Click Here
The Coalition for Public Health Care Transparency has been closely monitoring the Medicaid programs in several states. Here is an update on the Medicaid transparency and accountability issue from our Minnesota sources.
Table of Contents: “True Independent Third Party Audits Weakened”, “What is Senator David Hann really up to?”, “Commentary and Background”, “Sen. Hann has shown a lack of consideration”, “What will be Sen. Hann’s next move?”, “In the meantime, Action!”, “Latest Media Sources Talking About MN HMO Audit Bill”, “Progression of the HMO Audit Bill during the MN 2012 Legislative Session”
True Independent Third Party Audits Weakened
The Senate File 1824 and House File 2412 have been heard in their respective committees. And yet, the HMO Transparency Bill isn’t making acceptable progress in the Minnesota House and Senate. We have to start by looking at Sen. David Hann’s HHS Committee actions to find out why.
What is Senator David Hann really up to?
When the HHS Omnibus Bill was heard in the Senate Finance Committee, Sen. Hann moved the (A32) Amendment to delete the words “Legislative Auditor” and replace it with “Commissioner” (Commissioner of the Department of Human Services). This effectively killed the Bill's independent auditing component. The Committee remained silent except for Sen. Higgins who asked if Sen. Hann had talked to Sen. Nienow, the Chief Author, about deleting Nienow's language. Sen. Hann admitted he had not. Why?
Commentary and Background:
Two articles in the local Minnesota newspapers are cited below and report the current picture of the state of the HMO Transparency Bill. The articles rightly take the Leadership of the Minnesota Legislature to task for the demise of this straightforward remedy to what some are saying is one of the biggest cases of potential fraud in the Medicaid system.
There is currently a Federal investigation, and two Congressional Inquiries into Minnesota's Medicaid program, one by Congressman Darrel Issa, Chair of the Federal Government Reform and Oversight Committee, and another by Senator Charles Grassley, Ranking Minority Leader of the Federal Judiciary Committee.
Additionally, Federal Legislation is being authored by Congresswoman Michele Bachmann to address the issue of Medicaid fraud prevention. Numerous official government reports cite serious concerns with the lack of proper oversight and accountability of the Medicaid program in general and Minnesota’s program in particular.
This is a Republican-authored Bill during the Republican-led 2011-2012 Session. The Bill was presented to address a problem of potential fraud and abuse that has not been effectively remedied by the Administration of Governor Mark Dayton (D).
And Sen. David Hann has positioned himself to be the singular force to kill this legislation at the MN Capitol. The Bill has bipartisan support and has clearly logical and fact-based reasons for the need for urgent action by the Minnesota Legislature.
There seems to be no action by Sen. Hann to back up his claims of support for transparency and accountability. He may say he is for it, but he has done everything he could to stop SF1824. If Sen. Hann had concerns, he did not bring the parties together to work out a solution. In fact, House HHS Reform Committee Chair Rep. Steve Gottwalt scheduled a meeting to build unity on the issue. But Sen. Hann did not attend even though he was asked to be there. Instead Hann’s actions show he deliberately and intentionally worked to kill SF1824. Additionally Senate Majority Leader David Senjem has done nothing publicly to bring this legislation forward and there is no evidence, according to our sources, to indicate he has supported it behind the scenes. This lack of support for fiscal responsibility of tax dollars must infuriate conservatives who expect fiscal responsibility to be upheld by their party and their legislators.
Sen. Hann has shown a lack of consideration:
Sen. Hann has shown a lack of consideration for his respected colleague, Sen. Sean Nienow, and Minnesota taxpayers in the following ways:
• Sen. Hann publicly states he supports the HMO Transparency/Audit Bill SF1824, but behind the scenes, he is making procedural moves that block its passage.
• Sen. Hann authored amendments that gut the effective language of SF1824 and introduced those amendments without consulting Sen. Nienow.
• Sen. Hann offered those amendments from his position as Chair of the HHS Committee which goes against Senate protocol and over another Senator’s objections.
• Sen. Hann effectively over-loaded SF1824 with costly amendments.
• Sen. Hann moved his amendments with the SF1824 over Sen. Nienow’s objections.
• Sen. Hann then moved the (A32) Amendment to delete the words “Legislative Auditor” and replace it with “Commissioner” (Commissioner of the DHS). So Hann wants to put audit power in the hands of the person who is in charge of DHS and who admitted there is a Federal investigation of the MN Medicaid programs and her own DHS.
• Sen. Hann moved the (A32) Amendment without discussing the language change with the Chief Author Sen. Sean Nienow even though his actions were questioned by another Senator on the Committee.
• Sen. Hann’s movement of the (A32) Amendment effectively killed the SF1824’s independent auditing component – the entire purpose for the Bill.
• Sen. Hann did not attend a meeting called to bring all the parties together to work on SF1824 and HF2412 and to build unity on the issue.
• Sen. Hann’s actions regarding the HMO Transparency/Audit Bill show a complete disregard for protecting taxpayer dollars and his responsibility as Leadership in the Senate and on the Senate HHS Committee.
Minnesotans should not accept Sen. Hann’s actions which are concerning at best, if not completely underhanded.
What will be Sen. Hann’s next move?
Currently the HMO Audit Bills in the Senate and House have different language. This is probably intentional. If the HF2412 passes the House HHS Policy Committee, then the Chief Author in the Senate can “concur” (accept the House language), and a vote will be taken in the Senate on SF1824. (Right now, SF1824 is in the Senate Rules Committee and included in the HHS Omnibus Bill. But the language can be stripped at any stage of the process.)
If HF2412 passes the House, the Senate can pass their own version of the language. If that happens, the Bill would then go to a conference committee to work out the language. Committee members are appointed by Leadership. There, legislators can legitimately work out the language differences and keep the integrity of the Bill – Or they can rip out the rest of the true audit requirements and oversight of taxpayer dollars intended in the original Bill authored by Sen. Sean Nienow.
Which path the HMO Transparency/Audit Bill takes in Minnesota will be clear in the next few days. We are watching with great interest and will keep you informed.
In the meantime, Action!
Attention MN taxpayers who want their government and elected officials to be responsible stewards of taxpayer dollars:
Please take the time to help stop waste, fraud and abuse in the largest public health programs in the State of Minnesota. Call the legislators who are preventing the MN HMO Audit Bill from becoming law. Their contact information is listed below.
For those of you in other states, this level of detailed analysis is provided for all of you, so you, too, can identify obstacles to true reform.
• Call Sen. David Hann and tell him taxpayers do not approve of his actions to kill SF1824, and it will not go without consequence. 651-296-1749
• Call Rep. Steve Gottwalt and tell him his actions to weaken HF2412 are not going unnoticed. 651-296-6316
• Call Sen. David Senjem, tell him you expect better leadership than this – help Sen. Nienow get SF1824 passed with true audit language intact. 651-296-3903
• Call House Majority Whip Matt Dean and tell him you expect better leadership than this – help MN taxpayers by making sure HF2412 passes with true audit language intact. 651-296-3018
If these elected officials do not get this common sense legislation passed by the end of the 2012 Session, these legislators should be held accountable in the next election!
Minnesota taxpayers have a right to demand that Sen. Hann, Rep. Gottwalt, Sen. Senjem, Rep. Dean, and every member of the Senate and House Health and Human Services Committees be held accountable if this Bill fails to pass - or passes with language so weak as to render it meaningless. MN Taxpayers, please make the phone calls today!
Sincerely,
Your Coalition for Public Health Care Transparency
Latest Media Sources Talking about MN HMO Audit Bill:
Minneapolis Star Tribune Editorial, March 30, 2012
http://www.startribune.com/opinion/editorials/145214115.html (Full article at this link)
“Minnesota health plans' surprising profits from taxpayer-funded medical assistance programs have drawn scrutiny at the state and federal levels over the past year. Now, state lawmakers are poised to take a responsible step: authorizing an independent evaluation of the state's $3.8 billion-a-year Medicaid managed-care program.”
“Having the respected Office of the Legislative Auditor oversee the outside auditing firm's work will significantly enhance its credibility. Republican State Reps. Steve Gottwalt and Jim Abeler, and Republican State Sen. Sean Nienow, who have championed the audit bill, smartly steered its oversight to an organization known for its integrity and tough-but-fair program evaluations.”
“Diluting the legislative auditor's authority or shifting its responsibility to another organization would suggest lawmakers aren't serious about this audit, and would raise a red flag for federal investigators monitoring the situation.”
¹Politics in Minnesota: “HMO audit bill could be revived”
by Paul Demko, Published: March 30th, 2012
http://politicsinminnesota.com/wp-content/plugins/dmc_sociable_toolbar/wp-print.php?p=37871 (Full article at this link)
“Legislation requiring annual independent audits of the health care organizations that administer Minnesota’s Medicaid program has followed a tortuous path this legislative session.”
“The proposal initially cleared the House Health and Human Services Reform Committee with hardly a word of dissent.”
“But during a subsequent hearing before the Senate Health and Human Services Committee in March, the reception was very different. Committee Chairman David Hann, R-Eden Prairie, loaded up the legislation with four amendments that dramatically changed the scope of the bill and seemingly marked it for death.”
“The bill’s prospects appeared to grow even grimmer when it was heard before the House Health and Human Services Finance Committee last Wednesday. Gottwalt introduced several amendments, including one to shift responsibility for oversight of the financial probes to the Office of the Legislative Auditor. At the behest of the Department of Human Services (DHS), he also changed a provision requiring “auditable proof” that claims data reported by the health plans is accurate. In its place Gottwalt offered a less rigid mandate that the audit should evaluate ‘quality assurance protocols’ in place for such data.”
“But that arcane-sounding change, in the eyes of Laine, would gut the bill.”
“Rep. Laine says she intends to vet her interpretation with professional auditors before deciding how to proceed. ‘If I’m right, we have another expensive report that shows us nothing,’ Laine said. ‘He never consulted me on anything, and I would have assumed that would have been a logical thing to do.’”
“In addition, there’s a strong possibility that the audit provision will end up as part of the Senate’s HHS Omnibus Bill. Currently, the Bill is traveling both as a stand-alone Bill as well as added to the broader HHS Legislation. If that happens, Sen. Nienow would no longer control the fate of his own Bill. Changes could be made to weaken it, or it could be scrapped altogether.”
“Sen. Nienow continues to insist that the HMO Transparency/Audit Bill still stands a decent chance of becoming law. ‘Everybody seems to say they’re OK with the concept. Nobody opposed the Bill,’ he noted. ‘But the question is, are people publicly saying they’re OK with it and privately trying to weight it down and keep it from happening? There’s no way for me to know that. Nobody comes to me, closes the door in my office, and says, ‘Hey, by the way, I’m trying to scuttle your Bill.’”
KSTP TV: “HMOs Give Millions Back To Minnesota Taxpayers
Insurance plans that run the state's public health programs are giving back 73-million dollars. The four HMOs that run Minnesota's public health plans are Blue Cross/Blue Shield of Minnesota, Medica, U-Care and HealthPartners. Their operating income was up 21-percent in 2011, but the state negotiated a one-percent cap on their profits and that's why the money is being returned. Last year, U-Care gave back 30-million dollars and Governor Mark Dayton asked the other three HMOs to do the same. When they kept all of their profits, the Governor negotiated a one-percent cap for this year. All four HMOs and the Minnesota Department of Human Services remain under federal investigation. The Feds want to know if the state and the HMOs illegally inflated Medicaid costs to get more matching dollars from the federal government. There is also a Congressional inquiry into Minnesota's Medicaid system as well.
Progression of the HMO Audit Bill during the MN 2012 Legislative Session:
Senate File 1824:
This bill was heard in the Senate Health and Human Services Committee, Chaired by Sen. David Hann (R-Eden Prairie). After testimony both in support and in opposition, Senator Hann offered four amendments to the Bill. Hann’s fellow Senators chastised him for offering an Amendment from the Chair rather than passing the gavel as is customary Senate protocol. According to proponents of the Bill and the local media, the amendments added a hefty fiscal note to the legislation, which “dramatically changed the scope of the bill and seemingly marked it for death.”¹
Senator Sean Nienow, Chief Author, testified that he thought the amendments would add a “veto target” to the Bill and said he preferred it be “thinner rather than thicker.” But Sen. Hann persisted with his Amendments. No other Senate HHS Committee member – except Sen. Jeff Hayden, argued against the amendments. Sen. Hayden challenged Sen. Hann saying the bill was a clean bill with bipartisan support but the amendments would make it hard for Democrats to support. The rest of the Committee was strangely quiet! Our sources say legislators support the bill when asked privately, but in Committee they are unwilling to go against the Committee Chair Sen. Hann. Ironically, SF1824 was then “laid over” pending the new Fiscal Note to study the cost to MN taxpayers for all the additions to the Bill.
House File 2412:
HF2412, the House Companion Bill to SF1824, was heard in the Health and Human Services Finance Committee on March 27th. Rep. Steve Gottwalt is the Chief Author in the House. Rep. Gottwalt began by offering an Amendment that in the words of journalist, Paul Demko (Politics in Minnesota), “At the behest of the Department of human Services (DHS), he also changed a provision requiring ‘auditable proof’ that claims data reported by the health plans is accurate. In its place Gottwalt offered a less rigid mandate that the audit should evaluate ‘quality assurance protocols’ in place for such data.”
Representative Carolyn Laine said the Bill would lose its independent audit component, but Gottwalt disagreed. It is reported that the proponents of the Bill, including the Senate Chief Author of the Bill, thought the Gottwalt Amendment did in fact weaken the HF2412. The Bill with the Gottwalt Amendment passed out of Committee.
Back to the Senate, SF1824 was again taken up on March 27th. Sen. Hann and Rep. Gottwalt wanted Sen. Nienow to adopt the House version. Sen. Nienow agreed with one change, that there be additional language added to make sure that any auditing firm that the Legislative Auditor (given the authority to contract for the HMO Medicaid audits) contracted with would have the same subpoena power that the Legislative Auditor had. The Legislative Auditor sent a letter to Sen. Nienow telling him that language would strengthen the Bill. The Bill was amended as requested and was then passed to the Senate floor. Sen. Hann also stated he wanted the Bill attached to the Health and Human Services Omnibus Bill.
