POST-OP ON MEDICAID

Untangling Maine’s largest computer snarl – its semi-serviceable Medicaid reimbursement system called the Maine Claims Management System (MECMS) – is expected to take another year, longer than anyone imagined when the system went online and promptly crashed in early 2005. Nor did the state envision the cost of this meltdown, which is now expected to top $56 million, some $35 million more than originally anticipated. Maine taxpayers should be ready to pay for at least some of this but before they do a thorough public review should be part of the Legislature’s oversight duties.

A recent story in this newspaper by reporter Meg Haskell points out that about 90 percent of claims from the state’s doctors, dentists, therapists and other providers now are processed correctly, up considerably from last year and up in many cases above the efficiency of the old system. But a backlog of unresolved claims – some 180,000 – remains, as does balancing the books on interim payments, which were made to keep providers in business while the state tried to fix the computer.

Compensation for beyond-reasonable costs incurred by providers as they struggled along with the state has yet to be adequately discussed. Further upgrades and expansions of the MECMS systems also are expected.

When the costs for these are figured out, the Baldacci administration, the federal government and the computer firm that installed the system, CNSI, should all be prepared to share the added costs. As they do, legislators, perhaps with the help of the Office of Program Evaluation and Government Accountability – which last fall wrote an assessment of the meltdown – should want to see in detail the steps that led Maine into the problem and those that led it out.

Certainly, the Department of Health and Human Services has been properly alert about briefing legislative committees about the situation, but a thorough final accounting is important for several reasons.

It would, for instance, expose weaknesses in state government, including properly anticipating the number of claims and preparing for system expansions. It would provide a textbook on what to avoid and describe how the various repair teams were assembled and the effect they had. It would identify who was responsible for which costs and help determine how much each of the parties should contribute to the total.

To say that Maine government failed on a large scale on this project is merely restating the obvious. State officials now should be concerned with learning all they can from these events to prevent them in some future computer overhaul. That requires going back over a multitude of reports to examine mistakes and their corrections in detail as well as in writing – rather than relying on the institutional memories of a few officials.

This work would also assign responsibility for the mistakes so that the added costs can be fairly distributed too.