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In Laconia, Medicaid Commission hears downside of managed care, a blizzard of paperwork

LACONIA — When the Governor's Commission on Medicaid Management, the panel convened to oversee the introduction of managed care of the state's Medicaid program, met here last week commissioners for the first time heard from providers of the administrative burdens and clinical issues arising from the transition.

Since December 1, when the managed care program began, 110,526 Medicaid patients have enrolled in one of three managed care organizations (MCOs) — Well Sense, N.H. Healthy Families and Meridian. The enrollment includes those receiving physical and mental health benefits. The program is scheduled to be extended to those receiving long-term care — the developmentally disabled and elderly — and those treated for substance abuse in December, 2014, though the target is unlikely to be met.

The commission began meeting in May, well in advance of the start of program, but Katie Dunn, director of the Medicaid program at the New Hampshire Department of Health and Human Services (DHHS), said that the concerns expressed were the first the commissioners had encountered.

Ken Norton, executive director of NAMI (National Alliance on Mental Illness)-NH, agreed that two months into the program "some of the real life problems are coming to the surface."

Christine Thompson, a nurse at Genesis Behavioral Health in Laconia, described managed care as "the most time cumbersome and time-consuming process ever." In particular, she said that she spent some two hours on the telephone, much of it on hold, when seeking prior authorization for a specific medication only to have an unhelpful three-minute conversation with a representative of the MCO. "it's getting to be ridiculous," she said. "We're not giving our clients what was promised."

Maggie Pritchard , executive director of Genesis, said that because the MCOs are not familiar with the treatment plan of clients, they require excessive documentation for granting prior authorization for medications and services, including in the case of one patient 32 pages of records. Such requirements may lead to delays in providing clients with the medications they need, compromising their care, as well as impose burdens on staff. Pritchard feared the MCOs may require prior authorization for every contact with clients, which she said would "reduce care and increase paperwork."

Eugene Friedman, the chief financial officer of Genesis, said that as a result of such incidents the agency not only incurs an unnecessary cost but also forgoes a valuable revenue. He explained that that when clinical staff are engaged in resolving operational problems they are not providing the clinical services, for which the agency is reimbursed.

Prior to managed care, Friedman explained, Genesis billed New Hampshire Medicaid, but since must also bill the three MCOs, each with a different billing procedure. Moreover, reimbursements have not been timely, placing pressure on the agencies cash flow. He advised other providers to "have your line of credit in order."

Noting that reimbursement rates have not risen but fallen, Pritchard added that Genesis "has drawn on its credit line more than ever" since the advent of managed care.

Clyde Terry , chief executive officer of Granite State Independent Living, echoed Friedman's concerns about the increased administrative overheads managed care imposes on the already strapped budgets of providers. Likewise, as a provider of long-term care to the developmentally disabled he feared that the MCOs may question the necessity of many of the services his agency provides. He urged the commission expand the definition of "medical necessity" to include those personal services that enable the developmentally disabled to live with independence and dignity.

Two parents of autistic children told the commission of their ordeals in securing medications. Denise Colby recalled she spent eight weeks getting approval from Well Sense for an oral steroid that costs $450 a month out-of-pocket. Meanwhile, it took the MCO nearly as long to approve an appointment with an specialist to address her son's eating disorder. "I have a 5-year-old son who weighs 32 pounds and only eats Goldfish crackers," she said, "and he could not get the help he needed. It has been one headache and heartache after another."

Another man said that he encountered similar obstacles in seeking authorization for medications for his autistic daughter, whose mood swings, he remarked with a mix of empathy and levity that drew laughter from his listeners, placed a strain on the household.

Mary Vallier-Kaplan, former vice-president of the New Hampshire Endowment for Health who chairs the commission, and Donald Shumway, chief executive officer of Crotched Mountain Rehabilitation Center, the co-chair, urged anyone, — providers, parents and patients — with similar experiences to share them with the commission and call the hotline at DHHS (1-800-852-3344, extension 4344).

Last Updated on Saturday, 08 February 2014 01:24

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And you thought the Great Rotary Derby was all about fishing?

MEREDITH — If any proof is needed that The Great Rotary Fishing Derby is about more than just success at landing a fish through the ice, the example of Jim Dyer of Meredith and Mike Jakubens of Manchester offers convincing evidence that it is really about something more.
The two long-time friends have been taking part in the derby for over 30 years and maintain steadfastly that they have yet to land a single fish during the derby, although one year they did almost pulled a landlocked salmon, (which would have been illegal) through the ice.
But that lack of success hasn't dimmed their enthusiasm for the derby. They were out on the ice with their girlfriends, Cheryl Plumeau of Manchester and Angie Libbey of Meredith, Friday morning, standing next to their shelter (where the temperature inside was close to 100 degrees) and lighting a fire in their barbecue grille while sipping Pabst Blue Ribbon beers.
They said they had started their morning with mimosas (champagne and orange juice) along with their breakfast and were looking forward to a fun weekend of socializing with their fellow ice fishermen while enjoying meals of steaks, sausages, chicken and burgers.
''We've even got a bathroom potty in the second tent and have Internet out here thanks to the Wi-Fi from the hotels. We have everything we need,'' said Jakubens, who sells lumber for Boise Cascade to independent lumber dealers throughout the state and, along with Plumeau, who works in customer service for TCI, a Manchester firm which sells coated teflon products, spend as much time as they can fishing in Lake Winnipesaukee year round.
''I keep a boat at Awka Soleil (now Meredith Bay) and another in Alton,'' says Jakubens, who says that he and Plumeau like fishing for salmon in the spring and lake trout and rainbow trout the rest of the year.
Dyer, who used to live in Milford and lives on Tucker Mountain Road in Meredith and works at Webster Valve in Franklin says he moved to Meredith last year and has been fishing in Lake Winnipesaukee ever since he can remember.
''I moved up here so I could be closer to my boat,'' says Dyer, who also fishes year round in Winnipesaukee. Libbey, who grew up in Portland, Maine, says she hadn't fished for years until she started going with Dyer a few years ago and is just now getting into ice fishing and finding that she likes it although she hopes to enjoy more success than Dyer and Jakubens have had.
''Jim got me back into fishing and it's a great experience out here,'' says Libbey, who works in the health field taking care of the elderly.
Also out on the ice Friday morning and celebrating their 10th year with ''The Lodge'' at the derby were Peter Muse of Meredith and ''Captain Bob'' Myshrall of Center Harbor. Muse, who owns the the stylish hunting lodge style bob house, was working on a cleaning a fitting for the gas fireplace, which was keeping the structure toasty warm.
Muse said that the Pabst Blue Ribbon 30-packs with 16 ounce cans seemed to be the default choice of most ice fishermen in Meredith Bay, although The Lodge did have a 24-pack of Labatt beer that had been left behind by a team of grateful Canadians who took part in last weekend's Pond Hockey Tournament and were allowed to use the bob house over the weekend.
The Lodge has been honored in the past as the best bob house on the bay and about five years ago attracted a lot of attention when a hot tub was set up next to it and the resident ice fishermen delighted onlookers by donning bathing suits and jumping into the tub on days when temperatures were in the mid teens while other Lodge regulars played horseshoe games nearby.
Betsey Donovan, chairman of this year's Great Rotary Fishing Derby, says that ticket sales are excellent this year.
''We've gone over 2,000 for the first time in 8 or 9 years,'' says Donovan, who attributes the increase to a revised format which was adopted for last year's derby, which eliminated the tagged rainbow trout as the only possible winner category for the top three prizes, opened the derby up to any of seven species and switched to cash only prizes.
Now, the largest fish of each of the eligible species (white perch, yellow perch, cusk, lake trout, pickerel, black crappie, or rainbow trout) will be entered in the grand prize drawings, and a grand-prize winning fish can be caught in any fresh water body in the state open to the public.
The three top prizes will be awarded to the angler with a valid Derby ticket whose name is drawn on Sunday during the Grand Prize Drawing. First prize is $15,000, second prize is $5,000, and third prize is $3,000. Those who had the largest fish in each category on either Saturday or Sunday of Derby Weekend will be eligible.
There will also be drawings hundreds of dollars in cash prizes throughout the weekend for all derby ticket holders, whether they fish or not.
The two-day ice fishing competition is one of the top fund-raising events in the state, enabling The Meredith Rotary Club to donate a total of more than $1.5 million back into the community for charitable projects, area improvements, scholarships, and families in need over the last 34 years.




Angie Libbey and Jim Dyer of Meredith and Cheryl Plumeau and Mike Jakubens of Manchester are ready for a weekend of ice fishing n Meredith Bay during the annual Great Rotary Fishing Derby. (Roger Amsden photo for the Laconia Daily Sun)


Bob Myshrall of Center Harbor and Peter Muse of Meredith stay warm inside Muse's bob house ''The Lode'', now in its 10th year on the ice at Meredith Bay for the Great Rotary Fishing Derby. (Roger Amsden photo for the Laconia Daily Sun)


Bob Myshrall, right, of Center Harbor and former Meredith resident Steve O'Brien, left, stand next to ''The Lodge'', one of the most well-known bob houses on Meredith Bay. (Roger Amsden photo for the Laconia Daily Sun)

Last Updated on Saturday, 08 February 2014 01:11

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All rise, the Honorable Christopher Hobbs presiding

LACONIA — Even though he's only 8-years-old, Christopher Hobbs wants to be a judge.

Yesterday, he got his chance when Belknap County Superior Court Judge James O'Neill first met with him in his private chambers and then let young Christopher preside over his courtroom — if ever so briefly.

When he was 2 1/2 years old, Christopher was diagnosed with pilomuxoid astrocytoma — a malignant brain tumor.

Since his diagnosis he has surgery three times — most recently on January 15 — and undergone a year-long treatment of chemotherapy.

Despite this, Christopher keeps plugging along. Always fascinated by public safety, when he was 4-year-old he was made an honorary police officer and got to get behind the wheel of the police van and used the lights and siren.

Recently, said mom Leah Hobbs, the Laconia boy has been intrigued by courtrooms and judges.

"We taped every show on judges we could find while he was in the hospital and he's been watching them non stop since he got home," she said.

Christopher was able to return to school but yesterday got a special dispensation in order to meet Judge O'Neill and preside in his courtroom.

After assuring O'Neill he would never get in any trouble, he sat upright in the judge's chair. When court resumed, Christopher and his family stay behind to watch O'Neill in real action.

Last Updated on Saturday, 08 February 2014 01:05

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Police station project draws no comment at Gilford deliberative session

GILFORD – About 50 residents attended last night's deliberative session and with few exceptions, none had anything to say about the operating budget, the money portion of the proposed union contract with police, or the proposed $1.213-million police station renovation.

Although police were prepared, a majority of those who were there voted against seeing the presentation from them. Lt. Kris Kelley said the entire presentation he gave to the Board of Selectmen and the Budget Committee is on the Gilford Website and is also being run on Lakes Region Public Access Television.

Town Administrator Scott Dunn added that in the time since the warrant article was approved, the town had gotten a $169,000 federal grant that will pay for the the dispatch upgrades, the emergency generators and the Emergency Operations Center.

Chan Eddy pointed out that the EOC will also double as a community room when the police or fire departments are not using it for emergencies. Kelley said it will serve a triple purpose as a training room – something the department doesn't have right now.

Voters had no questions or comments on the $11,282,896 operating budget which will be put on the warrant as is.

In addition, voters had no questions about the $3,297 cost item for the Gilford Police Association Contract with the exception of Budget Committee Member Dave Horvath Sr. who wanted to know if the dollar amounts would be the same now that the Gilford Police Department will be adding an 18th police officer.

Dunn replied that it would be about the same because although there will be an additional employee, there has been some personnel adjustments within the department that will lower the costs to the contract.

The second part of the Annual Town Meeting will be held on March 11 when the electorate votes for the individual warrant articles and for town officers.

Last Updated on Friday, 07 February 2014 02:34

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