Tag Archives: New York State Department of Health

NYS TBI Waiver complaints: the fix is in

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If you are on the NYS Traumatic Brain Injury Waiver and you file a complaint with the NYS Department of Health you will never be told the outcome. The DOH has it fixed so they don’t have to tell you. Their complaint line agreement  with the Brain Injury Association of NYS does not require them too to tell you. More moral and ethical corruption from the state’s leading renegade agency which makes a laughing stock of the new governor and the new DOH commissioner.

If you are one of the nearly 3,000 New York adults on the waiver you are told to call the waiver complaint line  fielded by the Brain Injury Association of NYS. BIANYS staff will always treat you with respect and compassion. However, that might be the end of your respect and compassion experience unless of course someone from the RRDC’s (Regional Resource Development Center’s) office calls you to ask about your complaint and there too, you might, though not always, get treated with compassion. RRDCs across the state are contracted with DOH to oversee waiver providers and participants in their respective regions.

After your talk with someone from the RRDC’s office (there are many instances where you don’t even get that much attention), all compassion and respect stops. You will never learn the outcome of your complaint.  Several sources around the state have told this writer that the DOH makes it clear they want the complaints minimized if not ignored and abandoned altogether.

This is ethical corruption pure and simple and it needs to stop. Groups like the TBISCC, BIANYS and DOH need to address this as soon as possible.

The following is the actual complaint line protocol:

TBI Complaint Line Protocol – Updated 1/2010

1. BIANYS conducts complaint intake and completes the BIANYS portion of the complaint form.
2. BIANYS emails complaint to DOH TBI Waiver Program.
3. DOH staff emails the complaint intake form to RRDCs. (If determined a Serious Reportable Incident, DOH staff contacts RRDS immediately by phone and check the  appropriate SRI box on the form. DOH staff will follow up by emailing the complaint intake form to RRDS.) In those instances where the complaint is directed at the RRDC, DOH assumes responsibility to investigate.
4. RRDC confirms receipt of the complaint with DOH.
5. RRDC staff contacts the participant within two business days that the complaint has been received and investigation is in process.
6. RRDS investigates the complaint and completes the RRDS portion of the complaint form.
7. RRDS returns the completed form back to DOH within 30 days.
8. BIANYS will be notified when the complaint is closed via email.
9. BIANYS will provide DOH a monthly report of complaints.
10. DOH waiver staff meets monthly to review open complaints & discuss outstanding issues.

Essential Elements of RRDC Investigation

a) Provide a brief description/summary of the complaint.
b) Provide pertinent demographic information of the participant and any other people related to the complaint.
c) Provide a summary of all completed interviews or statements of fact.
d) Provide a summary of documents and any evidence reviewed.
e) Provide a description of your findings and analysis of the event.
f) Describe all corrective actions taken.
g) Describe the current status of the complaint and/or participant and any conclusions indicated by the investigation. The Complaint Form must indicate the final status and disposition of the complaint e.g. allegation/complaint confirmed/substantiated, allegation disconfirmed
h) Complaints are to be maintained in a regional and DOH database and reviewed on an annual basis to establish trends, patterns and systemic issues.

 

NYS Department of Health: Keep’m in the dark

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Murphy scoops a spoonful of sugar into his coffee and nudges the sugar bowl in Wrench’s direction. “So how do you think the conversation goes?” he asks.

“What conversation?” Wrench puts the lid on the sugar bowl and smiles. Since his accident Murphy’s memory gives him a hard time and he still doesn’t remember Wrench doesn’t take sugar, with anything for that matter.

“The DOH table, they’re in a meeting and whattaya think they say? You’d think they’d want to at least make an effort in acting like they give a damn about us.”

Wrench laughs. “Hard to imagine how they think they’re successful there. I mean, so they sit back and say, Okay, first thing we do is make sure these TBI people, like that’s all we are, have as little chance as possible in the fair hearings and the we keep using that form, what they call it?”

Sarah lifts her head from the pad she’s been doodling on. “PRI. It’s called a PRI. Patient Review Instrument. That’s how they assess us to see if we’d be in nursing homes without the waiver.”

“PRI,” Murphy says, eyes closed, trying to make it a memory. “The thing doesn’t address cognitive stuff at all.”

Sarah again. “That’s the idea. People been after’m for years to come up with another assessment form that really applies to brain injury and they don’t.”

Murphy, “You think they’re that stupid?”

“Like a snake stupid, they are. Long as they can use a bullshit tool the doesn’t apply to brain injury the more they can deny help to survivors and the more people they can throw off the waiver.” Wrench sips his black coffee.

“And then this latest thing they’re pulling.” Sarah leans back in her wheelchair and looks out the window. It’s begun to rain. “Now they’re dumping the mailing list they used to have to keep people informed of the meetings of that brain injury council.”

“Not to mention minutes and agendas,” Murphy adds.

“Keep the public in the dark, that’s the DOH motto,” Wrench says.

Sarah finishes drawing a straw hat a young boy that looks remarkably like Huckleberry Finn. “Maybe what we do is find out where they live –”

“Shit, they know where we live.”

“We get a bunch of us together, show up at their houses, bring cameras and recorders and some megaphones, and ask’m what’s up.”

“They’ll call the cops.”

Sarah smiles. “Good. Then the press will do something and won’t that be nice.”

“One thing,” Wrench says. “If we do this, we send out an email to everybody we know’n we make sure DOH ain’t on the email list.”

“Keep’m in the dark.”

A Renegade NYS Agency

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There are, as you might guess,  state and private agencies who put great effort  into convincing the public at large that they truly care about the people they serve and are working very very hard to meet their needs. Peel back a  few layers of public-relations spin and you will oftentimes find nothing could be further than the truth. Too often the motive is to look rather than do good, and raise a little money while you’re at it.

A few people I work closely with are beginning to look deeper into the activities of a non-profit agency. As those of you who read this blog already know, the NYS Department of Health is a problem in nearly every sense of the word when it comes to the lives of brain injury survivors in the state. However, in fairness to the DOH, it does not fall into the category of an agency who tries to look good. It makes little to look good at all because it is hard to determine who is actually holding them accountable. They are an arrogant renegade state agency if their ever was one. The way they treated the TBISCC (Traumatic Brain Injury Services Coordinating Council) earlier this month reeks of arrogance.

The TBISCC, to its credit, has asked the DOH to speak on the problems with Medicaid Fair Hearings being faced by brain injury survivors on the state’s TBIU Waiver because the DOH last year gave a verbal directive blocking their case managers from advocating for them at the hearings. The day before the TBISCC’s meeting on April 14, the DOH notified TBISCC Chair Michael Kaplen that no one would be available to discuss the matter.

Now, this writer and others wrote to the DOH’s  Cheryl Veith asking her to put us on a several years old email-list that tells the public when the TBISCC is having its public meetings and sends out agendas and minutes when they become available. Apparently the DOH has decided the mailing list was too friendly. Ms. Veith responded with “We have recently implemented a process whereby announcement of scheduled TBICC meetings, minutes of the last meeting, and a draft agenda for the next scheduled meeting will be posted for the public to view on the Department of Health website at: www.nyhealth.gov/events/meetings/index.htm.”

Some who live with brain injuries live with memory deficits, processing challenges, and more. Wading through a website can be tantamount to climbing Mt. Everest without oxygen.  This fact has been shared with Ms. Veith and other DOH officials like Deputy Commissioner Mark Kissinger, Mary Ann Anglin, Lydia Kosinski and Carla Williams, all of whom will do their level best to convince anyone who crosses their path that they really really really care about brain injury survivors. So far, a large number of survivors and their families and healthcare professionals who work hard to help us think that’s bunk.

Reinstating the email list is, to use a phrase right out of the ADA, a reasonable accommodation for those of us who live with brain injuries. I doubt they will reinstate it   because for some time now there are two words no one links to the NYS DOH: reasonable and accommodating.

NYS DOH Evasiveness, the BI Council & Unpaid Providers–Part II

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NYS Department of Health numbers released at last week’s meeting of the TBISCC (Traumatic Brain Injury Services Coordinating Council) reveal that TBI Waiver providers across the state may not be getting paid for nearly 11 percent of those individuals on the waiver. The DOH figures for March reveal that while there were 2,839 people were on the waiver, only 2,527 were billed for and 312, or 10.98 percent to be precise, were not.

In every region in the state it appears waiver providers are doing significantly more work than they are getting paid for, a fact the DOH was and is quick to blame on anyone but the DOH.  Some of the numbers are staggering. In New York City it seems providers are not getting paid for nearly 22 percent of those on the waiver with 374 enrolled and only 293 getting billed for. In Long Island providers were not paid for 14.2 percent of their waiver participants and in the Binghamton/Southern Tier region they were not paid for 12.29 percent.

While TBISCC chair Michael Kaplen pressed DOH officials at the meeting for an explanation of the numbers’ discrepancies, both Kaplen and DOH Official Maribeth Gnozzio speculated that the reasons for the discrepancies in the numbers may the responsibility of anyone but the DOH itself.  Gnozzio was more generous with her finger pointing, placing the reason for the discrepancies at nearly everyone’s feet but the DOH’s. She blamed the counties, delays in billing, lapses in service coordination, and fair hearings. Kaplen, on the other hand, speculated that the reasons may some are on the waiver who don’t need to be and others may not getting waver services. However, Kaplen made it clear the issues was a significant one when he said, “This is a huge number to go unaccounted for.”

Kaplen said, “If you have a discrepancy, and I’m just going to use Syracuse (with) approximately 40 individuals (that providers have not been paid for), it means… it could mean that some of these individuals don’t need services and that’s why there’s no billing and they really should be examined to determine whether or not they need to be on the waiver. It’s also possible being that some of these individuals need services and are not getting services and that’s why there’s no billing taking place. But I think there would be important to look at both of those items.”

This writer can tell you that he cannot remember single instance of a provider refusing to give services to a survivor. Moreover, both Gnozzio and Kaplen failed to mention what may well be the primary reason for the differences in the enrollment and billing numbers. When CMS (Centers for Medicare & Medicaid Services) recently audited the state’s waiver, they made it clear that providers could not bill until the received signed approval in the form of an NOD (Notice of Decision) from the DOH. Sources from around the state make it clear the DOH is often slow off the mark in signing NODs and some, including this writer, think at times this may be by design. Providers are only allowed to back-bill 90 days. So, if the NOD takes four to five months to get signed by the DOH, the providers lose one to two months of revenue they’ve truly earned.

The following are the regional numbers provided in the chart provided to the TBISCC by the DOH:

Syracuse: 321 enrolled, 287 billed for.

Rochester: 492 enrolled, 463 billed for.

NYC: 374 enrolled, 293 billed for.

Lower Hudson Valley: 236 enrolled, 212 billed for.

Long Island: 246 enrolled, 211 billed for.

Capital District: 356 enrolled, 324 billed for.

Buffalo: 273 enrolled, 257 billed for.

Binghamton/Southern Tier: 301 enrolled, 264 billed for.

Adirondack: 240 enrolled, 216 billed for.

 

Actions Speak Louder than… (you know the rest)

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Last year I had a face to face meeting with three officials from the New York State Department of Health: Mark Kissinger, deputy commissioner, Mary Ann Anglin, Division Director, and Carla Williams,  a deputy director and tough-guy wannabe.

Our conversation at the time, one the three officials insisted not be recorded, probably because Williams knew she was going to launch into what can best be described as laughable attempt to be intimidating, revolved around the state’s decision to sign a contract that would allow Timothy J. Feeney back into the state’s TBI waiver knowing full well he misrepresents his credentials. The contract was signed with STIC (Southern Tier Independence Center) in Binghamton. “STIC’s the one that’s on the hook” said Williams, mustering up a dramatically poor imitation of a snarling delivery. “If they don’t live up to the contract it’s on them.”

I left the meeting thinking there may have been at least some sincerity in their claim that survivors would be treated well and with respect and my oh my how all three said they cared so much. I was wrong, though, even now, I think Anglin might. I say I was wrong because Feeney while operating under the contract and being paid by your tax dollars continues to misrepresent his credentials and even though a complaint was filed with the DOH, they have not responded.  Why? They simply don’t care.

Don’t believe me? Ask them. Write to Kissinger at mlk15@health.state.ny.us or Anglin at Maa05@health.state.ny.us or Williams at Crw03@health.state.ny.us

If you want some real fun, write to the DOH’s Beth Gnozzio who issued a directive in a phone conference that TBI Waiver staff are not allowed to appear in support of their clients in Medicaid Fair Hearings. As her why she and the DOH refuse to put this directive in writing? Gnozzio can be reached at mjg07@health.state.ny.us

And copy me if you’d like. peterkahrmann@gmail.com