Chair, Committee on Oversight, Analysis and Investigation
The Public Eye reviews, from time to time, the activities of the Assembly Standing Committee on Oversight, Analysis and Investigation. This particular issue examines just one topic: the State Department of Health’s management of the prior approval process for durable medical equipment.
This report summarizes the Committee’s investigation which revealed the State’s failure to properly manage this particular Medicaid program, and thereby deny many people with severe, long-term disabilities the equipment they need to sit up, stand, move, and achieve small degrees of independence.
The Committee’s mission is to review how well laws and various government programs work, whether they are implemented as intended, and whether they operate efficiently and effectively. Two other projects we are now pursuing include ways to improve the Upstate economy and how State agencies handle New York residents’ personal information.
As I move forward, I welcome your guidance and suggestions.
Assembly Oversight Report on State’s Management of the Prior Approval Process
for Durable Medical Equipment
Report Faults Department of Health;
Calls for Reform
In July 2006, Oversight Committee Chair Sam Hoyt released a report entitled “Delaying Necessities, Denying Needs.” The report was a culmination of a year-long review of the New York State Department of Health’s (DOH) management of the prior approval program for durable medical equipment. Jointly issued with Richard N. Gottfried, Chair of the Committee on Health, Amy Paulin, Chair of the Task Force on People with Disabilities, and James Brennan, former Chair of the Oversight Committee, the report’s major finding was that DOH had been systematically depriving poor people with severe disabilities — many of them children — of wheelchairs and other “durable medical equipment” needed to help reduce their pain, preserve their health, and enable them to live more productive lives.
The 48-page report — compiled following two public hearings and a more intensive review of DOH’s “prior approval” process under Medicaid — details the failure of DOH to comply with state regulations and to properly support Medicaid recipients with severe disabilities. According to the lawmakers, DOH’s use and misuse of legal and bureaucratic means to unfairly prevent people with severe disabilities from getting necessary equipment means vulnerable people are hurt and programs face greater spending. Among the problems uncovered in the investigation is that, despite having installed a new, costly computer system ($375 million, with a recently announced $276 million addition), DOH does not track the time it takes to process all prior approval requests even though it is mandated to issue determinations within 21 days. And DOH seems to have been engaging in deliberate measures to “stop the clock” by sending out multiple requests for more information — often irrelevant, redundant and otherwise unreasonable — which can add months onto the process.
The report also charges that:
Taken together, these actions prevent Medicaid recipients with severe disabilities from getting what they need to continue living at home and to live independent lives. Federal and state laws, case law, as well as common sense, support the goal of keeping people in their homes and in the community; it is more humane and more cost effective than putting them in nursing homes or other institutional care.
Together with the intensive press scrutiny that contributed to the exposure of DOH’s failures in managing this program, the Committees’ actions have produced some gradual improvement within DOH but much more needs to be done.
The report offers recommendations to improve the durable medical equipment prior- approval system and ensure taxpayer dollars are spent more efficiently. Some of the report’s recommendations include:
Albany Office: Room 454, Legislative Office Building
Committee Office: Agency Building 4, 12th Floor
|PUBLIC EYE #11 (August 2006) is the eleventh in a series of updates from the NYS Assembly Oversight, Analysis and Investigation Committee. Other issues will follow. The Committee is charged with reviewing implementation and adequacy of laws and programs to ensure compliance by the public and government agencies. Through its monitoring and investigative activities, it seeks to determine whether programs are operating as required and whether funds allocated for programs are spent effectively, efficiently and in accordance with legislative intent.|
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