CMS document cache #1: Waiver renewal, responding to criticism

March 3, 2013

On January 22, the Department of Health and Human Services (HHS) released 229 documents in response to the FOIA lawsuit that Public Record Media (PRM) filed in federal court late last year. See our previous post for more background on our litigation.

Our initial FOIA request sought three categories of data from the Centers for Medicare and Medicaid Services (CMS), the component of HHS responsible for disbursing Medicaid funds to states:

1. Any and all memoranda, correspondence, or communications – in paper or electronic form – between employees or officials of CMS, and Minnesota State Senator John Marty;

2. Any and all memoranda, correspondence, or communications – in paper or electronic form – between employees and/or officials of CMS related to Minnesota State Senator John Marty;

3. Any and all memoranda, correspondence, or communications – in paper or electronic form – between employees and/or officials of CMS, produced between January 1, 2011, and February 1, 2012, related to determinations made by (CMS) about Minnesota’s 1115 Medicaid waiver status.

The documents that comprised the first HHS data cache are all un-redacted, and largely involve procedural matters relating to the evaluation and renewal of Minnesota’s 1115 Medicaid waiver. A smaller sub-set of documents relates to criticism of the management of Minnesota’s public health care programs, including concerns raised by Minnesota State Senators John Marty and Sean Nienow. These public programs receive federal funds under the 1115 waiver, and are administered by non-profit managed care organizations (MCOs).

The following is an overview of key documents contained within the HHS data cache.

Letter from Senator Sean Nienow, Senator Marty’s office, others – Aug 9, 2011
The August 9 letter thanks Richard Jensen and other CMS staffers for participating in an August 2 teleconference to discuss concerns related to the renewal of Minnesota’s 1115 Medicaid waiver. The letter extends thanks to CMS staff for making changes to the “Special Terms and Conditions” section of the waiver’s reporting requirements.

The letter goes on to note that while the undersigned parties applaud the addition of the new reporting requirements, they are also curious to know whether there will be independent audits of Minnesota’s 1115 waiver programs, since the new requirements only involve self-reporting by the participating MCOs. The letter states that, “The Minnesota group would appreciate a response from CMS on whether or not an independent audit will be conducted in Minnesota. If not, why?”

“Ongoing PMAP + Stakeholder concerns” e-mail
An undated e-mail from Jennifer Sheer of CMS notes the existence of “a number of letters and e-mails … expressing concern over the renewal of the PMAP demonstration” and solicits a discussion regarding two particular letters.

The CMS document cache contains several letters asking CMS for a more thorough review of the state’s public health care programs. Several other letters oppose the extension of Minnesota’s 1115 waiver. Letter writers include:

Alejandro M. Aguirre, member of the Board of Trustees of the Minnesota Dental Association.

Lisa Niles, MD; Executive Director of the Minnesota Universal Health Care Coalition.

Linda Hamilton of the Minnesota Nurses Association.

Letter from Donald Berwick, MD to Governor Mark Dayton
This undated letter from Donald Berwick of CMS to Minnesota Governor Mark Dayton sets out criteria to be met in order for CMS to renew Minnesota’s 1115 Medicaid waiver. According to Dr. Berwick’s letter,

“On March 10, 2011, Minnesota submitted to the Centers for Medicare & Medicaid (CMS) its revised extension for its section 1115 demonstration, entitled Prepaid Medical Assistance Project Plus (PMAP+) (11-W-00039/5), which is due to expire on June 30, 2011 … I am pleased to inform you that based on our discussion regarding your proposal, we are eager to partner with you. The proposal appears to further the objectives of title XIX by expanding coverage to additional needy individuals.”

Dr. Berwick further states that program expansion can only occur if the state agrees to modify two program elements. He notes that the state must remove the six-month waiting period for non-state residents, and allow an option for “adult-without-children” recipients to self-declare citizenship.

Letter from Cynthia Mann to Davd Godfrey, Jun 30, 2011
The letter announces that CMS has accepted the extension of Minnesota’s 1115 waiver, subject to the implementation of certain changes. Ms. Mann notes that the waiver will be in force on July 1, 2011, and will continue until Dec 31, 2013.

Letter from David Godfrey to Cynthia Mann, July 27, 2011
The letter states that Minnesota accepts the 1115 waiver extension, including all of its conditions. Mr. Godfrey further details the changes that the state plans to undertake in order to comply.

Letter from Senator Marty to Cynthia Mann, Jan 26, 2012
This letter from Senator Marty to Cynthia Mann of CMS inquires about when – and whether – CMS will take action to investigate alleged improprieties in Minnesota health plan spending. According to Senator Marty’s letter,

“When we are talking about billions in federal and state funds and some potential fraud, one would hope to see CMS immediately step in to investigate the situation and audit the program, yet I cannot even get a return call from your office … Many low income Minnesotans are not receiving the care they need, and the public deserves to know that their taxes are being wisely spent.”

Senator Marty’s letter is copied to B. Todd Jones, the U.S. Attorney for Minnesota, Lucinda Jesson, Commissioner of the Minnesota Department of Human Services, and David Godfrey, Minnesota Medicaid Director.

The bulk of the remaining documents relate to the implementation and verification of the changes to Minnesota’s public health care programs that were sought by CMS.

PRM will continue to post summaries of additional HHS documents as we receive them.