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Proposed Alaska regulations threaten Medicaid program

Amanda CoyneThe New York Times

Prior to the 1960s, there was a saying in the state about the various states of mind of Alaska’s citizens. You could be “Inside, Outside, or Morningside,” the latter referring to the nightmare of an Oregon-based asylum that housed nearly 3,500 Alaska citizens throughout the years, some of whom were lost to the place forever.

Morningside closed in 1961, but it took until the late 1980s for the state of Alaska make a statement about how the state would deal with those who needed help. Unlike nearly every other state in the country, Alaska would become institution-free community, leaders decided. Developmentally and otherwise disabled Alaskans who needed care would begin to be sent home or to community centers that resembled homes, ones that offered bedrooms with doors instead of bars and real meals served around real dining room tables.

To this end, a medication management program called Mediset was created in the state, one that’s paid for through Medicaid, a joint federal- state program for low-income Alaskans. The program serves roughly 2,000 Alaskans and is now on an Alaska Department of Health and Social Services chopping block, according to those who administer the program.

Medication management can be confusing, particularly for people who have cognitive disabilities and want independence. Mediset helps with such independence. Instead of a maze of different pharmacies and different pharmaceuticals, the program involves doctors working with community-based pharmacies to ensure that patients get exactly the right drugs at the right times. The drugs are also delivered by pharmacy staff to patients, who often can’t get to the pharmacy themselves.

According to various agencies across the state, the program is vital to patients’ success. But it’s a program that will be at risk of being shuttered if new regulations proposed in September by the Alaska Department of Health and Social Services (DHSS) are adopted.

Chad Hope, from the state agency, who helped write the regulations, says that the program can continue, but now it will be open to any pharmacy -- albeit at a lower reimbursement rate.

“The department proposed the regulations for a number of reasons to ensure appropriate and adequate reimbursement for providers,” he said.

Others aren’t so sanguine about the program’s future if the regulations are enacted.

Renae Axelson, a compliance officer with Geneva Woods Pharmacy, a community-based pharmacy and home-care center that works with the program says that “doing away with this program very much threatens the overall healthcare outcomes of recipients.”

Other agencies say that they’re worried about whether or not they can continue serving clients if the regulations are enacted and the community-based pharmacies are no longer able to administer the Mediset program. Theresa Briskey, Administrator of Marlow Manor, an assisted living facility for seniors in Anchorage, said that cutting the program threatens her facility.

“I don’t know how we would conduct business,” she said. “We would have to hire additional nursing staff, and that’s just not realistic.”

Hope said that DHSS proposed the changes to Mediset to stay abreast of national trends, including the slew of federal regulations that are forthcoming under ObamaCare.

However, more and more states as well as the federal government are moving to such programs because they ultimately help patients stay out of emergency rooms. It’s also unclear why DHSS didn’t reach out to the agencies prior to proposing the regulations.

“It was very surprising to us,” said Katrena Betts from ARC of Anchorage, an organization that serves those with disabilities. ARC heard about it from another agency. “It was news to us and our staff and the families of those we serve,” Betts said.

Hope said that the regulations will save the state a little bit of money. In a letter to Health and Social Services, however, Kim Warner, president of Geneva Woods, questions that economic analysis. She said that multiple studies have shown that such medication management is key to reduced hospitalizations.

“If this proposed regulation stands, economics will cause a dramatic change to the deliver of medication in the home health care systems that will result in higher costs to the state Medicaid program,” she wrote.

Contact Amanda Coyne at amanda(at)alaskadispatch.com