Method set to get MaineCare back on track

AUGUSTA- Much progress has been made in restoring the electronic billing system that’s been wreaking havoc with MaineCare providers’ cash flow since January, Gov. John Baldacci said Monday, but more must be done to meet goals he laid out at the beginning of March.

“I am pleased that significant progress has been made over the last month,” the governor said in a prepared statement. “In order to accelerate improvements and meet our commitments, I am implementing several new initiatives that will help speed up the progress in [MaineCare] payments and achieve my stated objectives.”

The initiatives the governor announced Monday afternoon include:

. Charging Rebecca Wyke, commissioner of the Department of Administrative and Financial Services, with creating a financial team to oversee the reconciliation of the state’s MaineCare financial records. Wyke’s team will include staff from the Department of Health and Human Services and the state comptroller’s office and also will contract with an outside financial consulting service to keep the program’s books straight.

Because emergency payments to providers over the past few weeks have been unassigned to individual services, and because those interim payments will be returned to the state once the MaineCare billing system gets up to speed, DHHS will have a sticky auditing problem to resolve before the end of the fiscal year. Wyke said Monday she hopes to have the state’s MaineCare billing records reconciled by the end of May and will work with providers to see their books are in agreement by the end of June, when the fiscal year closes.

. Directing the state’s chief information officer, Richard Thompson, to assume more control over MaineCare’s computer technology. A provision in the recently approved state budget calls for greater centralization of all the state’s computer systems, but Thompson’s purview of the MaineCare technology system will begin immediately.

. The formation of a special MaineCare provider advisory group. The panel will consist of about 20 members appointed by the Governor’s Office, to include providers, technology experts and others. The group will be charged with guiding state officials in resolving the current billing crisis, as well as working to resolve other points of conflict in the MaineCare program.

DHHS Commissioner Jack Nicholas said Monday he appreciated the governor’s interventions in a process that has already made substantial headway. Bringing in additional resources to support financial reconciliation and provider relations will help keep existing efforts focused on fixing the computer software program that has caused all the trouble to begin with, he said.

Nicholas said he would start working this week with provider groups, including the Maine Medical Association, the Maine Dental Association and the Maine Association of Community Service Providers, to help devise ways to make their bookkeeping problems less thorny.

“We’ll begin a generous outreach,” the commissioner said. “Rebuilding confidence – that’s a high priority.”

MaineCare is the state’s name for its Medicaid program. The program’s billing problem began in January when the Bureau of Medical Services replaced its vintage computerized MaineCare payment operation with a newer system, needed for compliance with federal regulations. The fault-ridden new system rejected providers’ claims almost without exception. Because the bureau normally processes and pays nearly $31 million a week to MaineCare providers, it didn’t take long for the situation to get out of hand. The cash flow crisis caused many providers to go into debt or curtail services, and bureau staff were overwhelmed with provider calls and complaints. It was March before the governor stepped in and gave DHHS 30 days to improve communications and get the money flowing.

While most providers have been getting payments in recent weeks, problems remain. Some providers say their payments are erratic and insufficient, while others have been overpaid and don’t know how they should handle the money. And, despite additional training and staff at the Bureau of Medical Services, consistent information reportedly is still hard to come by.

At least another six to eight months will be needed before software trouble is completely resolved, Nicholas said Monday. When the worst is over, the department will conduct an analysis into how the problem could have been avoided or minimized and what the cost has been in taxpayer dollars, consumer confidence and provider goodwill, he said.

Already the state has contracted for about $500,000 in private technology support services to resolve the problem. All but about 10 percent of that will be paid by federal Medicaid dollars, a DHHS spokesman said Monday. Another $100,000 has been spent to hire additional provider support staff, with the state responsible for about half that bill.

Some providers have threatened to stop seeing MaineCare patients, according to anecdotal reports, but Nicholas said Monday he didn’t think the problem is widespread.