Thursday, January 27, 2011

Oregon Department of Justice looks into financial irregularities with Money Follows the Person program

From The Lund Report:

The multi-level investigation into the Money Follows the Person program should be wrapped up within the next week or two, according to James Toews, assistant director of the Seniors and Persons with Disabilities Division (SPD).

The Department of Justice has been conducting an investigation since August, looking into financial entanglements surrounding the federally funded program, which moves seniors and people with disabilities out of nursing homes and hospitals into community-based settings.

“Once the investigation is done we can be very candid about what went wrong, and make a recommendation on the future of the program,” Toews told legislators at a December meeting of the Emergency Board Subcommittee on Human Services. Oregon’s Medicaid Fraud Unit may also be involved in the investigation, but Toews said he wasn’t privy to any of those details. “I’ve been kept out of it.”

The Centers for Medicare and Medicaid Services is also awaiting the results of the investigation. “I promised to debrief them,” Toews said.

Legislators will learn the details, and their advice sought on the future of the program, Toews said. “We may have to make changes, but that depends on the recommendations of the investigation,” said Toews, who hasn’t hired a replacement to fill the position held by Julia Huddleston, who designed and ran the program.

Toews hasn’t been in contact with Huddleston since she resigned in late August. Before leaving, Huddleston raised serious concerns about budgetary problems and the management of SPD.

Since 2008, when the program got under way, 278 Oregonians have been moved into Money Follows the Person, and the state has drawn down $14.9 million in federal funds and spent $5.5 million from the state’s general fund. When the program was halted in late August, it impacted Clatsop Care Center District, which had embarked on an $8 million building project and had been assured of $1.8 million in grant funding.

Now advocates are questioning the number of people who died as a result of being moved from a nursing home or the hospital to a community setting. Of the 83 participants in the program during the first six months of 2010, 15 died, according to a report submitted by state officials to the Centers for Medicare and Medicaid Services, which was obtained by The Lund Report.

That number is erroneous, Toews said. Of the 15 deaths, only 6 people transitioned into the program in 2010; the other 9 participants had joined earlier, in 2009. However, figures were not available on the total number of people who came into the program that year.

“A good number of people were moved from hospice back home, knowing full well they would die,” he said. “There are some very fragile people in this population. It’s a tough call to make.”

But that's open to dispute, according to the report Toews' agency filed. It showed that of the 15 deaths, 7 were elderly, 6 had physical disabilities and 2 had developmental disabilities.

When a person entered the program, it's not always easy to know precisely what kind of risks they might face. It’s an individual choice; no one forces people to join this program, Toews said, “Our planning doesn’t start until they consent. When they do go back home they have wrap around services.”

During the first six months of 2010, the program spent $7 million of which $754,774 was spent on home remodeling and refurbishing of adult foster homes, apartments and private homes.

That same year, the agency projected having 316 people enter the Money Follows the Person Program, 119 elderly; 40 developmentally disabled and 157 with physical disabilities, however had only reached 24.84% of that goal by the end of June.

At the December hearing, Sen.Alan Bates (D-Ashland) expressed deep concerns about Money Follows the Person. “We need to have a serious discussion with the managed care plans, SPD and advocates for the elderly about what we’re doing here. Having people siloed off in two different agencies is, to me, not effective. I have some real concerns and am waiting for something to pop up in a newspaper that we might have hurt someone. The goal here is to save money, but that’s not the goal I’m looking for. We need to have a safe and secure place for these people. Money is secondarily.”

If a patient is moved from the hospital to an adult foster home, and ends up back in hospital within 30 or 60 days, something’s awry, he said. “The buck doesn’t stop in the right place. I’m wondering who should be responsible for this program. I’m not sure it should be SPD.”

Bates suggested the managed care plans responsible for the Oregon Health Plan take over the coordination of these services, and urged discussions to get under way with the governor’s office.

Getting the appropriate care to this fragile population, Bates said, is his primary concern. “What’s happening to these people? Are we rushing them through a system to save money? Maybe a 5 percent increase in nursing home rates for elderly population who are aging and getting sicker is appropriate. I don’t know the answer, but am very concerned that people working in the hospital on behalf of SPD really have the training to do the job that’s necessary. My major concern is taking care of elderly people who can’t take care of themselves. We may be potentially putting them at risk. I’m not convinced we’re going in the right direction.”

Toews appears willing to participate in such discussions, calling the need to coordinate care “absolutely a good thing.” People considered dual and triple eligible who receive Medicare, Medicaid and long-term care services are the most vulnerable, and their quality of life can be impacted.

“If the system can move in that direction, that would be fantastic,” Toews said. “It’s yet to be determined what that would look like.”

Earlier, Toews told Bates, “Until we come up with a plan that either bundles or tightly coordinates those two things together, we won’t have the impact that assures safety and makes certain that the care transitions are appropriate and that we’re not cost shifting from one place to the next. If we’re just bouncing around and cost shifting, then costs can not be controlled. We need a much more grandiose plan that we have now.”