Home Medical Providers Get 60-Day Delay For New System
HARTFORD, CT—The 11th hour plea that home medical providers made to the Department of Social Services, and chairs of the Human Services and Appropriations Committee to delay the implementation of a new telephonic and computer-based in-home scheduling, tracking, and billing system was heard.
The state agreed to a 60-day extension pushing the start date for mandatory use of the new Electronic Visit Verification system from Feb. 1 to April 1.
Last Friday, 17 organizations, individuals, and advocates who offer medical care to elderly and disabled in their homes hand delivered a nine-page letter to Gov. Dannel P. Malloy detailing their complaints with the new Electronic Visit Verification system that more than 300 non-medical homecare providers have been struggling with since January 1.
Rep. Cathy Abercrombie, D-Meriden, said Tuesday that she’s pleased that the concerns the providers had were heard by the administration.
Abercrombie, who met with DSS officials on Monday, said that the department was unaware of some of the challenges providers were facing in trying to implement the system and seemed willing to have a more open dialogue. The delay will give the department a full month of claims data to understand better what’s happening and where the new system is falling short.
She said one provider was unable to submit 2,900 claims, which had to be manually entered into the system due to numerous problems and error messages. .
“Our message has been clear. We do not oppose the concept of EVV,” the letter signed by the 17 organizations and advocates says. However, the new system is full of errors and problems, which are not being addressed by the vendor the state obtained through an amendment to its existing contract with Hewlett Packard Enterprises.
The main complaint is that the state system created by Sandata Technologies LLC doesn’t interface with the systems providers currently use. That means homecare workers are logging in twice, once on the provider system and once on the state system when they get to the home of their client and then twice for each service they might perform, and then twice again before they leave. The system is also too inflexible to allow services to be rendered to individuals outside of the home. That means, homecare workers aren’t going to be taking their clients into the community, a place they are allowed to go with Medicaid-funded assistance.
The agencies say that violates federal Medicaid law.
There’s also problems with errors.
“There are so many times information needs to be entered manually in order to validate a claim,” Tracy Wodatch, vice president of clinical and regulatory services at the Connecticut Association for Healthcare at Home, said Monday.
She said a couple of full-time staff have had to manage the process and manually enter most of the claims, which is an additional cost.
In a quick 24 hour survey of organizations, the Connecticut Association for Healthcare at home found that out of 39 agencies, 14 said they plan to phase out their Medicaid clients.
Deborah Hoyt, president and CEO of the Connecticut Association for Healthcare at Home, said they have been willing to work with the Department of Social Services to help work out the kinks in the system, but have been met with resistance.
On a technical level, she said it seems like Sandata can’t figure out how to interface with the Electronic Visit Verification systems that the agencies already use. Before the new system DSS would use the provider’s systems to audit the information submitted to the state, but decided it wanted to implement its own system.
“We are not trying to be adversarial,” Hoyt said.
The Department of Social Services said it was implementing the system to make sure the state wasn’t paying for services that weren’t being performed or potential fraud and waste.
A Power Point presentation put together by the department says, “DSS chose a statewide solution to ensure standardization and to prevent costs and difficulty involved in patching together existing systems, to the extent they exist.”
It’s a goal shared by providers.
“We don’t want to spend money on care that’s not being delivered,” Hoyt said Monday in a phone interview. “Connecticut is also not known as a fraudulent state.”
The only reason the department has been able to conclude there are savings from the first month is because they’ve been unable to make claims for the services they provided, Hoyt said.
When legitimate claims are dropped it will save the state money in the short term by reducing payments to home care agencies, but “such inappropriate ;savings’ at the expense of conscientious providers will drive providers out of the Medicaid program.”
That means these individuals will likely end up in nursing homes, which is much more costly to the state, Hoyt explained.
On Tuesday following the announcement, 17 organizations who wrote the letter Friday said they “appreciate the 60-day delay,” but “we will continue to ensure that DSS works with the provider community to minimize disruption of care delivery in the home while optimizing home health agency operational efficiencies.”
They also thanked Abercrombie for her leadership on the issue.
Kathy Flaherty, executive director of the Connecticut Legal Rights Project, who co-signed the letter to Malloy said the issue is still not settled. She said federal law says advocates and consumers must be involved in the implementation of the EVV system and that has yet to happen. She said there’s a concern that advocates will continue to be left out of the conversations.
The statement DSS sent out Tuesday says it’s “Continuing and expanding discussions between DSS and caregiver agencies about implementation of the state’s single, statewide system.”
There’s no mention of consumers and their advocates.