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MRSI’s Holderegger, Wyo. Sen. Barnard discuss waiver issues

Posted: Friday, Jun 14th, 2013




By ED CLOSE | Herald Reporter



EVANSTON — Federal cuts to Medicare and Medicaid are causing problems for disabilities programs across the state, and in Uinta County. The waiver redesign currently underway at the state level was prompted by a four percent cut to state Medicare and Medicaid programs — a result of the federal cuts — that will affect virtually every person receiving help from disabilities programs across the state.

A presentation was held at Evanston High School April 11 to explain what the waiver redesign entailed, and to field questions from the public and providers of disabilities services. Another presentation will be given once rules and regulations of the new waiver system are finalized.

A preliminary report by personnel in charge of the waiver redesign has to be given to the Joint Labor, Health and Social Services Interim Committee by no later than Oct. 1 of this year.

The entire process started with Senate Enrolled Act 52 being amended, and finally passed as Senate Enrolled Act 82. That state legislation authorized the waiver redesign process, and though cuts to services have not taken effect at present, they will once the waiver redesign is completed. Senate Enrolled Act 82 mandated the changes to the current waiver system.

The mandates require the state’s Medicaid services to serve more individuals with special needs, without receiving more money from the state or from the federal government to do so. The only feasible way to serve more without more funds, the Legislature found, was to cut services to those already receiving services. The 534 individuals currently on waiting lists across the state for disability services will now have to be brought into the system, without any additional funds to pay for their services.

One of the major stumbling blocks to completion of the waiver redesign is case management; one clause in the legislation states the system must “provide for a case management system for the waiver programs that is free of conflicts of interest.” This sounds reasonable at first reading, but the interpretation of what that clause means is at the heart of a battle over services for waiver system recipients.

In an interview with John Holderegger, president and CEO of Mountain Regional Services, Inc., in Evanston, the subject of case management brought both new information and fresh ideas to solve the problem.

“Independent of direct service providers, 90 percent of case management is provided by the providers, but the new law takes that out,” Holderegger asserted. “They are interpreting the new law to read the same as the old law. They’re interpreting the law to say there has to be independent case management, outside of the providers.”

According to the Wyoming Department of Health website, “The division will transition to conflict-free case management over the next two years, but no timeline has been set. When the waivers begin in January 2014, the current case management structure will still be in place.”

“There are three providers in Evanston,” Holderegger told the Herald. “With ‘mom and pop’ providers, two things happen: the mom and pop burn out, and the clients are left high and dry, or by working with the moms and pops, you attract a certain kind of individual, who is a predator. So it provides them with an opportunity to abuse individuals because there is no oversight.

“The point of independent case management is that, somewhere along the line, those independent case managers have to be paid for, and that will take even more money out of the recipients’ hands to pay for them,” Holderegger said. “I have a solution, and so does the committee. The Wyoming Life Resources Center [in Lander] is a huge financial drain, without it being a resource. The $300,000-plus per person in state dollars that are being spent in Lander, if Lander was closed and that money went into the waiver, it would be massive, it would be $60 million, and all the people on the waiting list, and everybody in the Lander facility, and everybody in the community, would be served. The clients in that facility could be moved to other providers. So Lander is really the answer.”

The cost per person at the Wyoming Life Resource Center in Lander is about $330,000. The Lander facility has more staff than it does clients, and has for some time.

State Senator Paul Barnard met in May in Alpine with providers from across the state to discuss strategy, and to let them know he would be meeting with the governor in June. At the meeting with the governor on June 4, Barnard was allowed to speak first, and raised the following contentions against the actions taken by the Wyoming Department of Health:

“There is no timeline in the legislation. They are trying to decide the time, not the legislature.”

“The entire legislature should be allowed to vote on the details before implementation.”

“What happens to providers if this plan doesn’t work? There is no plan B.”

The loss of Evanston’s MRSI alone would cost the state 250 jobs, according to Barnard, and MRSI is the only facility in the state with a special class of clients no one else is licensed to take care of. “What happens to them if MRSI goes out of business?”

“How does Life Resources in Lander come into all of this? Why are you going after all the other providers and not them? You could take that money and use it for the waivers.”

“No date is in place for a public update. You plan to take a finalized plan to CMS in June. Why are you going to CMS with a final plan before the legislature has voted on it?”

“Independent case management was started 30 years ago and it didn’t work,

so why are you trying it again?”

CMS is an acronym for Center for Medicare and Medicaid Services. The agency used to be the Health Care Financing Administration, but was renamed in the summer of 2001. CMS is based in Baltimore, Md., and has the final say on whether the waiver plan is approved and implemented.

Barnard was asked where the money would come from to license and monitor independent case management. Would the funds needed for that cause further cuts to the existing programs and services?

“Exactly,” Barnard responded. “That’s a very good question. I have all these questions and can’t get any answers.”











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