.

A Maryland corrections division that provides inmate labor has backed out of a data entry contract with the health department after state auditors found that prisoners had access to some patients' personal information, which was supposed to have been redacted from documents, but occasionally wasn't. The findings were included in a Legislative Services report made public Tuesday, three months after Maryland Correctional Enterprises, an industry arm of the Department of Public Safety and Correctional Services, ceased providing the services to the Department of Health and Mental Hygiene.

Gov. Martin O'Malley's proposed budget was assailed on many fronts Wednesday as county executives, education advocates, Maryland hospitals and Republican leaders began making their case against the $36 billion spending plan. Some said cuts in payments to Medicaid providers would lead to higher medical bills for everyone else. Others argued that shifting $240 million in teacher pension costs to the counties would inevitably require cuts to community services - and schools. Even some leading Democrats in the General Assembly said the governor's proposal to increase income taxes on the top 20 percent of Maryland wage earners would hit people who don't earn enough to afford it. Republicans were more blunt.

The federal government has filed a lawsuit against Kernan Hospital seeking $8.1 million because of what is says was improper billing to the Medicare and Medicaid system. The lawsuit filed by the Department of Health and Human Services and Department of Defense accuses the rehabilitation hospital in Baltimore of falsely manipulating its computerized billing system so that it looked like patients had a severe form of malnutrition called kwashiorkor. Hospitals are compensated more for a patient who has a more severe and complex diagnosis.

The Maryland General Assembly mandated that the Medicaid program trim $40 million from its budget during this fiscal year. Rather than making its decisions in a closed room, the Department of Health and Mental Hygiene asked its Medicaid Advisory Committee for help in gathering input from a range of stakeholders through public hearings and an open comment period. Guided by a set of "least harm" principles, the committee and the agency sifted through more than 190 proposals and publicly evaluated less than 20 deemed "viable" for savings in Fiscal Year 2012.

It should surprise no one that Medicaid is the most out-of-control item in the embattled Maryland state budget. Enrollment in the welfare program jumped from 370,000 to 423,000 in just one year -- another grim result of economic hard times. State Health Secretary Nelson Sabatini does not exaggerate when he warns that "Medicaid, if it keeps going in the direction it is going, will drive states into bankruptcy."It is virtually certain that as health care costs rise, so will demands on Medicaid.

As expected, the federal government has issued regulations eliminating federal reimbursements for a creative financing scheme that state officials have been relying on to help pay Maryland's soaring Medicaid costs. As a result, the state's budget deficit will grow beyond the $300 million already predicted. Moreover, $13 million the state expected for last fiscal year has been disallowed by the feds, which further exacerbates the deficit.Federal officials maintain that states' efforts to increase their reimbursements would cost the federal government $3 to $5 billion a year, and they simply don't want their expenses to rise that much.

Gene Ransom, CEO of the Maryland State Medical Society, writes in his article to the Sun ("Don't cut services first," Aug 29) that thousands of vulnerable Marylanders stand to receive inadequate, substandard health care for years to come if the state's Medicaid Advisory Committee and the Department of Health and Mental Hygiene are forced to implement a series of radical cost cutting measures for the state's Medicaid program. According to Mr. Ransom, proposals on the desk include eliminating the kidney disease program, charging co-pays for emergency room visits and placing limits on outpatient hospital visits.

As we all know, it's not necessarily what you do that matters but how you do it. In response to the Maryland General Assembly's mandate to slash an additional $40 million from this year's fiscal budget, the state's Medicaid Advisory Committee (MAC) and the Department of Health and Mental Hygiene (DHMH) are being forced to consider a series of radical cost-cutting measures for the state's Medicaid program. Make no mistake: Spending must be curbed. It's how costs are contained that matters.