July 17, 2006

Report Assails State on Program for Disabled

By RICHARD PÉREZ-PEÑA

New York State has prevented thousands of disabled people from receiving equipment like walkers and wheelchairs, by delaying or denying their requests in violation of state and federal rules, according to an investigation by the State Assembly.

The situation has improved somewhat since the problems came to light 18 months ago, says the report, which is to be released today. But the report strongly asserts that the underlying problems at the state’s Department of Health remain.

The report also supports charges made by patients, doctors, physical therapists and equipment vendors: that ever since the department eliminated the Medicaid office in New York City that handled most of the claims in the state, there have been too few people processing requests, many of those people are not qualified to do the job, and the staff reviewing the requests consistently finds flaws that do not really exist.

“Whether this has been caused by callous pursuit of short-term savings, negligence or incompetence, the results are cruelty and long-term increased costs,” says the report, written by four Assembly Democrats — James F. Brennan of Brooklyn, Richard N. Gottfried of Manhattan, Sam Hoyt of Buffalo and Amy Paulin of Scarsdale.

Robert Kenny, a spokesman for the department, said the agency was not prepared to address many of the specific points in the report, but he took issue with some of the findings.

“This is a report with dated information that does not consider a number of improvements that we made,” Mr. Kenny said.

The department’s critics insist that improvements have been marginal. And the Assembly investigation, which was prompted by an article in The New York Times last year, received so little cooperation from the department, the report says, that it was hard to gauge the agency’s progress. For instance, the investigators say they still do not know how many people are processing Medicaid claims for items classified as durable medical equipment.

Many of the people who rely on Medicaid for the equipment are profoundly disabled, with conditions like cerebral palsy or paralysis from accidents. The requests, about 20,000 a year, range from small items, like a long-handled mirror one woman needed to insert a catheter into her bladder, to expensive items like wheelchairs.

After the New York City office closed in October 2004 and its functions were moved to Albany, some doctors and therapists who order the equipment said, approvals of equipment requests halted for months, and then resumed at a trickle. For many patients, that meant being trapped in their apartments or using ill-fitting or broken devices.

The Department of Health at first denied that the move had hindered its ability to operate the program. Then it said the Albany office was enforcing rules on documentation that the New York City office had ignored. Then it blamed a flood in the office for the delays.

Later, the report says, department officials acknowledged that — at least at first — they had quadrupled the workload of the Albany office without increasing its staff.

Some requests were denied, it said, while in other cases the department would approve a cheaper piece of equipment that the doctor and the patient considered inadequate.

But more often, the report went on, the department was late in responding, and then it would classify the requests as “pending” and return them, calling them incomplete and demanding more proof. In many cases, the documentation sought had been included in the original request or was not required by the state’s regulations.

Often, requests would be returned repeatedly, and doctors, therapists and patients reported waiting up to a year for equipment; others gave up. According to the report, one major supplier told Assembly investigators that the average wait for approval from a private insurance company was under 10 days, but the average wait for approval from Medicaid was 168 days.

The Assembly charged that the department had routinely violated its own rule requiring a response to each equipment request within 21 days. And the department’s computer system is so dysfunctional, the report said, that the agency cannot say with confidence how the durable-equipment program is operating.

Mr. Kenny, the department spokesman, said, “There is no current backlog and all requests that are complete with all necessary documentation are processed within 10 to 14 days, and often within a day for emergency approvals.”

But that, say the department’s critics, addresses only the 21-day requirement, and that problem continues, although now it may be less severe.