FUND.

SUPPORTING HEALTHCARE FOR MINNESOTANS STATEWIDE.

>> ERIC: LARRY FITZGERALD IS HERE TO TALK WNBA LABOR NEGOTIATIONS AND VIKES' FREE AGENCY TRADES, AND OUR POLITICAL PANEL WILL HELP US BREAK DOWN THE WEEK IN POLITICS.

>> CATHY: BUT FIRST, THIS WEEK GOVERNOR WALZ PROPOSED MAJOR CHANGES FOR THE MINNESOTA DEPARTMENT OF HUMAN SERVICES TO DEAL WITH FRAUD, SHIFTING MEDICAID WORK FROM PRIVATE HEALTH CARE COMPANIES AND COUNTIES TO THE STATE, CREATING HUNDREDS OF NEW POSITIONS AT DHS.

THE PROPOSAL ROLL-OUT RECEIVED CRITICISM, INCLUDING FROM THE GOVERNOR'S OWN PARTY.

HERE TO TALK MORE ABOUT THE PLAN, DEPARTMENT OF HUMAN SERVICES DEPUTY COMMISSIONER JOHN CONNOLLY, WHO IS ALSO THE STATE MEDICAID DIRECTOR.

THANKS FOR SPENDING FRIDAY ?IGHT WITH US.

>> GOOD TO BE WITH YOU.

>> Cathy: APPRECIATED IT.

TO MORE OF A CENTRALIZED CONCEPT, RIGHT?

AND I CAN HEAR SOME OF OUR VIEWERS SAYING, DOESN'T THIS ADD TO A BLOATED BUREAUCRACY ON THE STATED LEVEL?

HOW DOES THIS ACHIEVE YOUR GOAL OF TRANSPARENCY AND ACCOUNTABILITY?

>> THAT'S A GREAT QUESTION AND I THINK IT DOES IN FACT ACHIEVE THOSE AIMS.

SO RIGHT NOW WE HAVE A HIGHLY DELEGATED AND A HIGHLY FRAGMENTED SYSTEM AND IT'S REALLY ABOUT TRANSFORMING THAT SYSTEM.

THROUGH A CONTRACTED SERVICE ORGANIZATION AND BRING ELIGIBILITY AND ENROLLMENT FUNCTIONST FOR THE MEDICAID PROGRAM INTO THE STATE.

SO IT'S A MORE CONSISTENT, TRANSPARENT, AND EFFICIENT SYSTEM AS A WHOLE.

IT'S NOT JUST ABOUT D.H.S.

IT'S ABOUT ALL THE ACTORS IN THE SYSTEM.

>> Eric: WHAT DO YOU DO TO PREVENT FRAUDSTERS FROM SIGNING UP PEOPLE AT WILL AND THEN NOT PROVIDING ANY SERVICES?

>> SO I THINK THAT REQUIRES A VARIETY OF ACTIONS.

IT STARTS WITH THE DESIGN OF LEGISLATION, BENEFITS AND PROGRAMS.

IT'S ABOUT ENHANCED PREPAYMENT REVIEW WHICH THE DEPARTMENT HAS INITIATED.

IT'S ABOUT ENHANCED POST-PAYMENT ACTIVITY, OING AUDITING, REFERRING CREDIBLE ALLEGATIONS OF FRAUD TO THE INSPECTOR GENERAL FOR INVESTIGATION.

AND IT'S REALLY ABOUT MAKING SURE THAT WITH THIS PROPOSAL, I THINK THE GOVERNOR IS AGAIN ROOKING AT STANDARDSZATION, SO THE DEPARTMENT CAN HAVE BETTER OVERSIGHT AND VISIBILITY INTO THE OPERATIONS STATEWIDE F WHAT'S HAPPENING IN THE MEDICAID PROGRAM.

>> Cathy: THE DEPARTMENT'S BEEN UNDER FIRE, OBVIOUSLY.

AND I'M WONDERING WHY ADD THIS RESPONSIBILITY TO AN AGENCY THAT'S ALREADY KIND OF STRUGGLING?

>> WELL, AGAIN, I THINK IT'S ABOUT THE SYSTEM.

AND SO WE LOOK AT HOW THE DIFFERENT ACTORS ARE DOING THEIR WORK.

THIS IS A SERIES OF BOLD PROPOSALS TO RELOOK AT THE ENTIRE SYSTEM OF ACTORS AND LOOK AT HOW WE CAN DO THE WORK AS A COMMUNITY, AS A GROUP OF ACTORS IN THE MEDICAID PROGRAM MORE EFFICIENTLY.

SO IT'S ABOUT THOSE LINES OF VISIBILITY.

A STANDARDIZED EXPERIENCE FOR THE MEMBER AND HOPEFULLY WITH BETTER SERVICE QUALITY.

AND AGAIN, MORE CENTRALIZED OPERATIONS.

>> Cathy: SO WITH THE MANAGED CARE ORGANIZATIONS THAT HAVE DONE THE WORK TO THIS POINT, RIGHT, THE GOAL WITH THEM WAS TO SAVE MONEY.

SO HOW MIGHT THIS SAVE MONEY?

>> SO I THINK, AGAIN, WE HAVE EIGHT MANAGED CARE PLANS UNDER CONTRACT IN THE MEDICAID PROGRAM.

WE'VE GOT 87 COUNTIES DOING THE WORK.

AND SO WE CAN BE MORE EFFICIENT IF WE STANDARDIZED UNDER ONE CONTRACTOR, THE ADMINISTRATIVE SERVICE ORGANIZATION, HOW WE SET PAYMENT RATES, HOW WE PROCESS PAYMENT, HOW WE SET UTILIZATION MANAGEMENT POLICY AND HOW WE SERVE PEOPLE.

>> Cathy: AND DO THESE ORGANIZATIONS THEN LOSE THEY, IF THEIR CONTRACTS ARE GONE, THEY'LL MONEY ON THIS DEAL; IS THAT CORRECT?

>> SO CERTAINLY WE WOULD NOT BE FUMING CONTRACTS WITH THE MANAGED CARE ORGANIZATION.

>> Eric: HOW IMPORTANT IS AN UPGRADE IN COMPUTER TECHNOLOGY?

>> O MODERNIZATION IS A KEY PIECE OF THE GOVERNOR'S PROPOSAL AND IT'S A HUGE NEED.

WE CERTAINLY HEARD ROM COUNTIES AND TRIBAL NATIONS THAT USE OUR SYSTEMS AND WE CERTAINLY UNDERSTAND THEY NEED MODERNIZATION.

SO WE AREN'T SATISFIED WITH THE STATE OF OUR INFORMATION SYSTEMS AND WANT TO WORK WITH COUNTIES, EXTERNAL PARTNERS AND HAVE VENDORS TO MAKE IMPROVEMENTS.

>> Eric: SOUNDS LIKE THERE'S AN AMBITIOUS PLAN TO HAVE A STUDY THAT'S MORE COMPREHENSIVE THAN THE WHOLE SITUATION, THE WHOLE EPISODE OF WHAT'S GOING ON?

OR TELL US ABOUT THAT?

>> THAT'S RIGHT.

SO IN ADDITION TO THE MANAGED CARE PIECE AND THE ADMINISTRATIVE SERVICE ORGANIZATION TRANSITION, THERE'S A LOOK ALSO AT ELIGIBILITY FOR THE PROGRAM AS A WHOLE.

SO PROGRAM ELIGIBILITY, ELIGIBILITY FOR LONG-TERM SERVICES AND SUPPORTS FOR OLDER ADULTS AND PEOPLE WITH DISABILITIES.

LOOKING AT WAIVER CASE MANAGEMENT, CASE MANAGEMENT FOR AGAIN PEOPLE WITH DISABILITIES.

AND THEN LOOKING AT THE SYSTEM AS A WHOLE AND LOOKING, AGAIN, AT HOW COUNTIES, TRIBAL NATIONS, AND THE STATE CAN WORK TOGETHER IN A BETTER WAY THAT'S MORE STREAMLINED AND REALLY ELEVATES THE QUALITY OF SERVICE THAT PEOPLE GET.

>> Cathy: PLENTY OF PUSHBACK TO THIS.

IT'S ALMOST LIKE YOU'RE GOING TO ROLL THIS BOULDER UP THE HILL IN A SENSE.

SO WHAT'S YOUR ARGUMENT TO LAWMAKERS WHO ARE SKEPTICAL?

>> WELL, AGAIN, I THINK THIS IS A SERIES OF BOLD PROPOSALS.

WE'RE ACKNOWLEDGING I THINK AS YOU'VE SAID, WE'VE HAD CHALLENGES.

WE'VE DONE A LOT OF WORK IN THE LAST YEAR AND A HALF, A LOT OF NEW PROCESSES, A LOT OF I THINK STRENGTHENED FUNCTIONS IN THE DEPARTMENT.

AND THIS REALLY TAKES THAT JOURNEY A STEP FORTH AND LOOKS MORE BROADLY JUST BEYOND INTEGRITY AND REALLY REIMAGINES THE SYSTEM.

AND SO THIS IS AN INITIAL SET OF BOLD PROPOSALS, BUT CERTAINLY LEGISLATORS WILL HAVE THEIR OWN IDEAS.

THE GOVERNOR ALWAYS HAS A PROPOSED BUDGET AND IT'S THE START OF A CONVERSATION.

>> Cathy: DO WE KNOW HOW LONG, IF INDEED YOU'RE SUCCESSFUL, I MEAN, HOW LONG WOULD THIS TAKE TO ROLL THIS OUT?

>> SO SEVERAL YEARS.

SOME OF THESE PROPOSALS WILL TAKE AFFECT AS THE GOVERNOR'S PROPOSED THEM IN 2028, SOME IN 2029, SOME AS LATE AS 2032.

>> Eric: WE'LL WATCH AND SEE HOW THE BILLS PROGRESS.

TIME IS OF THE ESSENCE.

>>