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Statement of Beverly Tran to the U.S. House of Representative Ways and Means Committee, Subcommittee on Income Security and Family Support Hearing to Review the Use of Child Welfare Waiver Demonstration Projects to Promote Child Well-Being

Statement of Beverly Tran to the U.S. House of Representative Ways and Means Committee, Subcommittee on Income Security and Family Support Hearing to Review the Use of Child Welfare Waiver Demonstration Projects to Promote Child Well-Being

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Published by Beverly Tran
Statement to U.S. Ways and Means Committee on Title IV-E Waiver Demonstration Projects to Promote Child Well-Being continuance addressing issues of the lack of Medicaid regulation in child welfare.
Statement to U.S. Ways and Means Committee on Title IV-E Waiver Demonstration Projects to Promote Child Well-Being continuance addressing issues of the lack of Medicaid regulation in child welfare.

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Categories:Types, Letters
Published by: Beverly Tran on Aug 15, 2010
Copyright:Attribution Non-commercial

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10/25/2012

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Honorable members of the U.S. House of Representatives, Committee on Ways andMeans, Subcommittee on Income Security and Family Support, my name is Beverly Tranand I come to participate in the discussions of 
The Use of Child Welfare Waiver  Demonstration Projects to Promote Child Well-Being 
as An Original Source.
Introduction
A general consensus has resounded throughout the testimonies that being a needfor financial reform, but the foremost question before this body is, “Have the waiversworked?” Yes. The waivers have elevated the need for financial child welfare reform tothe national agenda, but have failed to demonstrate the most serious nature in the promotion of child well-being, which is the need for transparency and accountability.It is a novel concept to believe the child welfare industry operates without anyflaws but reform may only be formulated with an expansion of waivers.
Improving Access to Home and Community-Based Services
Expansion of the scope of waivers must go beyond the Title IV-E rule of construction funding stream to become more inclusive of demonstration projects whichmust incorporate transparency and accountability in the area of Medicaid.
1
Traditionally, the only way for children and individual family members to accessneeded services and resources (
i.e.
housing, medical, transportation, education,employment) has met by Title IV-A poverty-means testing, the eligibility criteria for child welfare services, statistically reported as neglect. Much of the time this eligibilitycriteria leads to unnecessary and improper removals of children to be placed in long-termsituations of foster care. The purpose of Home and Community-Based Services (HCBS)is to provide targeted benefits to keep children in the least-restrictive and most integratedsettings based upon States’ Medicaid options of financial eligibility, respective of FederalPoverty Level.In addition, HCBS provides an enhanced opportunity for child welfare waiver demonstration projects under Medicaid provisions for the new features of the 1915(i)Benefit. With that said, consideration must now be given to the redirection of Title IV-Efunding streams to Medicaid for the purposes of implementing, for the first time in thehistory of this nation, regulation of the child welfare industry.
1
Letter dated August 6, 2010 from the Center for Medicaid, CHIP, Survey & Certification to the StatesMedicaid Director informing of several changes to Section 1915(i) of the Social Security Act(the Act) made by the Affordable Care Act (ACA)
1
. These changes, which become effective October 1,2010, include revised and new 1915(i) provisions for removal of barriers to offering home and community- based services (HCBS) through the Medicaid State plan. This letter is intended to provide States guidanceon those important changes to the law.
 
Capacities for Medicaid Regulation to Improve the Well-being of Children
1
.
Child Welfare Exclusionary Database
:
Even though there is a comprehensive plan for Medicaid program integrity
2
with the exclusionary program, it does not includethe Targeted Case Management,
3
the largest component of child welfare services.Revenue-maximizing schemes in child welfare manifest in a multitude of complex shapesand forms, yet continue to go undocumented.The heaviest weighted reason there is no background for Medicaid provider eligibility or exclusionary database reporting for child welfare providers is, under Freedom Of Information Act (FOIA) exclusions and exemptions, any information dealingwith a child is protected, under seal, including the management and quality of services provided. Furthermore, child welfare agencies are, for the most part, non-profit and privatized
4
, meaning they are automatically accredited by Quasi-GovernmentalOrganizations
5
which advocate for further exclusions of external audit and qualityimprovements in the delivery of services as a charitable organization.In the event a child welfare agency was found to be ineligible as a child welfareservices provider, the remedy is to reorganize under a different name, for there is limitedto no competition in local regions, allowing rates to be set without comparability toquality and delivery of services with other regions. These actions and inactions set thestage for fraud, waste and abuse in child welfare services which artificially generatenational statistics presenting a false façade for the current well-being of children.
2. Electronic Health Record Technology
:
Currently, data reporting andwarehousing incidences of child abuse and neglect
6
should be considered suspect asstudies continuously “mimic”
7
  previous methodologies, lacking in identification of errors,obstacles and barriers to reliability and validity. There has never been anyacknowledgement of kickbacks, false claims and other classifications of unallowable or questionable cost reimbursements of the States.
8
Electronic Health Record (EHR)
9
2
The Centers for Medicare and Medicaid (CMS), Medical Integrity Group (MIG) published the May 19,2010 memorandum report:
 Excluded Medicaid Providers: Analysis of Enrollment 
, OEI 09-08-00330, providing information on States' enrollment procedures for eligible Medicaid providers.
3
Child Welfare League of America,
Targeted Case Management (TCM) and Rehabilitative Services For Children in Foster Care, May 2007.
4
Internal Revenue ServicePublication 4221-NC, 
Compliance Guide for Tax-Exempt Organizations (other than 501(c)(3) Public Charities and Private Foundations
)
5
Council on Accreditation Standards for Private Organizations and Public Agencies,
 Eight Editions.
6
Sedlak, A.J., Mettenburg, J., Gasena, M., Petta, I., McPherson, K., Greene, A., and Li, S.. (2010)
 Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress.
Washington, DC: U.S.Department of Health and Human Services, Administration for Children and Families.
7
 
 Ibid 
, p. A-24, referring to the replication of methodologies of previous NIS publications.
8
Michigan Auditor General,
 Financial Audit Including the Provisions for the Single Audit Act of the Department of Human Services,
October 1, 2002 through September 30, 2004, documenting the first in aseries of escalating child welfare services program questionable and unallowable costs in foster careservices.
9
The Center for Medicaid and State Operations letter to States Medicaid Director dated September 1, 2009,SMD # 09-006 ARRA HIT #1, providing initial guidance on section 4201 of the American Recovery and
 
technology is severely constrained in documenting unallowable and questionable costs inchild welfare services as demonstrated in the
ad hoc
queries of the Office of Inspector General Health and Human Services evaluations, reviews and litigation.
Meaningfuldata reporting and maintenance may only be established through further waiver demonstration projects to improve the well-being of children, for there the repercussionsof false claims in child welfare are met with a slap on the wrist.Funding mechanisms are currently in place to feasibly implement EHR to properlyreport the status of the well-being of children receiving services of child welfare under the States Medical Integrity Program, but the States must still be encouraged to establishassurances for reporting violations in child welfare programs and Medicaid to the StatesMedicaid Fraud Control Units.
3. State Medicaid Fraud Control Unit 
s
: In the arena of child welfare, there are noState provisions which penalize the States Medicaid Director for not reporting violationsof law, including Medicaid fraud, to the States Attorney General, who heads up theMedicaid Fraud Control Unit
,therefore, violations of the material provisions of federalor state laws would not necessitate exclusion from the Medicaid providers program asassurances for the reporting of other States agencies outside its Medicaid Directorsauthority.States need to be encouraged to establish statutory assurances to prosecute andrecover child welfare program frauds. As it stands in Michigan, there is no authority toenforce statutory assurances for reporting suspected violations of law to the Counties prosecutor or Attorney General.
4. Whistleblower Protections:
It is the authority of the States Attorney General(or in the case of approved exemptions) to prosecute and recover Medicaid fraud, but notall States have False Claims Acts, or False Claims Acts that encourage reporting from thegeneral public or that include whistleblower protections for government employees. Inmany instances, dedicated and caring child welfare workers are penalized for simplytrying to improve the well-being of children in the care of the States.
5. Original Source Protections:
There are established reporting mechanisms for violations of inter-country adoptions, yet there is nothing in existence for compliance tothe Interstate Compact on the Placement of Children
 nor the Interstate Compact on
Reinvestment Act of 2009 (Recovery Act), Pub. L. 111-5 which establishes a program for payment to providers who adopt and become meaningful users of electronic health records.
10
 
11
It must be noted that there are some States that do not house its Medicaid Fraud Control Unit in its Officeof Attorney General.
12
TRAN v. RUFFIN, Office of Children’s Ombudsman, Michigan Court of Appeals # 291799, 2009.
13
U.S. Department of Health and Human Services Office of Inspector General Interstate Compact on thePlacement of Children:
State Structure and Process
, OEI -02-95-00041.

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