The Joint Legislative Committee for Health and Human Services reconvened this week for their monthly interim meeting to hear updates from NC Department of Health and Human Services (NC DHHS) staff and consultants on problems with the NCTracks Medicaid claims system, and Medicaid reform among other issues. The day-long meeting covered:

NCTracks issues:

While NCMS members continue to experience significant problems with the NCTracks Medicaid claims system, NC DHHS Chief Information Officer Joe Cooper reported that much progress has been made in resolving the health care providers’ problems in successfully filing claims and being paid. Both Cooper and NC DHHS Secretary Aldona Wos said outstanding issues remain and they continue to address them.

Committee members questioned DHHS staff on the comparisons they drew between the old MMIS Legacy system and the new NCTracks claims system, arguing that such comparisons were not accurate reflections of how the new system is working.  Professional services are still be reimbursed at well below the Legacy system that was only reimbursing 70 percent of claims by doctors and other professionals. 

The PowerPoint presentation used by Cooper during his presentation to the committee may be viewed here.

Representatives from CSC, the vendor responsible for NCTracks, told legislators that they have been holding individual help sessions throughout the state to aide providers with their taxonomy codes and other issues to allow them to successfully file claims. A top priority for DHHS is to reduce the backlog of unpaid claims to CSC’s contractual agreement level, Cooper said.

While the individualized attention by CSC has been appreciated, NCMS members continue to call for assistance regarding systemic problems that plague the reimbursement system.  Even those that are now receiving some payments cannot reconcile the payments to claims in order to verify if they are receiving the proper amount or are owed for other claims.  Additionally, some practices whose original complaint was corrected are now facing a cascade of new errors resulting from that fix preventing them from being reimbursed. 

NCMS stands ready to provide your practice with assistance to get your problems remedied.  Please go to our website’s Trouble Log  or call us at 919-833-3836 for help.

The Medicaid Budget:

The General Assembly’s Fiscal Research staff reported that the overall Medicaid budget is within the approved budget and rebase for the first four months of 2013-14, assuming no unreported liabilities and that estimates for unprocessed NCTracks claims and other costs associated with NCTracks are accurate.

This is refreshing news considering the additional $1.5 billion in surplus state dollars that have been necessary to keep Medicaid flush over the last few years.  The NCMS shares concerns with many that while this outlook is positive, circumstances with payment errors around NCTracks and other issues could show a significant swing in the numbers in coming months. NC DHHS told legislators that currently there are approximately $350 million in suspended Medicaid claims due to the problems with NCTracks.

Additionally, NCTracks analytics and claims have not been communicating with Community Care of NC (CCNC) since the July 1 implementation.  This breakdown means that we don’t have a reliable picture of Medicaid spending currently is for the majority of Medicaid patients enrolled in the coordinated care activities managed by CCNC.  NCMS will continue to monitor this closely going forward.

See the supporting documentation presented by the Fiscal Research staff here. The Medicaid Financial Review for October 2013 is available here.

Medicaid reform in other states:

Bob Atlas, a DHHS consultant hired to oversee the Governor’s Medicaid reform plan, presented an overview of various options for Medicaid reform and what other states have pursued. The information presented by Atlas pointed to a risk-based managed care plan as the best option for the state. View the slides from his presentation.

Many members of the committee seemed to accept Mr. Atlas’ presentation as a foregone conclusion that our state would transition to corporate managed care.  He emphasized the fact that North Carolina is already using some of the tools of traditional managed care in Medicaid, alluding to the successful CCNC program, but also was quick to say that any plan would have to come back to the NC General Assembly for approval.

The Governor’s administration will present their plan to the Legislature by March 17.

Mental health legislation overview:

Presenters highlighted the successes and challenges faced by our mental health community as North Carolina has transitioned using managed care organizations (MCOs).  The Department acknowledges that our system is still in crisis and that further refinements are essential.  Further consolidation of the MCOs continues to be a topic of conversation.  An outline of the Department’s presentation may be viewed here.

Appointment of Members of Sub-Committees:

Sen. Hise, Co-Chair of the HHS Legislative Oversight Committee, named a number of subcommittees that will begin working this month.  We would like to highlight two of those committees:

Certified Nurse Midwife Study Commission

• For the Senate: Sen. Louis Pate, Sen. Jeff Tarte, Sen. Mike Woodard
• For the House: Rep. Sarah Stevens, Rep. Marilyn Avila, Rep. Michael H. Wray

Oversight of CSC Contract Performance and NCTracks Implementation:

• For the Senate: Sen. Jeff Tarte, Sen. Tommy Tucker, Sen. Don Davis, Sen. Ralph Hise
• For the House: Rep. Marilyn Avila, Rep. Jason Saine, Rep. Tom Murray, Rep. Jim Fulghum, MD

To view all of the handouts from the committee’s meeting click here.