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R.I. nursing homes say UHIP has caused 'unprecedented' disruption

Providence Journal - 4/8/2019

April 08-- Apr. 8--PROVIDENCE -- The nursing-home lobby is fighting back against the state's "mischaracterization" of them as scofflaws refusing to repay $60.8 million in advances that were, in most cases, subsequently double-paid.

The nursing homes say they are victims of the state's painfully slow process for determining who qualifies for Medicaid, which leaves them caring for people who need nursing home care for months without payment -- in some cases, more than a year. They place the blame on the infamous eligibility-verification computer system known as UHIP, that the state installed before it was ready in September 2016.

In response to statements the state's Medicaid director made to the House Oversight Committee on Thursday, LeadingAge, which represents 83 nursing homes, and a companion group, the Rhode Island Health Care Association, "strongly denied ... that nursing homes have been unresponsive to the state in its quest to recoup double payments for Medicaid reimbursements, and assert that nursing homes are not holding state money."

"In fact, because of the UHIP debacle, nursing homes are owed tens of millions of dollars in Medicaid payments from the State of Rhode Island," said James Nyberg, director of LeadingAge RI.

"This false depiction of our industry is extremely frustrating."

"While we acknowledge over payments to some providers, we are refunding that money through a state-approved repayment plan," added Scott Fraser, president and CEO of the Rhode Island Health Care Association. "We are willing to work with the State to come up with a way to accelerate this process. However, we have to make sure that both sides can agree on the amount owed for each claim before repayment can be made."

"What's at stake? Care of our frail elders," Fraser said. "Some of our homes are still owed hundreds of thousands of dollars in payments for pending Medicaid claims. Yet, we are still being asked to repay money that the flawed UHIP system paid out to us in error. It makes for a precarious financial situation."

The Executive Office of Health & Human Services was provided a copy of the joint statement from the two nursing home groups on Friday, after it was emailed to news outlets.

The office, which oversees the state's billion-dollar Medicaid program, had not responded as of noon Monday.

According to the joint statement: "The most recent data from EOHHS shows that there are 1,079 backlogged Medicaid applications, including 150 that have remained stalled in 'pending' status in excess of one year. Once approved, additional billing hurdles must be overcome before reimbursement checks are actually sent. UHIP has disrupted the financial ecosystem of the entire nursing home industry in unprecedented fashion.

"Two plus years is long enough. We have worked with limited resources to ensure continuity of care for the families who have entrusted us with their parents and grandparents," Nyberg said.

At the State House hearing on Thursday, state Medicaid Director Patrick Tigue said that an unspecified number of nursing homes were not responding to the state's entreaties to return $60.8 million, most of which represented double-payments.

"There's been not so much a dispute, but simply that there has not been a response," Tigue told the lawmakers. He did not name the nursing homes.

"Don't these nursing homes have any responsibility for paying us back?" state Rep. Patricia Serpa, the House Oversight Committee chairwoman, asked Tigue.

"I don't have to tell you that this is a very bad budget year, and in plain English," she said. "This is money out there somewhere that I am sure the [House] Finance Committee would love to use to fill in holes. You seem to be taking a rather lackadaisical attitude. You know, 'We're working on it. We'll get it.' That's good. I'm glad. But we need it now."

"We absolutely agree," Tigue assured her. "We have taken a voluntary approach to the recoupment to date. [But] we do recognize now because of those fiscal pressures that you are citing, that we do need to take a more aggressive posture."

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