New York City has failed to recover tens of millions of dollars in Medicaid reimbursements for services it provided to special-needs students in recent years, as the Education Department has struggled to adapt to new rules imposed after a devastating federal audit forced the city to return money it received for claims it could not properly document.
State Health Department data from 2006 to 2010 show that education-related claims by the city were 60 percent lower last year than they were five years ago. And virtually all of the $302 million in Medicaid reimbursements the city did receive during that period were for administrative claims that, under the rules that took effect in September 2009, are no longer eligible for reimbursement.
New York, where more than two-thirds of the 168,000 special-needs students are poor enough to qualify for Medicaid, has lagged far behind the state’s other large school districts in filing claims. In fact, the city’s Education Department filed no claims related to nursing services, occupational and physical therapy, psychological counseling, audiological evaluations or transportation between 2006 and 2010; meanwhile, Buffalo, Rochester, Syracuse and Yonkers — where the combined special education populations are less than 10 percent of New York City’s — were reimbursed $77 million for such services.
The city’s Education Department did not try to file thousands of claims in the 16 months immediately after the new rules were announced, the state records show. A spokeswoman said it was because the department lacked the staff and the training to handle the more demanding requirements. (Data for 2011 was not available.) Claims can be filed for up to 24 months after the service is provided, but much of the required material cannot be retroactively documented.
“The Medicaid reimbursement process has become increasingly cumbersome,” the spokeswoman, Barbara Morgan, said.
Ms. Morgan said a city analysis found that the Education Department did not have proper documentation for all but 9,000 students during the 2007-8 and 2008-9 school years, a period covered retroactively by the new rules. The analysis shows, however, that even for those students, almost 20 percent of the $10 million in claims filed were rejected for not meeting the new criteria.
The city says the new claims process is really, really hard and gee, they just can't figure it out so well just yet, but they're getting there...they're getting there.
Except that lots of other cities are dealing with the same process and handling it pretty well:
At a time of tight budgets and grim economic forecasts, many districts and states — each with its own set of filing rules — have invested heavily in compliance. Bruce Hunter, associate executive director for policy at the American Association of School Administrators, said the reimbursements, generally from 50 percent to 70 percent of the cost of a service, had become “an enormous help to school districts” across the country.
In New Jersey, where the state treasury retains 65 percent of the reimbursements, filing the claims has been mandatory since 2008, and the state has set precise goals for its districts, including a 90 percent return rate on forms giving parental permission for schools to file on a child’s behalf. In Washington, Mayor Vincent C. Gray asked the accounting firm Deloitte in February to suggest, among other things, ways to improve the system used by local schools to apply for reimbursements.
Each of the 57 county-level school districts in Michigan, where 40 percent of the reimbursements are kept by the state, has had its own Medicaid coordinator for years. Their duties include hiring therapists and nurses whose certification meets federal requirements and, much like an attendant at a doctor’s office, keeping students’ prescriptions up to date to ensure the claims are not disallowed, said Jane E. Reagan, a Medicaid specialist at the Michigan Education Department.
“It’s a hassle, but once you’ve got the infrastructure and staff in place, the costs are almost always worth the benefit,” said Ms. Reagan, who is the president of the National Alliance for Medicaid in Education, a professional group.
In New York State, Buffalo hired a company to handle the claims; Syracuse sent social workers knocking on students’ doors to make sure their parents signed the required consent forms; and New Rochelle hired a consultant to train school bus monitors to note pickup and drop-off times for special-needs children, as mandated by the new rules, which district officials estimate will lead to $100,000 in additional claims each year.
“We’ll be able to put more teachers in the classroom and more staff in our schools without costing the local taxpayer any additional money,” said Yvette Goorevitch, New Rochelle’s director of special and alternative education.
So why can't New York City handle the process right?
Because the people at Tweed are morons, that's why:
But in New York City, according to a September letter from the State Health Department, officials were still submitting some claims using forms that are no longer accepted. A second state audit, released in April, showed that many of the city’s claims in 2009 were missing documentation or showed incorrect dates for services, forcing the Education Department to return $87,000 as a result.
The Manhattan borough president, Scott M. Stringer, wrote to Dennis M. Walcott, the schools chancellor, in October, criticizing the city for failing “for years to apply in an organized fashion” for the reimbursements. “Funding for public schools have been cut to the bone, and it’s unconscionable that the D.O.E. will leave millions of dollars on the table,” Mr. Stringer, a mayoral hopeful, said in an interview.
Don't worry, though - the Children First folks at the DOE are going to get this thing right.
They've got a plan:
Ms. Morgan, the spokeswoman, said the city was working on the problems. In addition to putting a manager in charge of the claims, the department hired a Medicaid compliance officer last year. This fall, it added 15 doctors, who are paid about $60 an hour, plus some benefits, to work approximately four hours each week writing the service orders that must be attached to each claim. It also hired three medical consultants who are paid $110 an hour, without benefits, to do the same work.
The department has also screened therapists to determine whether they have the appropriate certification, and whether the services they provide are eligible for reimbursement. It has offered compliance training to more than 16,000 therapists, supervisors, outside providers and finance staff.
And it has spent $80 million to build a database — the Special Education Student Information System — that it hopes will make filing claims easier by making prescriptions, treatment plans and schedules of services readily available. Many teachers and principals, however, have complained about the time it takes to load the database and how often it crashes.
Ah, yes - the famed SESIS computer system that is so shitty it makes the famously buggy ARIS computer system look like it was created by divine intelligence.
That's their plan for fixing the problem.
As I said earlier, if this were about teacher evaluations tied to test scores so they can fire teachers or a new testing contract for an online servicer, you can bet your sweet ass they'd get it right the first time.
But this isn't about firing teachers or handing out computer contracts to corporate cronies (that part they already screwed up with SESIS) - so they screw this up and screw it up and cost the city millions and millions of dollars.
When the deadline for the new teacher eval system comes up and Chancellor Putzo holds a press conference to say the teachers are costing the school kids millions because they won't agree to having 40% of their evaluations based on two different sets of tests (one state, one city), somebody in the press needs to call him on this support services/Medicaid fiasco.
Frankly, it's not even true that teachers are costing city kids millions of school dollars if the eval agreement isn't hammered out - that money can only be used for useless crap like data tracking systems and new standardized tests.
But the Medicaid money IS useful and necessary and the city ought to figure out how to get the reimbursements.
After all, didn't Bloomberg say only his fiscal genius could save the city during a time of economic turmoil?
Wasn't that the rationale for his third (illegal) term?
I'll answer that for you - it was.
Yet we see time and time again how this man wastes hundreds of millions of dollars on computer projects that go way over budget because he allows crooks to steal tens of millions of dollars (and in the case of CityTime, hundreds of millions.)
Or he puts millions into garbage projects like the infamous GPS systems for the FDNY and the Sanitation Department that are so bad, they show trucks in the East River when they're actually in Astoria.
Or millions into garbage computer programs like SESIS or ARIS.
But he can't figure out how to get Medicaid reimbursements.
Bloomberg has a reputation for being a shrewd businessman.
The only thing shrewd about this guy is how he keeps the majority of the populace from seeing how incompetent he is as a manager.