I-Team 10: Unpaid therapists

Posted at: 08/16/2013 5:31 PM | Updated at: 08/16/2013 6:50 PM
By: Berkeley Brean | WHEC.com

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Because of mistakes and lack of communication by New York State insurance companies, hundreds, if not thousands of therapists have not been paid since April 1. Now the state has a solution.

Part of the state's solution is to pay the therapists with taxpayer money, but only part of what they earned. It's coming in the form of a loan. By next summer, the therapists have to re-pay the state. That doesn't help people like Jennifer Gallup, who hasn't had a full paycheck since April.

Jennifer Gallup is a speech pathologist for infants and children. She's being doing it for 13 years, but because of a state-mandated change in the way her work gets billed, she hasn't gotten paid.

Gallup said, “I have about 60 to 70 unpaid visits.”

But it gets worse. Instead of paying her, the insurance companies are cutting checks to her children's parents.

It started last year when the state took over billing control from counties for early intervention care and put it in the hands of what it calls a fiscal agent. The state didn't hire a full-time fiscal agent by the time the billing change took effect on April 1 and lawmakers could sense a problem.

In January, a senator and the commissioner of state health spoke about the problem. To this day, the state only has an interim fiscal agent.

I-Team 10 Berkeley Brean said, "So how does something like that happen?"

Joe Morelle, (D) Majority Leader NYS Assembly, said, "It happens I think when you try to make major changes in the way you administer a program of this size and magnitude."

Assembly Majority Leader Joe Morelle thinks the state wanted to reduce the burden of early intervention work on counties, but underestimated the size of it.

Morelle said,"I think the lesson learned is that sometimes making these larges changes are difficult."

The state blames insurance companies. In a release this week, state health pointed to insurance companies' “lack of compliance" with new billing procedures. This is also where state health announced its plan to get those therapists their money. But the payments are only 75 percent of what they're owed and they have to be paid back by July 2014.

Leslie Grumbler runs the organization that represents early intervention therapists, like Jennifer Gallup. I-Team 10 reached her on Skype.

Leslie Grubler, UNYEIP, said, “Well, it makes sense in one way. Our providers desperately need to be paid. Just think about yourself or anyone else employed. How long could you go without being paid?”

For Gallup, it's no longer. When I-Team talked with her, it was her final day as a self-employed speech pathologist. Because of these problems, she applied for a job in the Honeoye Falls-Lima School District and she got it. She believes her work over the last 13 years has made the lives of children, their parents and teachers better.

Gallup said, “ It's made a huge impact on our schools and now to have this part of the system suffer is only going to mean that our kids are going to suffer. When they get to schools, they're not going to be prepared and they're going to have difficulty.”

Here's the deal with the 75 percent safety net loan. State health says it's a lump sum payment to help therapists get by until insurance companies come up with the money to pay them in full. The state release says therapists will get 100 percent of what they're owed, but there are no details on who makes up that remaining 25 percent. The state's full time fiscal agent doesn't start until October.

Blue Cross and Blue Shield Statement

“The Blue Cross and Blue Shield Plans have been working diligently to ensure compliance with the changes to the early intervention payment statute. With delayed guidance from the state and new payment rules for providers, especially those who do not participate in a plans network, the implementation of this new law has been especially challenging. We will continue to work with all stakeholders in addressing these problems.”  Deborah Fasser, spokeswoman for the New York State Conference of Blue Cross Blue Shield Plans

NYS Dept. of Health Statement

"The Early Intervention Program provides services to children with developmental delays aged birth to three. Approximately 69,000 children were served in the program in 2011-12 across the state. Services provided include physical, occupational and speech therapies and special education. Historically in the program, more than 30 percent of enrolled children have some form of private health insurance coverage; insurers have paid only 2 percent of the costs of services. As part of a series of program reforms enacted April 1, 2013, participating therapists now bill insurers through the New York State Department of Health’s (DOH) contracted fiscal agent. These reforms provide fiscal and mandate relief for local governments.
 
Since April 1, 2013, under this new system, DOH, through its fiscal agent, has issued payments to providers totaling more than $133 million, including Medicaid and local government funding. Unfortunately, most insurance payments remain outstanding resulting in cash flow problems for providers. While nearly 400,000 claims have been submitted by providers to insurers, only about 75,000 – less than 20 percent - have been adjudicated.
 
On July 26, 2013, DOH notified counties and providers of the option for counties to issue "Preliminary Escrow Payments" to interested providers, using county Early Intervention funding. Unfortunately, very few counties opted to participate.
 
The Early Intervention Program for infants and toddlers with disabilities or developmental delays is vital to the healthy development of New York's youngest residents.
DOH will issue state-funded "safety net payments" to early intervention providers to bring financial relief and ensure continued availability of essential services to developmentally disabled children in the Early Intervention Program and their families.
 
Early Intervention providers requesting safety net payments will receive 75 percent of the amount of their unpaid claims to insurers for the period April 1, 2013 through July 29, 2013 for which no known payment or denial has been received. The safety net payments will be reconciled between October 1, 2013 and July 31, 2014 when providers' claims are paid by insurers and the counties. Providers will receive full payment for 100 percent of outstanding claims.
 
The Department continues to work at several levels to address this issue; the safety net payments are one part of a multi-faceted approach to ensure providers receive their payments. The focus of the overall approach is to get insurance companies to adjudicate claims in a timely fashion. The Department is working with Insurers and the DFS to this end. Our approach includes exploring technical solutions with insurers to the challenges currently preventing them from complying and also to investigate complaints against insurers. The Department has also employed early release of EI Medicaid payments to accelerate other funding to providers."


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