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Sept. 13, 2012
TOPEKA Administration officials and insurance company representatives assured a legislative committee today that KanCare should be ready to launch as planned on Jan. 1, pending federal approvals.
But spokespersons for hospitals, nursing homes and other Medicaid providers told members of the Joint Budget Committee that they were growing increasingly alarmed about the lack of operational details and remaining unanswered questions about how Gov. Sam Brownback's anticipated Medicaid system makeover is expected to work.
"We are increasingly anxious about the lack of specific answers concerning how KanCare will actually operate," said Rachel Monger of Leading Age Kansas, an association of the state's nonprofit nursing homes that was generally supportive of KanCare after the initiative was announced in November 2011.
Monger said the group's members continued to ask administration officials and the insurance companies for specific details on a range of operational matters, including billing procedures, policy manuals, record keeping requirements and quality tracking but were still coming up short on answers.
"With less than four months until launch, we find the inability to provide detailed answers worrying," she said.
Monger and others also raised questions about the administration's claim that the new system will save the state and federal governments hundreds of millions of dollars over the next five years.
"What happens to providers and consumers if those savings are not realized through this program," she said.
The Kansas Hospital Association, another group that earlier this year testified to the Legislature in favor of KanCare, aired similar concerns.
"As we move closer to January 2013 and the launch of KanCare, we feel that these implementation issues take on a new urgency," said Chad Austin, KHA vice president of government relations.
Austin said some questions raised by hospitals had been resolved over the past weeks but that several items "still remain unresolved."
Among other things, administrators for critical access hospitals, he said, were still trying to get more information about how they will be reimbursed by the managed care companies.
"We stand willing to be partners," he said, "but we must also emphasize that the success of that transformed system depends significantly on the confidence of those who are actually delivering care to patients every hour of every day."
A common concern raised by the provider groups was the lack of provider manuals from the managed care companies even as the companies push for providers to sign contracts that reference the manuals, which company officials said recently were made available in draft forms.
"We are talking about their financial livelihood and they are being asked to sign contracts on blind faith," said Cindy Luxem of the Kansas Health Care Association, speaking on behalf of the state's for-profit nursing homes.
Slow the process
Luxem urged policymakers to slow the process until providers get the details they need to cope with the planned changes.
"The pace has been staggering and the deadlines have not been met," she said. "In what other area of business would you see an old system completely disregarded for an entirely new system without sufficient time to develop infrastructure or at least examine it to see whether what is being planned will even work?"
Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, said the administration had begun its readiness reviews of the managed care companies last week and that officials would decide by Oct. 19 if the new system was ready to go forward. He said it would be "a heavy lift" for the insurance companies to get their provider networks established by the October deadline, but he said he was confident the firms would be able to pull it off.
One of the managed care companies, United HealthCare, already covers more than 250,000 Kansans under its commercial health policies and has an established provider network in the Kansas City area, a company official said. The other two companies, Sunflower State Health Plan and Amerigroup, have started from scratch to build their networks. Provider contracts were only recently made available for signing. But spokespersons for both companies said they were pleased with the progress they were making.
Gary Haulmark, a KDADS commissioner, told legislators that the administration had no interest or desire to certify the companies ready to go, if indeed they were not.
But Matt Fletcher of Interhab, an association that includes most of the state's community developmental disability organizations, warned against succumbing to "go fever," a term coined by NASA engineers to describe the tendency to downplay last-minute warnings before the launch of spaceships.
"Because so much energy is expended to get to the moment of launch, the temptation to ignore the warning and just go is great. Go fever is never a good thing," Fletcher said.
Representatives of each of the three managed care companies said they were confident they would have their provider networks 90 percent established by Oct. 12, a deadline set by the administration for them to demonstrate "network capacity." They also said they were making good progress in hiring workers and establishing their "leadership teams" in the state.
Ready to talk waiting lists
In other news Thursday, Sullivan responded to legislators' questions regarding the waiting lists for home- and community-based Medicaid services.
Wednesday, Haulmark refused to answer questions on the topic, saying the state faced a possible lawsuit by federal officials for alleged violations of the Americans with Disabilities Act and that he had been advised by his agency's chief attorney to stay silent.
Sullivan said after further consultations with attorneys, including those in the Attorney General's Office, he determined it would be OK to respond cautiously to questions from the Legislature.
Sullivan said the U.S. Justice Department had recently been in communication with the administration about the alleged violations but that no "formal investigation" was underway and no lawsuit had been filed.
He also said the administration in July hired a company to review the waiting list for services for the physically disabled and that the contractor was only able to reach 377 of them or about 11 percent of the 3,462 people on the list. Of the 377 contacted, 45 indicated they no longer needed services, four had moved out of state and 14 said they didn't know they needed services.
Sullivan said the findings showed that waiting list was not "credible for making policy decisions."
He said the administration was continuing its efforts to come up with a reliable list in order to "make decisions about how to most effectively utilize the funds that were allocated (by the Legislature for this fiscal year) to address" the waiting list for physical disability services.
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