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Advocates: KanCare concerns clear

2/27/2013

By KALEY CONNER

kconner@dailynews.net

With the clock ticking on implementation of the state's new Medicaid program, advocates in northwest Kansas are saying it is not right for facilities providing long-term care to clients with intellectual and developmental disabilities.

A bill introduced in the House seeks a permanent carve-out for community services, meaning organizations such as Developmental Services of Northwest Kansas would not transfer to the new KanCare program.

"We've had concerns over the last 18 months where we have said, 'This is not a good fit,' " said Jerry Michaud, DSNWK president. "We're trying to make it work. ... Try as we might, it appears it doesn't fit and we have real concerns about that."

While most aspects of developmental disability services will not be covered by KanCare until Jan. 1, a few facilities in Kansas have gone live with the program for intermediate-care facilities offered through the ICFMR program.

DSNWK offers the services in Norton and has had difficulties making the transition, Michaud said.

The organization has not yet reached contracts with any of the three private managed care companies now administering state Medicaid claims. Negotiations are ongoing, but DSNWK staff is concerned the proposed contracts do not reflect the service's mission, he said.

DSNWK, as of last week, had not received payment for ICFMR services provided during the last month and a half, Michaud said, noting a sum in excess of $125,000.

"We're working with the state, and we believe they're going to try to resolve this," Michaud said. "But this is, out of the box, a process that was supposed to be ready and operational.

"If this is the test drive, why would you want to buy the car?"

When KanCare was implemented Jan. 1, providers were given a 90-day "continuity of care" period to continue contract negotiations. Payments during this time were supposed to continue as normal, Michaud said.

Michaud acknowledged some bumps are to be expected with a new system but said staff does not believe KanCare is the best option for developmental and intellectual disability care.

Seeking a 'carve-out'

DSNWK is not alone. Many care providers throughout the state, as well as consumers and their families, object to the new system, said Matt Fletcher, associate executive director of Interhab, a Kansas advocacy group.

The possibility of carving developmental services out of KanCare first was introduced during last year's legislative session. More than 20,000 Kansans contacted their representatives regarding the issue and 57 counties -- including all 18 counties in northwest Kansas -- passed resolutions of support, Fletcher said.

A hearing on the bill, HB 2029, was last week.

A concern often expressed during the past year has been whether the contracted managed care organizations understand the types of facilities or have adequate experience working with them, Fletcher said.

"A number of parents spoke in favor of the bill at the hearing and indicated there are concerns with services for their sons or daughters being managed in these companies that have very little experience nationally with something like this and almost no experience with the Kansas system of services for this population," he said.

Gov. Sam Brownback's administration has predicted KanCare will save the state $1 billion in five years by curbing increasing Medicaid costs.

There is concern, however, additional administrative requirements associated with KanCare could increase costs absorbed by local facilities.

At DSNWK, Michaud said employees are "spending hours" on the phone to get approval for Medicaid payments.

"Our programs are becoming more expensive solely to pay for new administrative layers at the expense of services which are already underfunded," Michaud said in his testimony at the Feb. 20 hearing.

Pilot program

Meanwhile, the state of Kansas recently launched a pilot program to give service providers an opportunity to experience KanCare before full inclusion in the program next year. Fifteen providers and 85 consumers throughout the state have expressed interest in participating, said Angela de Rocha, spokeswoman for the Kansas Department for Aging & Disability Services.

Others are hesitant to sign up for the pilot. Many providers had hoped the pilot would be a test of the new program's effectiveness, Fletcher said.

"It's certainly not going to be a true test of whether this type of managed care should be applied to these services, and so we're disappointed with the outcome," he said.

Government officials are confident inclusion in KanCare will enhance care for consumers, de Rocha said. The program is intended to coordinate all aspects of care, she said, noting patients with developmental disabilities often require medical and behavioral health care in addition to home-based support.

"We think the people who are receiving these services will get better care under a managed care organization. Their care will be coordinated," she said. "Someone will be paying specific attention to whether their three kinds of care mesh and work for them."

The state's other Medicaid waivers, such as care for the frail elderly and people with physical disabilities, were incorporated into KanCare at the beginning of this year.

"Nothing is perfect, but all in all, it's worked fine for them," she said. "So we have reason to believe that it would also work out for the DD population."