A cumbersome, bureaucratic system will be drastically pared and bills expedited to ensure that the nonprofit groups providing services to city residents who have HIV or AIDS get reimbursed within 30 days, the city's health director announced yesterday.
"This is not triage," Director Gregg A. Pane said, one week after being given an ultimatum by the D.C. Council's Health Committee to fix months-long payment delays that caused many groups extreme financial distress. The problems have stemmed in part from a process that requires invoices to pass through eight or more sets of hands -- and to be audited in full every month -- before any check can be written.
On Wednesday, the Department of Health will terminate that process. Eight steps will be reduced to four. More detailed reviews will be completed quarterly, and payments will be sent out prospectively every quarter to keep providers from essentially having to advance money for critical medical, legal, housing and social services.
If the changes at the HIV/AIDS Administration succeed, the impact will be considerable, Pane said. "It's going to make people's lives so much easier. It's going to unclog the system."
And in turn, he told the committee, "people can actually spend their time on the content of their mission."
Committee Chairman David A. Catania (I-At Large) and his colleagues reacted positively to much of the department's action, with Catania calling it "a plan that, on its face, makes sense" and Vincent C. Gray (D-Ward 7) labeling it "an exciting framework."
Although Pane promised "there'll be more steps," one that was omitted yesterday was Catania's suggestion that the administration turn over its reimbursement function to an outside company.
Pane maintained that the change was not necessary, blaming the system, not the people who work in it, for the situation. "Let me be clear," he said. "This is a case of good people, bad practice."
The HIV/AIDS Administration has long struggled to correct delayed reimbursements, inadequate oversight of community programs and other substantial problems, which were partly responsible for the return of $3 million in unspent federal grant money in 2004. Nearly 20 percent of its positions are vacant, which Pane said was another legacy of years of dysfunction.
The agency faces more scrutiny in coming months with the completion of an audit by the D.C. inspector general. Discussion earlier this year of some preliminary findings was wearily familiar to critics. The agency had not conducted the four site visits required annually for any of 35 grant recipients -- two programs "showed no evidence" of providing HIV or AIDS services, according to testimony -- and the language of some site reports indicated that they had been altered.
There were more questions yesterday about possibly doctored paperwork, with council member Jim Graham (D-Ward 1) focusing on a series of monthly bills dating to October. A printout given to the Health Committee showed that the organization seeking reimbursement submitted every invoice on May 9. If true, the fault for delayed payment would lie with the nonprofit; even under its new plan, the administration would have at least another week to cut a check.
"I want you to do an audit of HAA staff," Graham told Administrator Lydia L. Watts. "Let's see just what the truth of this is."
The groups on the other end of the discussion are waiting for proof, in the form of timely checks, of the system's reform.
"I think it's only fair to give [the administration] an opportunity" to succeed, said Sharon A. Baskerville, executive director of the D.C. Primary Care Association.
She sounded bemused over health officials' response to last week's ultimatum.
"It's amazing to me how quickly a solution can be found," she said.
