Legislators want answers on DHHS problems [Winston-Salem Journal, N.C.]
(Winston-Salem Journal (NC) Via Acquire Media NewsEdge) Oct. 06--Two Triad members of a health legislative oversight committee want to get to the bottom of the computer problems confounding the N.C. Department of Health and Human Services, including hearing directly from Secretary Dr. Aldona Wos.
A daylong committee meeting on Tuesday will be the group's first since DHHS and Wos have drawn criticism for problems with timely services and payments on NC FAST and NCTracks, for the hiring of young full-time staffers and contractors at high-dollar salaries and for the unexpected resignation of state Medicaid director Carol Steckel.
Sen. Earline Parmon, D-Forsyth, and Rep. Donny Lambeth, R-Forsyth, agree it will be "a long and intense meeting." They differ in their confidence on whether they will get answers they can rely upon from Wos and top DHHS management.
Parmon said she is frustrated by "being misled by the very people you are trusting to make the right decisions."
"I have lots of questions, and I want truthful answers to what is going to be done to fix these two programs," Parmon said. "This should not be a political issue, but a competence and efficiency issue."
Lambeth said he has been getting responses from DHHS officials about his operational questions.
Rep. Mark Hollo, R-Alexander but who also represents Wilkes and Yadkin counties, is one of three co-chairman of the joint committee. Other Triad legislators are Sen. Gladys Robinson, D-Guilford, and Rep. Bert Jones, R-Rockingham.
According to Lambeth, the first half of the meeting will focus on NCTracks, the state's Medicaid processing-system: the problems in getting claims processed and paid properly, and assisting providers and health-care systems with resolving questions and issues.
NCTracks is considered as the first major test for the McCrory administration's focus on overhauling information technology in state government. At a $484 million contract cost for development, implementation and ongoing support, it represents the biggest IT project in state government history, DHHS spokesman Ricky Diaz said in June.
Diaz is one of two former Pat McCrory campaign workers whose salaries have been criticized. Diaz received a $23,000 raise in April, bringing his annual pay to $85,000, more than the top listed salary for his position.
NC FAST is the state's new benefits distribution system, handling such services as the food stamp program.
"I have been sending e-mails from concerned medical groups or professionals for several months now," Lambeth said. Lambeth was president of N.C. Baptist Hospital for three years and for Davie and Lexington medical centers before retiring in June 2012.
"I have gone through many system conversions, and I know these are very difficult and take time to resolve all the system flaws and special situations that exist," Lambeth said. "It takes patience and cooperation by all parties working together.
"I am more focused in my work with DHHS as to how we can contain costs and reform a broken system. I am determined to change the culture in this program to be more customer-service oriented and manage the care within a model designed around care management and utilization control."
Millions in claims delayed
DHHS said that as of Oct. 1, it had processed 49 million claims through NCTracks and paid more than $2.6 billion to North Carolina health-care providers.
With the state Medicaid budget projected at $13 billion, it appears DHHS is about $600 million to $700 million behind on average monthly payments.
Diaz said that dividing the $13 billion into monthly allocations is not an apt comparison because the budget includes more than the weekly checks paid on claims for services provided by providers.
"Every month is different, and payments to providers vary month to month," Diaz said. "Also, NCTracks pays providers more often than the legacy system."
William Pully, the president of the N.C. Hospital Association, sent DHHS officials a letter that stated "hospitals and other providers continue to experience serious problems with NC Tracks."
In Pully's letter to Joseph Cooper Jr., DHHS' chief information officer, he wrote member hospitals are facing "four issues that not only impact their operations, but also will affect the state's cash flow in the Medicaid budget if not resolved with dispatch."
They are: claims are being denied because the system requires information/ codes not in existence; all inpatient claims are currently being paid improperly; the design of the system administrator function does not allow providers to operate efficiently; and the call center needs improvement, with technical questions not routinely answered correctly.
Cooper offered a 90-day update Wednesday that acknowledges payment glitches and that the NCTracks call center was not adequately staffed to handle the initial high call volume.
"We recognize that challenges remain, and some providers are still struggling," Cooper said.
"DHHS and CSC (its software vendor) continue to put all available resources towards proactively reaching out to providers to assist them with this monumental transition to a new claims payment system."
Robert Seligson, chief executive of the N.C. Medical Society, said that since NCTracks' launch, "instead of the system improvements and increased efficiencies that have been promised since July, the same problems continue to impede the ability of physicians to deliver care in the Medicaid program."
"Many problems in NCTracks go beyond simple technical glitches, and the medical community is losing confidence in CSC's ability to resolve these problems.
"In the meantime, physicians are being forced to choose between risking the future of their clinics and limiting the number of Medicaid patients that they serve," Seligson said. "Something must be done immediately to get NCTracks functioning properly."
Problems with NC FAST
Multiple media reports and local Department of Social Services officials have said food-stamp recipients across the state, including in the Triad and Northwest, have been experiencing delays in receiving their food and nutrition services benefits.
Parmon said NC FAST has been "a total nightmare."
"I have heard from providers and constituents every day since July 1 wanting to know when they will get their benefits and why things are so far behind.
"DHHS officials keep assuring us they recognize the problems and they will have them fixed soon," Parmon said. "It's just not happening at the level they say it is. I'm talking to DHHS officials who have the authority to make fixes with NC FAST, and it's just not happening."
Parmon said members of the black legislative caucus are preparing a letter to U.S. Department of Health and Human Service officials requesting that they review state DHHS operations. "Our requests for information to the governor and state DHHS are just going unheard," Parmon said.
On Sept. 18, two Democratic legislative leaders requested that the State Auditor's Office investigate what they call "apparent systemic mismanagement" at DHHS.
Senate Minority Leader Martin Nesbitt of Buncombe County and House Minority Leader Larry Hall of Durham requested that State Auditor Beth Wood complete an audit of the agency by Jan. 1. They said Wos has been unresponsive to their Aug. 29 letter asking her to address the agency's issues.
They have called for bipartisan House and Senate committees to investigate administrative failures at DHHS and ensure accountability throughout state government.
Wake Forest Baptist Medical Center has two major concerns about NCTracks, "missing electronic remittance advice and claims processing errors," said Ken Kubisty, associate vice president for corporate revenue cycle.
"While we anticipated challenges post go-live, several critical issues remain unresolved and materially weaken our ability to understand the financial performance of Medicaid post conversion to NCTracks," Kubisty said.
"Combined, these two issues have resulted in a significantly diminished ability to process Medicaid claims transactions and have led to artificial growth in receivables and cash flow delays from claims denied in error."
The former chief executive of WakeMed, Bill Atkinson, recently criticized DHHS' oversight and questioned management's priorities and focus. He said problems with NCTracks are hurting the medical center financially.
Many questions likely
Chris Fitzsimon, with left-leaning N.C. Policy Watch, said the daylong meeting "may not be enough time to get to the bottom of things, but it ought to at least give lawmakers a chance to get some answers from Wos and her key lieutenants."
That is, Fitzsimon said, if they are willing to go beyond previous comments and provide a candid assessment of problems and potential solutions to NC FAST and NCTracks.
"Many low-income families are turning to soup kitchens and food pantries as they wait for their long overdue food stamps, and medical practices are taking out loans to stay afloat while many legitimate claims are being denied and reimbursements from the state are not being distributed," Fitzsimon said.
"Gov. McCrory likes to blame the Perdue administration for the problems with both programs, but it was his DHHS that rolled them out and is now struggling to make them work."
John Hood, president of John Locke Foundation, a conservative policy research group, said he expects DHHS officials to field "lots of questions, some are about department projects that have been under way and over-budget for many years."
"Other questions are about how North Carolina should rein in its expensive and rapidly growing Medicaid program -- whether to proceed with the McCrory administration's competitive-contracting model or come up with something else."
Hood said he has "no doubt" that the interest in DHHS personnel issues will continue.
"But I suspect most legislators will focus more on the questions involving hundreds of millions or billions of dollars rather than questions, certainly legitimate ones, that involve hundreds of thousands of dollars," Hood said.
"There will be some political posturing, no question about it. But lawmakers of both parties are also deeply concerned about the substantive issues such as the over budget, underperforming software and the future of North Carolina's troubled Medicaid program."
(c)2013 Winston-Salem Journal (Winston Salem, N.C.)
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