Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — The House Committee of Aging and Long-term Care heard testimony today on a bill intended to address conflicts of interest in how the state pays for home and community based services for the disabled.

“It appears that some people are gaming the system,” said the committee’s chairman, Rep. Bob Bethell, an Alden Republican.

House Bill 2424 would prevent a single social service agency from assessing a disabled person’s needs, serving as their case manager and providing the Medicaid-funded services they need to live in community settings rather than nursing homes.

Instead, each service – assessment, case management, in-home care – would have to be provided by a separate entity.

Bethell said he’s long been troubled by reports of agencies inflating their assessments in ways that generate higher payments.

Department on Aging Secretary Shawn Sullivan testified that he enacted polices last year that block case-management agencies from also providing in-home services for the frail elderly.

Similar policies, he said, are not in place for agencies that serve the physically and developmentally disabled and autistic and emotionally disturbed children.

“It’s a little bit of a mishmash,” he said.

Sullivan said he supported the bill but noted that Gov. Sam Brownback’s Medicaid reform plan includes a “conflict-free” process for assessing each individual’s needs and for helping them figure out which of three managed care companies is best suited to meet those needs.

The process, he said, would be guided by a new statewide entity called Aging and Disability Resource Connections (ADRC).

Sullivan said he expects to issue an RFP (request for proposal) for creating the ADRC in February. The new agency would coordinate care plans for people in all disability groups.

The managed care companies, in turn, would be expected to subcontract with agencies already providing case-management and attendant care services.

The governor’s reform plan calls for letting three managed care companies take over day-to-day management of the state’s $2.8 billion Medicaid program, starting Jan. 1, 2013.

If HB 2424 were to become law, it would take effect July 1, 2012.

The ARDC would be independent of the managed care companies.

Janet Williams, who owns communityworks inc., a Overland Park-based home health company, said there’s little doubt that some agencies have been padding their assessments.

“When an agency is both the case manager and the attendant care provider, there’s no incentive to decrease plans of care because they’d be getting paid less on the attendant-care end,” Williams said. “The only incentive is to increase plans of care. This has been going on for years.”

Currently, many of the state’s independent living centers provide assessment, case management, and in-home services for the physically disabled.

Shannon Jones, executive director of the Statewide Independent Living Council of Kansas, said her organization also supported HB 2424.

“If there are bad performers out there,” she said, “they need to be put out of the system.”

HB 2424 was introduced by Rep. Peggy Mast, an Emporia Republican.