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March 15, 2012
TOPEKA The Senate Ways and Means Committee has introduced a bill that would create a new joint committee to oversee implementation of Gov. Sam Brownback's KanCare Medicaid makeover plan.
Administration officials today welcomed the development and told lawmakers there would be a "rigorous readiness review" before KanCare is launched. If the managed care companies hired to implement the plan fail the reviews, officials said, then KanCare's Jan. 1, 2013, launch date would be pushed out.
SB 459 would create an 11-member oversight committee for the program, including six House representatives and five senators. It also would create a new fund in which would be deposited dollars saved from moving Medicaid beneficiaries from nursing homes to private homes or community settings. The secretaries of the Kansas Department of Social and Rehabilitation Services and the Department on Aging would each provide quarterly reports to the Legisalture on the status of the savings fund. The same bill will be introduced in the House, according to administration officials and Rep. Brenda Landwehr, a Wichita Republican who is a sponsor.
The oversight committee would be charged with examining the program's progress, watching to assure access to Medicaid services doesn't suffer and that quality-of-care benchmarks are met.
“Legislative oversight will be key in accomplishing the objectives of KanCare that lead to improved delivery of health care to Medicaid consumers," said Lt. Gov. Jeff Colyer in a prepared statement endorsing the bills. Colyer has been point man on the governor's plan to remake Medicaid.
KanCare would move virtually all of the state's Medicaid clients into fixed-cost, managed-care plans, including the elderly, disabled and mentally ill receiving long-term care services.
The plan has met resistance and some lawmakers have faulted the administration for moving too quickly with its plan, which still needs federal approvals.
A resolution was introduced in the Senate urging the administration to delay KanCare's start until July 1, 2013. A hearing on it was held today in the Senate Public Health and Welfare Committee.
In the House, there is a bill that would require the administration to exclude or "carve-out" from KanCare the long-term Medicaid services provided to the developmentally disabled.
That bill was the subject of hearings Wednesday and again today in the House Health and Human Services Committee.
At Wednesday's hearing, various advocates for the developmentally disabled spoke in favor of House Bill 2457, which was introduced by Rep. Jim Ward, a Wichita Democrat.
Administration weighs in
Today, Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, and Secretary Shawn Sullivan of the Department on Aging made the administration's argument for moving forward with KanCare without delay and with long-term services for the developmentally disabled included in the plan.
Sullivan said, as he has in other legislative hearings and public forums, that the administration aims for as little disruption as possible to Medicaid clients. He said the state's contracts with the managed care companies will require that they use existing Medicaid providers and that the roles of the state's 27 Community Developmental Disablity Organizations (CDDOs) would remain intact.
He said the governor and other top officials, including himself, considered it "very important to maintain the structure, infrastructure and the integrity of the current (developmental disability) system."
He said many of the state's developmentally disabled are served by small organizations that might have only five clients and that KanCare would be particularly beneficial to those in their care because it would bring "much more robust coordination (of services) for all the client's needs," whether the client had diabetes, mental illness or another chronic medical condition.
Moser also said the main focus of KanCare would be improved coordination of care with the goal of preventing illnesses leading to costly hospitalizations.
He assured the committee that KanCare would not move forward on Jan. 1, 2013, unless everything was in place to do it effectively.
Kari Bruffett, a KDHE assistant secretary, gave similar assurances today to the Senate Public Health and Welfare Committee.
'On the right track'
Several of the House committee members indicated they were in support of the KanCare plan.
"I continue to feel we're on the right track," said Rep. Jim Denning, an Overland Park Republican.
Landwehr, the committee chair, closed the hearing by delivering something of a lecture to those in the room who were opposing the administration's initiative.
She urged Medicaid providers to work with the managed care companies as they try to develop their networks and she told opponents that instead of "fighting or opposing" the administration plan they should work with Brownback officials to come up with something that would work.
"It doesn't take a brainiac to figure out something needs to change," she said. "The status quo is not going to be acceptable. It's not going to work. The money's not there."
But some Democrats and at least one Republican on the committee seemed less convinced.
Rep. Ann Mah, a Topeka Democrat, said she wasn't satisfied that the administration had thoroughly reviewed the financial soundness of the managed care companies competing for KanCare contracts.
"What are you doing to make sure they are financially solid?" she asked Moser.
Moser said the companies would have to meet rigorous "solvency" standards before contracts were awarded but did not respond in detail.
Rep. Geraldine Flaharty, a Wichita Democrat, said she couldn't see how the plan would work as described.
"I sincerely hope you're successful," she said. "But I seriously doubt you cannot cut services or reimbursements, improve outcomes and somebody make a profit. It defies logic to me."
Rep. Barbara Bollier, a Mission Hills Republican and a physician, said there were too many unanswered questions and too few details about how the plan would work.
"None of us know the answers to a lot of these questions," she said. "The fear is in details."
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