A MEDICAID PATCH

Though neither the state nor the computer firm that built the state’s Medicaid billing system could have wanted to continue a relationship in which together they created a $58 million well-publicized mess, both were right to find agreement on continuing until the state finds an alternative to its current system. The agreement between the two this week required that both find where their interests coincided.

The Maine Department of Health and Human Services and CNSI reached an agreement in which the company will continue its work for 18 months at $9.5 million, with the federal government paying half, and settling back payments at $1.2 million, with Maine picking up the entire tab. The agreement represents movement from both sides – the back pay question began with CNSI at near $6 million and the state adamantly at zero – but they needed to appease the federal Centers for Medicaid and Medicare Services because future funding for both depended on it.

As of Feb. 1, CNSI had suspended all computer development activities on the Maine Claims Management System and had served notice that it would be leaving the state in a few weeks because it said the state had refused to pay for work being done. The state’s position was that the work had been done poorly and it refused to pay more for what should have been done right the first time. The two went back and forth countless times over what was expected and what level of support would be provided; meanwhile, the computer system lacked required security and still could not handle claims that needed adjustments.

Under the new agreement, CNSI will continue operations and work on the system’s shortcomings. The 18 months should give Maine enough time to thoroughly research and hire an outside fiscal agent that already has a federally qualified system. DHHS Commissioner Brenda Harvey says she is determined that this time Maine will sign with an excellent processing system.

For now, however, Maine benefits from its agreement with CNSI because, while the current system is limited, the absence of trained computer technicians could have returned Medicaid providers to the chaos that began when the faulty system was started in 2005. CNSI benefits not only with more pay but because it does not leave a state helpless as it applies for more government work elsewhere.

It’s almost never satisfying to note that a bad situation could have been worse, and that’s true in this case. But the Maine-CSNI agreement avoids more trouble for a system that already has had more than its share.