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Lets fight the RFP!!!
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BGraves



Joined: 09 Apr 2006
Posts: 20

PostPosted: Sun Apr 23, 2006 9:36 am    Post subject: Lets fight the RFP!!! Reply with quote

Hello all out there! I have been watching this site for some time now and I see many smart people giving their thoughts regarding the status of the Waiver program. I thought this would be a good place to call for action from those of us involved in the Waiver program. I am a case manager and I have been working for my families and consumers for 5 years, which may not be that long compared to other case managers, but I feel I have worked hard every day of that 5 years. I see posts from others talking about how hard their case managers work and how much they have helped their loved ones. Now the state is trying to take yet another aspect of choice from the waiver program. They are counting on us to just take another blow and live with it. I say NO!! No more! We have had our budgets cut, our rates cut, and our services limited. ENOUGH IS ENOUGH! There are far more expensive programs in the state and why does ours have to continue being hit so hard?
In other states that have forced people to use one central case management agency the waiver program continued to decline even faster. What people need to realize is this hurts the program and caused further reductions in services. The other state's administration then "partner" with the central case managment agency and they work together to control the funding. The state says "keep it under 100 million (just a number made up for example) and you get to keep your contract." So guess what? The central agency essentially becomes the state and continues to limit the needed funding. This way they continue earning their revenue by keeping the contract. They keep the contract only if they keep the state happy. Keeping the state happy involves limiting the funding available to our families and consumers in Indiana.
I say we stand united and tell the Governors office and the FSSA that enough is enough and our disabled citizens will not be pushed aside to save money, which the state can't account for anyway. We stand together and say our choice is important and we need our services. If you are interested in joining me in fighting this RFP and the Annual Plan please contact me at bgraves@ascendinc.biz to see what we are doing and have done to fight. I hope you will help us fight for those we care for. Action needs to be taken now!!!!!

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Choice is the basic building block of our freedom; lets not ever let that be taken away or limited from those who cannot speak for themselves.
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cjhelser



Joined: 24 Apr 2006
Posts: 28

PostPosted: Mon Apr 24, 2006 6:47 pm    Post subject: Fight the RFP Reply with quote

It is critical for ALL providers to fight the case management RFP. Anytime a "monopoly" takes over, it means no competition exists for continued improvement of services. The IPMG monopoly in essence does become a contract agent of IFSSA just as EDS is a private contracted state entityl. With no competition and no means for monitoring of a state contracted entity, IPMG can do or not do anything it wants to providers, rates and consumers. In fact, IPMG becomes funder, provider and monitor of itself. Do any of the residential, BMGT or day services providers think that one monopoly CM entity is going to do anything to protect them? Think again.....IPMG becomes a state entity trying to continue to stealing of funding and producing even poorer services and monitoring to the 9000 disabled consumers across the state!

But the state did get a surprise. The federal agency that must approve all waiver amendments; CMS has indicated in writing that to consolidate CM into one entity, this is a strict violation of the federal Medicaid Waiver program rules. Therefore, for IFSSA to continue with this RFP.....case management can no longer be a "waiver" service. It must be paid for through only state Medicaid dollars.....no federal match. This information from CMS per the RFP was shared with IFSSA thus the reason for Peter Bisbecos last memo........"don't listen to any other sources but him per the Case Management RFP." Guess old Peter and IFSSA got caught with their pants done. Are they really going to give up the 63% federal dollar match for case management just to incorporate a monopoly. And please understand, the case management RFP is meant to hurt CM companies but its prime purpose is to devastate the other waiver services.......IPMG will control all funding through every consumers' CCB. Good luck to Indiana's waiver programs.

By the way, does anyone know the inside scoop of why John Dickerson of ARC of Indiana is knee deep in all this funding mess. Why is John D endorsing all the waiver rate cuts, the CM RFP and kissing up to the morons at IFSSA? Is he looking for a position at the state or even higher political seats?
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WaiverWatch



Joined: 21 Oct 2005
Posts: 35

PostPosted: Mon Apr 24, 2006 11:50 pm    Post subject: Reply with quote

John Dickerson has posted on this board before--perhaps he will chime in now and explain his position. Are you out there, Mr. Dickerson?

WW
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ora



Joined: 24 Oct 2005
Posts: 12

PostPosted: Tue Apr 25, 2006 10:50 am    Post subject: Fight the RFP Reply with quote

Thanks to all of the behavior managers who support the case managers, and more importantly, thanks for supporting those on the waiver and their families in having FREEDOM OF CHOICE.

One correction to the above posting, though. ALL Medicaid services, whether the "state plan" (regular Medicaid) or the waivers, receive the 63% federal funding match. This isn't an issue.

What is an issue is that the choice of only one case management entity is a violation of the availability of choice in providers that must exist on the waiver.
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WaiverWatch



Joined: 21 Oct 2005
Posts: 35

PostPosted: Tue Apr 25, 2006 12:47 pm    Post subject: Reply with quote

I read the message to mean that, if the state were to consolidate CM into one entity in apparent violation of federal regs, they'd be on their own for funding it. So it wouldn't literally be "state Medicaid dollars" but rather simply "state dollars". Without a federal match it would all come from the same budget.

Regarding Mr. Bisbecos' statement discounting the credibility of other sources, I took it to be a thinly-veiled reference to WaiverWatch and other independent sources, not CMS. Ironic, since the reason this board began and continues to exist to this day is the lack of useful, credible, and timely information from the state to providers, case managers, and families. We've seen a similar reaction from the state before when we re-posted information that went to a privileged few and didn't include families in the distribution.

WW
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EyeoftheDay



Joined: 21 Mar 2006
Posts: 22

PostPosted: Tue Apr 25, 2006 9:37 pm    Post subject: Reply with quote

Thank you WaiverWatch for some valuable information. Good post!
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ora



Joined: 24 Oct 2005
Posts: 12

PostPosted: Tue Apr 25, 2006 10:20 pm    Post subject: Reply with quote

There was a time when case management was taken off the DD waiver and put as a service under regular Medicaid, as Bisbecos' letter was suggesting. It was called targeted case management. It wasn't part of the waiver, but was still a medicaid service, sort of like a billing as a dentist or a doctor. Case managers could bill case management by the unit and bill larger amounts of case management without having to get it pre-approved by the state, as it is now on a plan of care/CCB. They were not supposed to bill over 10 hours a month, but could essentially bill more than that and still get paid. There was no CCB to limit the case management units or costs. The state eventually got rid of targeted case management and moved the service back as part of the waivers, probably so they could have more control over the costs. But it was always a medicaid service.
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noplacelikehome



Joined: 22 Oct 2005
Posts: 45

PostPosted: Tue Apr 25, 2006 10:48 pm    Post subject: Reply with quote

cjhelser, I would love to know more about what CMS has said about the RFP. Is there a letter or something else in writing that you could post here?

I have suspected from the beginning that CMS would not be pleased with some of the changes the state was making, including parts of the Annual Plan. I would love to see people continue to write to CMS about the CM RFP, as well as any falllout they are seeing from the Annual Plan--for example, I am hearing that consumers all over the state are getting less service per dollar being spent by the state. Anyone who can bear this out, please write to CMS!
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alwaysadvocating



Joined: 09 Dec 2005
Posts: 14

PostPosted: Wed Apr 26, 2006 3:41 am    Post subject: I am so confused Reply with quote

I read a letter from John Dickerson stating that the reason this will be a good change is because case management has been so "shoddy" for some people he knows. Funny thing, there have been people on TV stations, writing letters, and now here on Waiver Watch singing the praises of their case managers. I guess I'm confused. Maybe case managers aren't doing such a bad job on the whole, maybe it's just that some of these case managers tell the state off on a regular basis, ask for more money for services, and in general just bug the dickens out of them "good old boys up there".

Everyone is absolutely right...the bottom line is the money. They really don't care about the quality of services or the people...and evidently that includes ARC of Indiana, or else they have sure been duped!

And by the way let's talk privatization...yesterday prison services and other human services...today case management and DFC...tomorrow Behavioralists???...and in the not too distant future...could it be the actual providers of services under one entity??? Wouldn't that really give the state total control of those dollars!!!

Better wake up folks, and rattle some of those cages up there before it is too late.

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alwaysadvocating
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BGraves



Joined: 09 Apr 2006
Posts: 20

PostPosted: Wed Apr 26, 2006 9:28 am    Post subject: Reply with quote

You are right ora. There were many case managers abusing the funding and alloted hours in targeted case management. As a case manager I have heard from lots of families about what their CM didn't do etc. We all have heard the stories. The burden shouldn't be on the families and consumers to correct that though. Those agencies or providers who weren't doing their jobs or following the rules should carry the burden by being decertified. It is the state's job to correct those providers. The state should hold those individuals accountable. Instead the state decided to punish the whole field.
I also agree with alwaysadvocating about privatization. Its case managers today, but dont think for a minute this isn't the first step towards all the other services as well. Not necessarily privatization of all services, but you can be sure the ultimate goal here is to continue to dwindle down all the other services. RHS, BMAN, and DSRV providers better realize that one entity serving as case management will be controlling their budgets and only looking at the bottom line in order to keep their contract. Its all about the $$$$$$$$$ That means families and consumers lose.

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Choice is the basic building block of our freedom; lets not ever let that be taken away or limited from those who cannot speak for themselves.
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ora



Joined: 24 Oct 2005
Posts: 12

PostPosted: Wed Apr 26, 2006 9:05 pm    Post subject: Shoddy case management Reply with quote

Someone told me that the PMG proposal to the state was that 200 "full-time" case managers were going to take on the over 9400 waiver clients. If this is true, that is a caseload of nearly 50 clients per case manager. That, simply put, will not be feasible or possible to do a good job given the current computerwork, paperwork, and regulations. Mr. Dickerson, you ain't seen shoddy yet until you see a case manager trying to serve 50 clients!

Does anyone know if the above figures are correct? I was told it was mentioned in a press conference.
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indianawaiverneedshelp



Joined: 05 Apr 2006
Posts: 3

PostPosted: Thu Apr 27, 2006 11:37 am    Post subject: Check on some of the practices of IPMG's partner companies Reply with quote

I have heard many stories first hand from many current and former employees of several of the companies that make up IPMG. Many of their business practices are at a minimum, highly unethical, some probably could be illegal. What's worse, they know exactly what they are doing is wrong, but yet they continue to do it and discuss the "high-quality" case management services they deliver !!

Being able to live with yourself and sleep at night, probably wasn't one of the areas that they gave points on the RFP scoring scale when they were reviewed.
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sanga61



Joined: 22 Oct 2005
Posts: 13

PostPosted: Thu Apr 27, 2006 8:34 pm    Post subject: Fight the RFP Reply with quote

The best rumor is that a provider asked INARF about consolidating services and it was stated that the Case Management Consolidation may have hit a wall because CMMS isn't going for it. The State will either have to change the type of case management or go to targeted case management.
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"The voice of conscience is so delicate that it is easy to stifle it; but it is also so clear that it is impossible to mistake it Madame de Stael
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hoosiermama



Joined: 24 Oct 2005
Posts: 8

PostPosted: Fri Apr 28, 2006 12:31 pm    Post subject: Reply with quote

One of the CM's from IPMG told me today that since they will have
X number of case managers assigned to each region and families
could choose which case manager out of those that they wanted, that
covered them as far as choice was concerned. Uh....what if all the families
all want the same CM? How would that work out?
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rkf64



Joined: 12 Apr 2006
Posts: 10

PostPosted: Fri Apr 28, 2006 1:15 pm    Post subject: Reply with quote

I wonder which one of the IPMG Executives had conversation with you? Well if the families all want the same CM I guess that CM will be pretty busy and then they will eventually choose another CM cause that CM is too busy to work for them.....that would be my guess.
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It appears the $15M is to run the businees NOT for services that dollar amount is outside of this as it appears.
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