Case Study of Maine's Medicaid System

In 1996 the Health Insurance and Accountability Act (HIPPA) was signed into law. The states had until October 1, 2002 to comply with the new law. This law required states to comply with its new patient privacy and security standards. According to the official website provided by the U.S. Department of Health and Human Services, HIPPA is explained as:

The HIPPA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.

This is a tall order to fill, and as mentioned earlier, all 50 states had a deadline of October 1, 2002 to comply with these new requirements. As the 1990s ended, Maine began to plan on the overhaul of its Medicaid claims processing system in order to meet the proposed deadline, and to meet the requirements of HIPPA. Even though the case study does not make mention of it, the states also had to contend with Y2K and were not sure how it would affect its emergency services. Piled on top of that were the HIPPA compliance requirements. Poor IT staff must have been pulling their hair out and drinking massive amounts of coffee to stay ahead of the curve, if that was even possible.

Case Study 3

Maine's Plan

Let us return our attention back to Maine and its attempt to become HIPPA certi...

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...rms that required 30 to 40 fields of information, 300,000 froze claims within the first two months, and errors in payment. Another mistake would be the lack of training for the participant's staff.

Case Study 9

Along with the complicated form, the lack of training led to the overpayment to doctors totaling $9 million. The state had to recover the overpayments. The delay in requesting help was a major mistake. XWave might have been able to "right the ship" faster than they did had they been called in earlier.

Conclusion

Both the state and CNSI made huge mistakes. Those mistakes resulted in the overruns required to complete the project. They finished their Medicaid claims form and security system some 72 months behind schedule. I hope that Maine, along with CNSI learned a valuable lesson so that mistakes like this can be avoided in the future.