In twin actions, federal and state officials on Thursday suspended enrollment by elderly Coloradans with the state’s largest provider of community-based home health care after concluding the company failed to deliver medically necessary services to patients.
Officials with the federal Centers for Medicare & Medicaid Services (CMS) told the president and CEO of Denver-based InnovAge on Wednesday that the agency is halting the provider’s ability to enroll Medicare beneficiaries in the program effective Dec. 23.
The agency said it made the decision after an audit discovered deficiencies in InnovAge’s delivery of care.
“Consequently, CMS has determined that the seriousness of these deficiencies requires the suspension of any new enrollments of Medicare beneficiaries into InnovAge CO,” the federal agency said in a letter sent to Maureen Hewitt, President & CEO of InnovAge.
The Colorado Department of Health Care Policy and Financing followed suit, notifying Hewitt on Thursday that the state is also suspending the company’s enrollment of Medicaid patients in Colorado’s Programs of All-inclusive Care for the Elderly.
The sanction, which applies to InnovAge’s six centers in the state, doesn’t affect the provider's existing patients, who will continue to receive services from the company. But it puts Colorado’s senior citizens who live in a county where InnovAge is the designated program provider – and who have yet to enroll – in a quandary. They will need to seek care elsewhere.
Colorado’s health program for residents 55 and above who need nursing facility level of care offers comprehensive health services to residents with a goal of allowing them to live in their community so long as it's medically and socially feasible. The program provides primary care and emergency services, among other things.
As of December, InnovAge provides services to more than 3,500 Medicaid members in the Colorado program.
In a statement, InnovAge, the Denver-based company that is also the nation’s largest provider of this type of care, said it is working with health officials to resolve issues.
“As a healthcare provider in a highly regulated industry, InnovAge has established protocols to cooperate with and fully support regulatory measures. Our primary concern is always the health and safety of our participants in every market we serve,” the company told Colorado Politics. “We are focused on working closely with CMS to expeditiously address and resolve the points they’ve identified.”
The Colorado attorney general is also investigating the company after it paid back $13.6 million this year to Colorado’s Medicaid program amid the audits by state and federal regulators. InnovAge had disclosed the audits and the Colorado repayments in its Sept. 23 annual report to the federal Securities and Exchange Commission.
The company's shares fell sharply in Thursday's trading following news of the sanction.
In its letter, the Colorado health agency outlined the results of its own separate audit, which concluded that InnovAge failed to “provide all Medicare and Medicaid covered services, as well as other services determined necessary by the interdisciplinary team to improve and maintain the participants' overall health status.”
The audit also said InnovAge failed to ensure access and adequate services to meet patients’ need; that its interdisciplinary team failed to coordinate 24-hour care delivery, and track and share important information; and, its primary care providers failed to manage participants’ medical needs and facilitate access to medical specialists.
State officials have asked InnovAge Colorado to submit a plan to correct the deficiencies identified in the audits and said the sanction will stay until the state and federal health agencies overseeing the program are “collectively and individually satisfied” that the provider has corrected the violations’ causes and demonstrated they won’t recur.
Marc Williams, a spokesperson for the Department of Health Care Policy and Financing, acknowledged the conundrum that some older Coloradans face following InnovAge’s enrollment suspension.
Providers of the state program operate based on geography – meaning residents living in counties under InnovAge's purview cannot enroll until the sanctions are lifted.
Williams told Colorado Politics that senior citizens needing care will need to contact their county’s single entry points – the entities that provide case management – to figure out alternative ways to access the care they need.
“The most important thing is that folks get the appropriate care and the help they need,” Williams said. “Unfortunately, we couldn’t allow these kinds of poor care to continue just to allow more folks to receive poor care.”
The state’s healthcare agencies launched the audit into InnovAge CO’s operations in May last year. Federal authorities began a separate audit a month after.
Both audits found similar deficiencies.
The federal audit said the failures occurred because the company failed to schedule or delayed scheduling appointments for necessary services, including urgently needed care in some instances; failed to adequately follow-up on pertinent information, such as diagnosis and recommendations from specialists; and, its clinical staff failed to share important medical information with the interdisciplinary team.
Federal officials asked InnovAge Colorado to submit a plan to correct the deficiencies by Jan. 6, 2022. The state gave the company 30 days to respond and also submit a plan.
Federal authorities earlier barred InnovAge’s Sacramento, Calif., operations from enrolling new Medicare-funded patients. The agency said an audit found problems including that the firm “failed to provide medically necessary items and services to participants’ needs, and that those failures adversely affected or had the substantial likelihood of adversely affecting its participants.”
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Colorado-based health care provider for seniors sanctioned over failure to deliver services - coloradopolitics.com
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