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Governor Ivey announces new Medicaid long-term care program

Brandon Moseley

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Monday, Alabama Governor Kay Ivey (R) announced that the federal government has approved a new statewide care-management program to complement and enhance the state’s current system of long-term care services provided to approximately 23,000 Alabama Medicaid recipients.

The Integrated Care Network (ICN) program was approved by the Centers for Medicare and Medicaid Services (CMS) on September 12, 2018, to offer more community options for Medicaid long-term care recipients. The ICN program is for Medicaid recipients who live in a nursing facility, or receive services in their homes through Medicaid’s Elderly and Disabled (E&D) waiver or the Alabama Community Transition (ACT) waiver.

“This is a significant step in our efforts to transform the delivery of services to Medicaid recipients,” Gov. Ivey said. “My goal remains to ensure that all Alabamians receive high-quality health care, no matter their economic status,” Governor Ivey said. “We will continue to work with CMS to improve our Medicaid system and look for new, innovative ways to bring quality health care to our citizens, especially those in rural Alabama.”

Alabama Medicaid Commissioner Stephanie Azar said, “Over the last few years, Medicaid has been working with the Legislature, CMS and many stakeholders to develop a long-term care program that responds to the needs of these recipients while being sustainable under the state budget. I appreciate the Centers for Medicare and Medicaid Services for approving Alabama’s plan.”

Commissioner Azar praised the efforts of state Senator Greg Reed (R-Jasper), who in 2015 introduced legislation to create the ICN.

“Senator Reed has championed the development of this initiative that will not only help Medicaid recipients now but will lay the foundation to meet future needs in the state,” Commissioner Azar said.

The ICN program, the state will implement a system of case management, outreach and education, with the long-term goal of increasing the percentage of Medicaid recipients receiving in-home care rather than living in a nursing home facility. The Alabama Select Network will administer the program under a contract with the state’s Medicaid agency.

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The Alabama Select Network has an address of 3008 Seventh Avenue South in Birmingham. Ronald Chaffin is the Chief Executive Officer.

SeniorSelect Partners is owned by a group of investors representing 28 providers and 120 skilled nursing facilities. The company has two wholly owned subsidiaries: Simpra Advantage, a Medicare Advantage plan with an institutional special needs plan (I-SNP) and Dual-Eligible SNP; and Alabama Select Network, LLC, which was formed to participate in the Alabama Medicaid Integrated Care Network (ICN) managed LTC program.

“To me, the most important part of it was the provider-owners themselves — who were investors and going [to be] at risk for this — decided this was really an opportunity to make themselves more relevant in the health care environment,” Chaffin told Skilled Nursing News. “It starts as a defense mechanism, but then it turns into: ‘We’re a responsible provider, we’re multigenerational owners, we see an opportunity here to invest and become more relevant in health care delivery.’”

Skilled nursing operators have found benefits in providing I-SNPs and are increasingly considering moving into the insurance space.

“If the state’s going to go in the direction of managed care, there should be recognition that provider-sponsored plans will do the same things [as insurers’ plans], but they’ll probably be more in touch with the beneficiaries that they serve because they’re already serving those beneficiaries,” Chaffin said.

The program does not change any Medicaid benefits, but will help recipients learn about and apply for services available to them, such as medication management, support for independent living, or help to manage or prevent illness or accidents.

Medicaid recipients and potential recipients can learn more about long-term care services available to them by calling 1-800-243-5463.

Medicaid is the most expensive portion of the state’s general fund budget and is a joint federal and state program that provides healthcare services for: low income children, lower income pregnant women, the disabled, as well as caring for disabled persons needing long term care services. It is hoped that offering more home healthcare options will allow seniors and the disabled to stay in their homes longer.

(Original reporting by Skilled Nursing News’s Maggie Flynn contributed to this report.)

Brandon Moseley is a senior reporter with eight and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.

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Health

Madison County seeing surge of COVID-19 hospitalizations, ambulance calls

Eddie Burkhalter

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Dr. Pam Hudson, the CEO of Crestwood Hospital, speaks at a city briefing Wednesday. (CITY OF HUNTSVILLE)

A surge of COVID-19 cases in Madison County troubles the CEO of Crestwood Hospital, who said the public needs to take the virus seriously and do what’s needed to slow the spread by wearing masks and practicing social distancing. 

Madison County added 66 new COVID-19 cases Wednesday, when the county’s total case count hit 1,620. Though Madison County had largely been spared through the early months of the pandemic, with very low case counts and deaths, over the last week, the county has reported 563 new cases — a 53 percent increase.

“Our county cases continue to climb,” said Crestwood Hospital CEO Dr. Pam Hudson, speaking at a briefing Wednesday.

“We have to flatten the curve again,” Hudson said.

Hudson said the percentage of tests that are positive in the county used to be much lower, but are now in line with the state’s current percent positivity rate of 9.92 percent. The percent positivity was 13.52 percent on Wednesday, based on fourteen-day averages of case and test increases. She said the county’s hospitals are very busy. 

“We were already busy before we had this uptick,” Hudson said. 

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There were 1,110 COVID-19 patients being cared for statewide Wednesday, the highest number since the start of the pandemic. 

Paul Finley, the mayor of the city of Madison, said there were 163 COVID-19 patients Wednesday in the Crestwood and Huntsville Hospital systems, which is a 31 percent increase from last week.

“There’s no question that these numbers continue to rise,” Finley said.

Hudson said, on average, the hospital is running at between 80 and 90 percent capacity.

“Our ambulances yesterday had their greatest number of runs since this started,” Hudson said, adding that in about 20 percent of calls staff is having to wear full personal protective equipment. “That indicates that they are working with patients who have symptoms that could be compatible with COVID.” 

A face mask order for the public went into effect Tuesday in Madison County. Similar orders are in effect in Jefferson County, Montgomery, Mobile, Selma and Tuscaloosa.

Last week Madison County had 500 people who tested positive for COVID-19 and were under active quarantine and being tracked by the Alabama Department of Public Health, Hudson said. On Wednesday that number was 847.

“So things are not all well in our county,” Hudson said. “COVID-19 has gained, and is continuing to gain footholds in our community.” 

Hudson said she believes the spike in cases and hospitalizations in the county comes down to people not wearing masks in public, not practicing social distancing and bars and restaurants, which are hotspots for the virus’s transmission. 

Hudson reiterated a statement made by Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases and a member of the White House’s coronavirus task force, that up to 40 percent of coronavirus cases are caused by someone who is infected and has no symptoms, and one in 10 COVID-19 patients need hospitalization, Hudson said. 

“So this is not a nothing disease. Thirty percent of those patients who are hospitalized will end up in an ICU,” Hudson said. “And of those, 30 to 40 percent will die.” 

Local hospitals are “bumping up into some challenges” with the availability of ICU beds, Hudson said, and the medical staff is under strain and the threat of becoming infected themselves every day.

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Health

UAB expert: We can’t wait until it’s too late to act on surging cases

“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” UAB specialist Dr. Jodie Dionne-Odom said.

Eddie Burkhalter

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UAB's Dr. Jodie Dionne-Odom, an infectious disease specialist, spoke to reporters Wednesday about surging cases and hospitalizations in Alabama. (UAB HOSPITAL)

Alabama continues to see record numbers of new COVID-19 cases and hospitalizations, and the best way to turn the trend around is to wear face masks and practice social distancing, a UAB doctor says. 

Dr. Jodie Dionne-Odom, an infectious disease specialist at UAB, told reporters in a press conference Wednesday that the seven-day average of new daily coronavirus cases in Alabama has increased fourfold over the past several weeks. 

“We still are at a time point when we have an ability to intervene, and do something to reduce that case count, to reduce the eventual mortality,” she said. “You don’t want to wait until things are so bad that it’s difficult for us to reverse the trend at all.”

Dionne-Odom said she’s concerned that the window of time to turn the trend of increasing cases, hospitalizations and the impending deaths that will surely come is limited. Wearing masks in public and practicing social distancing are some of the best tools we have to do so, she said.

On Wednesday, the state added 1,161 new COVID-19 cases and 25 deaths from the virus. It’s killed 1,032 people in Alabama, the UAB physician said. At least 1,110 people were being treated in hospitals in the state Wednesday, according to the Alabama Department of Public Health, the most since the pandemic began.

The 14-day average of new daily cases was 1,057 — the highest it’s been since the start of the pandemic. 

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“The fact that we’re seeing these sharp increases and hospitalization in cases over the past week or two is really concerning,” Dionne-Odom said. “And we expect, given the lag that we know there is between cases and hospitalization — about a two-week lag, and a three-week lag between cases and deaths — that we’re on a part of the curve that we just don’t want to be on in our state.”

UAB Hospital’s COVID-19 intensive care and acute care units were approaching their existing capacity Tuesday, when the hospital was caring for 92 coronavirus patients. The hospital had 91 inpatients who had been diagnosed with COVID-19 on Wednesday.

Of those being treated in UAB’s COVID-19 ICU unit Tuesday, less than half were on ventilators, a UAB spokesperson, Bob Shepard, said in a message to APR on Tuesday. Ventilator usage is actually dropping, he said, a positive sign. The hospital has both a COVID ICU and a COVID acute care unit designated to keep patients separated from those who don’t have the virus, but it has more space in other non-COVID units.

“If we reach a point where we have more patients needing space in either unit, we will create more space in other areas of the hospital and designate additional beds for COVID patients,” Shepard said.

“The issue is that designating more beds for COVID care reduces the number of beds we have for patients with non-COVID illnesses, which can have a profound effect on the overall health of our community,” he said.

That flexibility was echoed by Dionne-Odom, who said that it is the type of system where they can create capacity as it’s needed. 

“And we have units that we can open and close and take care of patients with COVID and staff who are familiar with the procedures of wearing PPE and gowning and keeping healthcare workers safe,” Dionne-Odom said. “So we’ve used everything that we’ve learned since March, working really hard to be able to take care of more patients. That said, you have to remember that every bed that we’re using today for someone with COVID can potentially be a bed that someone else would need, who’s having a stroke or having a heart attack.” 

“These problems are continuing to happen, and they need ICU-level care too,” she continued. “So we don’t want to continue to see an increase in the COVID cases because that has the indirect effect of affecting how we care for all the other patients with serious diseases.” 

Dionne-Odom said that they know from experience that some of those being hospitalized for the virus will die in the coming weeks, “so we’re all watching the next several weeks very cautiously.” 

Testing across the state has increased in recent weeks, but so has the percentage of tests that are positive, a sign that not enough testing is being done, and cases are going undetected. 

Dionne-Odom said many cities across the southeast have high testing positivity rates of between five percent and 15 percent, and in some cases as high as 20 percent.

“And what that number means is when you’re getting one of five tests back positive, is that there’s a lot of spreading infection in the community that you are not detecting,” Dionne-Odom said. 

Alabama’s seven-day percent positivity rate was 14.69 on Wednesday. Public health experts say it should be at or below five percent or cases are going undetected. 

In Jefferson County, as of Wednesday, the percentage was roughly 14 percent.

While the majority of hospitalized patients are older, UAB does have COVID-19 patients in their 30s who are very ill and in ICU units, Dionne-Odom said.

“So the message is still true that this disease tends to impact older adults more than younger adults, but if you’re 20, 30, 40, especially if you have an underlying condition, but even if you don’t, you’re not immune from this disease. You’re still at risk of having severe outcomes,” Dionne-Odom said.

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Under cloak of secrecy, dark money nonprofit targets Birmingham law firm

From the beginning, Forbes’s “BanBalch.com” website set out to tarnish the law firm by claiming to expose “unsettling controversies surrounding Balch & Bingham,” much of which stems from allegations, inference and speculation.

Bill Britt

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A mosaic of headlines from Forbes's website, which attack the Birmingham law firm Balch & Bingham.

A California-based, dark money organization has set up shop in Alabama. It appears the move has substantially improved the group’s financial outlook and altered its core mission.

Because of the group’s federally protected status, it is impossible for the public to know who is pouring cash into Consejo de Latinos Unidos — translated as United Latinos Council — but a state tax lien and its CEO’s website may offer a peek at what might be hiding behind the nonprofit’s dark-money veil of secrecy.

Founded in 2001, and originally headquartered in Los Angeles, CDLU’s stated mission, according to reports was to “foster, encourage and develop educational opportunities and programs in Latino communities.”

Leaving its Latino-centric advocacy roots, the current website says the group’s “primary mission is helping to provide urgent and life-saving medical care for those in need with nowhere else to turn.”

Although it relocated to Birmingham sometime between 2013 and 2014, CDLU has never registered with the Alabama Secretary of State’s Office — and its board of directors is still located in California and elsewhere.

In 2017, it appears CDLU once again found an added purpose for its activities far from its previously stated missions.

CDLU’s CEO, Kevin Brendan Forbes, who goes by his initials “K.B.” launched a website in 2017, on which he targets Birmingham-based law firm Balch & Bingham.

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Mother Jones characterizes Forbes as a “self-styled ‘child of the Reagan revolution,’ [who] grew up in a mixed household in a Los Angeles suburb.” Forbes also worked for far right-wing commentator and one time Republican presidential hopeful Pat Buchanan, as well as media-mogul and former Republican presidential contender Steve Forbes. (The men are not related.)

Why a leader of a nonprofit would devote daily energy to attacking a law firm is not entirely clear, but it seems to have begun with what Forbes refers to as the “Newsome Conspiracy Case,” which involves an extended court battle between Burt Newsome, a Birmingham attorney, and Balch & Bingham.

Not only did CDLU’s focus change when Forbes became close to Newsome, the organization’s fortunes began to improve, as well.

Forbes is considered the driving force behind the group’s ventures in Alabama. He is also personal friends with Newsome. Facebook posts show both Newsome and Forbes’ wives enjoying social events on multiple occasions.

There is a direct friendship between the wives of Forbes and Newsome. They have been friends since at least 2016 and posts show a number of public interactions since then.

Forbes reserved the website “BanBalch.com” shortly after the Newsome and Forbes families formed a friendship, and the website’s first articles were aimed squarely at Newsome’s lawsuit with Balch & Bingham.

From the beginning, the website set out to tarnish the law firm by claiming to expose “unsettling controversies surrounding Balch & Bingham,” much of which stems from allegations, inference and speculation.

Under the banner of his nonprofit, Forbes has also taken further steps to attack the firm’s largest clients.

Forbes has taken credit for costing Balch & Bingham hundreds of thousands of dollars in client fees while also remaining fixated on the firm, writing Newsome a check to settle the disputed lawsuit with CDLU as mediator.

Why would CDLU offer itself as a mediator in a private lawsuit especially given the fact that Forbes is not an attorney?

From a ragtag blog to a more sophisticated web presence, BanBalch.com has expanded its coverage to include those associated with Balch & Bingham.

Veteran politicos who asked not to be directly quoted in this article to avoid being dragged into Forbes’ intrigues suggest that those with other darker motives could use the site for a broader political agenda. These insiders question whether political operatives are now feeding Forbes opposition research and money to do their bidding.

As a federally sanctioned nonprofit, CDLU must complete an annual tax filing.

Federal Form 990, the annual statement that must be filed by all IRS recognized nonprofit organizations, shows that in the past five years, annual gross income of CDLU averaged $7,030. The last 990 filed for the year 2018 shows CDLU finishing the year with a $12,363 deficit, and all the 990s filed by CDLU for the past decade show the nonprofit has never paid anyone a salary.

While the 990 for 2019 is not due until November of this year, a tax lien from the state of Alabama filed on January 3, 2020, suggests that in the first three months of 2019, CDLU paid someone or some number of people between $186,000 to more than $500,000. The lien for $11,671.73 was for unpaid withholding tax to the state of Alabama — including up to a 25 percent penalty.

Depending on the number of people paid and the amount each person was paid, this lien represents a minimum of $186,000 in compensation paid and a maximum possibility of more than $580,000.

As a 501(C)(3), Forbes’ organization is not required under federal law to publicly disclose donors. As a charitable organization, it is barred from engaging in political activity or supporting political candidates, and while most “dark money” groups are 501(C)(4)s for this reason, (C)(3)s operate with similar opacity in regard to their funding sources, though many publicly disclose their donors in the interest of transparency.

501(C)(3)s are also required to remain true to their founding purpose unless they notify the IRS in advance of the change in purpose.

An organization with a long history of little income and zero salaries appears from the lien documents to have paid more in compensation in the first four months of 2019, than it had collected in gross income for more than five years. Where did the money come from and what was CDLU doing to attract this kind of investor?

In his writings, Forbes has made it clear that paying Newsome would make the attacks on Balch & Bingham and the firm’s clients go away.

Excerpts from an article Forbes has posted at least twice summarize the central focus of his efforts:

So, we ask, would it not have been cheaper to simply resolve the Newsome Conspiracy Case for $3 million? If Balch & Bingham had simply reached out to us, the CDLU, and tried to resolve the Newsome Conspiracy Case in early 2017, this blog would not exist and our advocacy efforts at the CDLU would not be focused on educating the public, law enforcement, legislators, corporate leadership, and institutional investors on Wall Street about Balch & Bingham's alleged unsavory if not criminal conduct. When Newsome originally wanted to settle this matter, back in 2015, his legal team asked for three things: An apology. The end of the tracking of Newsome's banking cases by Balch partners. $150,000 for revenue lost from the alleged defamation. Balch rejected the offer and now that decision has cost them millions and millions more to come.

Forbes’s words would seem to indicate that he set out to harm Balch & Bingham to force them to pay Newsome.

Is Forbes attacking the firm’s clients to coerce a payment to Newsome? Did someone pay CDLU hundreds of thousands of dollars in 2019, as is indicated by the tax lien. Did Forbes pay his friend Newsome all or any of this money? Where did the money come from and who did Forbes pay?

Nonprofit organizations like CDLU do not have to reveal their donors. But during 2019, Forbes’ attacks on Balch & Bingham’s clients took on a wide-ranging field of subjects.

Politicos, who spoke with APR, posed the following questions: Did someone recognize that Forbes had created a communication channel through which they could accomplish goals that had nothing to do with Burt Newsome? Was a rival law firm paying Forbes to attack Balch to steal Balch’s clients? Could environmental groups or their supporters be paying Forbes to attack utility companies? Were Washington-based lobbying firms paying Forbes to bolster their efforts to take Balch’s national lobbying contracts?

The answer to these questions would easily be resolved if Forbes revealed who was paying him.

Forbes has indicated in writing that “this blog would not exist” if someone would just write Newsome a very large check.

Forbes has attacked clients of Balch & Bingham and told the clients the attacks would go away if they forced Balch to settle with Newsome, according to APR‘s sources.

A veteran of hundreds of legal skirmishes who, like others, asked not to be quoted because of Forbes’ propensity to write unfounded accusations, said Forbes’ actions in his opinion rose to extortion and tortious interference with business relationships.

Forbes has never fully explained why his nonprofit moved from California to Alabama, nor why CDLU’s mission changed from Latino advocacy in Los Angeles to attacking a Birmingham law firm and its client.

When social media hoaxes and fake news are trade craft, there is a ready market for blogs like BanBalch.com, insiders believe.

The question that may need answering by law-enforcement is what is going on at CDLU that would allow them to operate Banbalch.com under a cloak of federally sanctioned secrecy?

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Crime

Tenth state inmate dies after testing positive for COVID-19

As of Tuesday, 97 inmates had tested positive for COVID-19.

Eddie Burkhalter

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As of Tuesday, 97 inmates had tested positive for COVID-19. (Stock photo)

A tenth Alabama inmate has died after testing positive for COVID-19, according to the state.

Raymond Earl Allen, 59, who was serving at the St. Clair Correctional Facility died Monday at a local hospital, where he had been taken after exhibiting symptoms for coronavirus, the Alabama Department of Corrections said Tuesday. 

Allen was considered high-risk because he had end-stage renal disease, according to ADOC. 

ADOC also said another inmate at St. Clair has tested positive for COVID-19, bringing the total number of confirmed cases among inmates at the prison to 28. Six workers at the prison have also tested positive for the virus. 

The department also announced that four workers at the Kilby Correctional Facility, two at the Fountain Correctional Facility and one at the Alex City Community Based Facility and Community Work Center also tested positive for COVID-19. 

As of Tuesday, 97 inmates had tested positive for COVID-19, while 28 have since recovered. Of the state’s approximately 22,000 inmates, 490 have been tested. Of the 184 confirmed cases among prison staff, 100 have recovered. 

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Two prison workers at the Julia Tutwiler Prison for Woman have died after testing positive for coronavirus. There have been confirmed cases of the virus in 27 of the state’s 32 facilities.

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