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News › Payments on hold while state sorts out therapy rates
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Finance: Payments on hold while state sorts out therapy rates
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Posted by Sylvia on Thursday, April 15, 2004 (14:17:10)
Lancaster Eagle Gazette 26/03/2004
By CARRIE SPENCER
COLUMBUS — The state is withholding some $13.5 million in Medicaid payments from hundreds of programs that provide therapy to disabled people while the state works to correct billing problems, officials said Friday.
This is the second week money is being withheld by the Department of Job and Family Services, which oversees all payments from the federal insurance program for the poor.
Emergency rules will allow payments to resume late next week, while the Department of Mental Retardation and Developmental Disabilities revamps its newly adopted payment rates for various services and ensures all participants are complying with federal law, said Greg Schneller, MR/DD’s interim finance director.
“The services are absolutely being provided,†he said. “What is being affected is the reimbursement.â€
The problems arose in January as the state switched the way it pays therapists and others, for the first time allowing the possibility of profit.
The changes are attracting more private companies to a $360 million state and federal program providing nursing, psychological care, and physical and other therapy for Ohioans with problems such as mental retardation and autism. The program works through all 88 county MR/DD boards, 220 school districts and about 45 private companies.
The private providers were first allowed in 2001, but the state and Medicaid then covered only direct expenses such as salary, overhead and equipment, Schneller said. As of this year the state pays standard fees for each 15 minutes of a service such as counseling or speech therapy.
Those new rates, however, were based in part on past payment records, so they varied widely from county to county and didn’t meet guidelines for what Medicaid is willing to pay for services, officials said.
In one case, 15 minutes of psychological service jumped to $59 from $39, an $80 hourly raise, said MR/DD spokesman Robert Jennings.
“It immediately became clear that some smaller counties could not sustain those rates,†Jennings said.
The state is trying to adopt uniform rates that meet Medicaid guidelines.
Meanwhile, as more private companies enrolled, the department discovered not all are following state law, which requires them to enter contracts with either with a county or a school district. The local governments must pay for 42 percent of a service before Medicaid pays.
The state is investigating the contract status of 32 such companies, Schneller said.
If none exists, the state will cover the local payments due those companies until a county or school district can take over, said Debbie Hoffine, MR/DD’s assistant fiscal director.
Also, the state in January found possible double-billing by the state to Medicaid for some administrative fees, requiring the cash-strapped state to front $10 million for the programs. Medicaid is expected to repay most of that, Schneller and Jennings said.
It is not yet known how much of the administrative costs the state might have to repay, if any, they said.
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Posted by Sylvia on Thursday, April 15, 2004 (14:17:10) (2142 reads)
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