North Carolina's Unfair Taxation Problem. Part I
North Carolina's Unfair Taxation Problem. Part II
US Senator Kay Hagan introduces Anti-Fraud Software proposal on the Senate Floor. This Software will help eliminate Billions in National Medicaid and Medicare Fraud.
GOP Caucus Proposes Tax Reform, Spending Principles
Sunday's column on tax reform mentioned the General Assembly's Republican Joint Caucus proposal for tax and spending reforms. The proposal, outlined in a news release under the names of House Republican Leader Skip Stam of Wake, NC Senate Republican Leader Phil Berger of Rockingham and Joint Caucus Leader Eddie Goodall of Union.
Proposed Principles for Job Creation through Tax and Spending Reform:
1.) The concept of substantially reducing personal and corporate income tax rates and sales tax rates is good. If that reduction is accomplished by broadening the base in a revenue neutral way, that is the right way to go. But it raises four major issues.
2.) Neither the public nor Republicans trust Democrats to keep the rates low. There must be a mechanism to ensure this. Two possibilities:
a) A Constitutional amendment limiting the state sales tax rate at 3% + and the county sales tax rate to an equivalent. The Constitution currently specifies a 10% limit on tax on net income.
b) A Statute that sets out as a Rule of Order, applicable to each House, that an increase in the rate must be separately passed by both Houses and signed by the Governor, and cannot be combined with any other matter unless by a 2/3 vote of each House.
3.) The base widening must delete the exemptions and refunds which are in current law for political reasons/not because of true economic considerations.
4.) Tax Reform must include spending reform that has passed the House in the past – zero based budgeting, and must include:
a) Procedural reforms must allow “off budget” sources of revenue to be considered as
part of the budget process.
b) The minority party is entitled to proportionate representation on the Budget
Conference Committee.
c) The Governor’s proposed budget must only include the amount of revenue
collected in the prior year (with a recession exception).
5.) In determining what is “revenue neutral” the temporary taxes imposed in 2009 shall be treated as if they had expired.
6.) We should also look at other reforms that take advantage on behalf of our citizens as federal taxpayers of federal deductibility issues. This could save our citizens $1 billion a year in federal income taxes.
Anti-Fraud Software included in NC State Budget
NC State Rep. Paul Stam's proposal to buy anti-fraud software for Medicaid was included in the state's budget.
Early in the legislative session, Stam, an Apex Republican, pitched the idea that buying software meant to prevent fraud before Medicaid payments are made could save millions every year.
The idea has been previously pushed, particularly by Republicans. Stam said he found a more receptive audience among the Democrats who wrote the budget this year since the state was facing a deficit.
"I think what changed is they were desperate for money and they realized if they were going to be short on Medicaid money they had to stop wasting so much of it," Stam said.
U.S. Sen. Kay Hagan is pushing an amendment to federal health care legislation that would implement similar software meant to prevent billions of dollars of fraudulent claims.
US Senator Kay Hagan: NC Tools Prevent Fraud, Waste
U.S. Sen. Kay Hagan (Dem) says a North Carolina initiative and software sold by a Cary company could save billions in wasted and fraudulent health care expenses.
Hagan was speaking on the Senate floor Tuesday in support of an amendment to the health care reform package that is meant to lower costs by preventing fraud and waste.
Hagan spoke in favor of a program meant to catch Medicare and Medicaid fraud before payments are made, rather than having investigators try to recover spent money. SAS has written software that would catch irregularities that suggest fraud before payments are made, she said.
Hagan also spoke in favor of bringing a state program to the national level. ChecKmeds NC, a program of the N.C. Health and Wellness Trust Fund, provides free consultation with seniors about their medications. The cost of patients not following doctors' orders on medications is $290 billion a year, Hagan said.
In the state's program, seniors bring all their vitamins, prescriptions and over-the-counter medications to a participating pharmacist who offers a review and consultation.
Pharmacists discuss ways to save money by switching medications or potential problems and pitfalls with combinations of medications. Hagan said the program, which served 15,000 seniors in 2007, saved $10 million and avoided countless health care problems.
NC State owes Feds $300 Mil for Medicaid Overbilling
The State of NC must repay about $300 million to the Federal Government for overbilling Medicaid.
Starting last November, public hospital Medicaid payments were improperly billed to the federal government rather than to a state account, according to the NC State Department of Health and Human Services, Lynn Bonner reports.
The state has agreed to repay $200 million by the end of the month, and the rest by the end of the year.
"This mistake should not have been made," NC DHHS secretary Lanier Cansler said in a statement. "Originating almost eight months ago, it should have been identified and reported earlier. I have discussed the matter with the Governor, and I am aggressively working to strengthen the internal controls and will take whatever other remedial actions may be necessary."
North Carolina Slashes Medical Assistance Funding For State's Poorest Citizens
Legislative leaders who monitor North Carolina’s mental health system are surprisingly positive after negative actions they took last month to close a budget hole.
They’re pleased with new Department of Health and Human Services leaders who oversee treatment for more than 300,000 mentally ill patients, substance abusers and the developmentally disabled.
However, spending cuts for treatment reaching as high as $400 million this fiscal year mean there’s no doubt patients will lose local treatment options and see other services curbed.
“I’d be optimistic if we didn’t cut the budget 20 percent,” said Dave Richard, executive director of the Arc of North Carolina, which advocates for the mentally disabled. “You can’t do what they’re doing without hurting thousands upon thousands of people in the state.”
The cuts had to be deep, according to Democrats who calculated the budget gap for this year at more than $4 billion. But improved cooperation with the department helped prevent patient cuts from getting worse, said Sen. Martin Nesbitt, D-Buncombe.
“We now have people we can work with,” said Nesbitt, co-chairman of the Legislature’s mental health oversight committee. “This (reduction) is what we had to do to preserve the system.”
The good feelings contrast with eight years of frustrations and setbacks for a mental health reform effort that a legislative watchdog agency said in July ultimately wasted up to $635 million in government money on one initiative alone.
The positive vibes are traced to Secretary Lanier Cansler, who was hardly a newcomer when Gov. Beverly Perdue appointed him in January. The former House member, from Buncombe County like Nesbitt, was deputy secretary during then-Gov. Mike Easley’s first term before a brief consulting career.
Under Easley, the department struggled to carry out a 2001 law designed to shift the state’s mental health programs away from institutional care to community-based treatment offered by private providers.
Lawmakers and advocates clashed with the department under then-Secretary Carmen Hooker Odom because they said she didn’t seek their input enough. But advocates say Cansler wasn’t part of the problem.
Relations improved in late 2007 when Dempsey Benton, a career bureaucrat in state and municipal government, succeeded Hooker Odom and pledged to fix the department. But his time was short and marked by the fallout from hospital patient deaths and hemorrhaging cash with the Community Support program.
Cansler, a Republican in a Democratic administration, seemed to have bipartisan support on the oversight committee last week. Nesbitt said he had never seen committee members listen so intently to a department secretary.
“I think we’ve got somebody that’s very capable,” said Rep. Fred Steen, R-Rowan, a committee member who acknowledged the panel has been accused at times of micromanaging.
Cansler acknowledged current cuts, among them $55 million less to “local management entities” that evaluate patients and find them community treatment, a $16 million reduction for in-home services and lower Medicaid reimbursement rates for providers, will hurt families and those that treat patients but his agency is working to minimize the harm.
“There will be some Providers out there that will not survive,” Cansler said. “There are going to be repercussions and there’s no way to avoid it when you take $350, $400 million out of the system.”
Cansler talked about a new effort to provide more financial accountability within the department and get divisions to work together to meet common goals.
He’s also hired outside the department, a Tennessee behavioral health consulting firm director, a Lumberton hospital executive and Sandhills-area local treatment manager among them, to take key mental health positions.
“Sometimes when you have a new set of eyes with a different background, different understanding, you see issues that those who have been within the forest for many years don’t see,” Cansler said during a break in last week’s meeting.
The good relations were tested in last week’s oversight meeting, the first since the session ended.
Legislators complained how Cansler’s department allocated $55 million in cuts to the 24 local management entities.
They spent most of the afternoon peppering new state Medicaid director Dr. Craigan Gray over the phaseout of the Community Support program, which provides non-medical care for 33,000 mental health patients living at home.
The Legislature agreed to eliminate the program by next June after a series of unflattering reviews that found overpriced care — such as paying $61 per hour to take clients to the movies or shopping.
But lawmakers were worried that patient transition to other treatment programs left out more fundamental assistance like teaching patients life skills.
By meeting’s end, Cansler said the department would provide more data to legislators to help them decide if they believed lower-skilled treatments needed to be restored, according to Nesbitt.
Nesbitt quipped: “Isn’t that refreshing?”
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Sources: McClatchy Newspapers, Under The Dome, News & Observer, Charlotte Observer, Daily Southerner, Wikipedia, Youtube, Google Maps
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