Brenda M. Harvey Monday, May 21, 2007

Those are tough words. Personal and likely offensive, especially when I use them to describe an editorial that appeared in the Kennebec Journal on May 16.

They are also apt.

It's easy to take shots at the faceless workers in state government who toil in near anonymity until something goes wrong -- trying to do the right thing and help some of Maine's most vulnerable residents.

What's harder is to get the facts and present them fairly. But that's the expectation for a paper of the KJ's quality.

In its May 16 editorial, the Kennebec Journal attacked the state and specifically those who are working diligently to both deliver a fully-functional computer system to Maine and work with providers to process current Medicaid claims.

Powerful, negative words led the editorial. As is sometimes the case, the opinion piece did not tell the full story.

Maine has had a difficult time with the computer system that process Medicaid bills from doctors and other service providers. That much of the story is true.

Contrary to what the editorial would have the public believe, the system processes 96 percent of new claims correctly -- this surpasses the industry standard for commercial insurance. In addition, of the claims that are currently unpaid, almost half of them are less than 90 days old and 99 percent are paid within 180 days.

It's not perfect, but we aren't throwing up our hands and giving up either. We are working with providers -- the ones who are willing -- to make sure they get paid.

The last paragraph suggests that a 14-year-old "diabolical genius could figure this one out." Perhaps hyperbole has no bounds.

Unlike a home computer that can be fixed by many of its users, or at the very least by a local PC or big-box store, the needs of the state computer system and the requirements that are mandated by the federal government are complex.

Meeting federal requirements is critical and moving in a new direction by hiring an outside contractor to manage the system is Maine's best and fastest opportunity to satisfy these requirements.

A certified system will allow Maine to match every state dollar with two from the federal government. With these dollars, we help more than 270,000 Mainers access medical and long-term care services.

Despite the improvements we've made in billing, the system must be replaced. There are certain things that the system must be able to do in order to meet the federal government's requirements and to assure their financial participation in the future.

The current system can't do them all and may never be able to do so. We must move toward a new system.

A new system can't be put in place overnight. It's not a question of ordering a couple of Dells online and plugging them into the wall.

The reality is that a three-year timeline is based on the experience of states that have recently completed the process. If we don't set realistic and responsible timetables, we'll be a lot more likely to repeat the mistakes of the past.

We understand the hardship that has been placed on the providers of Medicaid. And we all feel the frustration oozing from the KJ's editorial.

The staff at the Office of MaineCare Services works hard every single day to help providers on a case-by-case basis to solve their problems. That's not going to change, no matter how many names we're called.

It's difficult to stand idly by while these hardworking, dedicated and committed people are called incompetent, which could not be further from the truth.

Medicaid billing is detailed and complex. I am confident that these issues will be resolved by those who are in the trenches today -- people who I am proud to call competent colleagues.

Brenda M. Harvey is Commissioner of the Maine Department of Health and Human Services.