KanCare pilot project launched but opposition to DD "carve-in" persists

Administration and advocates at odds over project's purpose

0 | Legislature, KanCare

During the 2012 session, a bipartisan group of representatives and senators introduced a resolution attempting to delay the Jan. 1, 2013 launch of KanCare. The resolution failed, but lawmakers succeeded in persuading the Brownback administration to hold off a year on including in the program long-term services for the developmentally disabled. DD advocates say they will ask this year's Legislature to extend or make permanent that temporary "carve-out." Given the large numbers of new legislators following the 2012 elections and the administration's push to expand KanCare, it remains to be seen what will happen. Of the eight legislators shown in this file photo, only three are still serving.

During the 2012 session, a bipartisan group of representatives and senators introduced a resolution attempting to delay the Jan. 1, 2013 launch of KanCare. The resolution failed, but lawmakers succeeded in persuading the Brownback administration to hold off a year on including in the program long-term services for the developmentally disabled. DD advocates say they will ask this year's Legislature to extend or make permanent that temporary "carve-out." Given the large numbers of new legislators following the 2012 elections and the administration's push to expand KanCare, it remains to be seen what will happen. Of the eight legislators shown in this file photo, only three are still serving.

— After months of advisory committee haggling over what it should look like, state officials say they are ready to launch the pilot program that will pave the way for including long-term services for the developmentally disabled in the new KanCare program.

Now, all they need to start the pilot are participants.

A recruiting letter went out Friday, seeking organizations and individuals willing to volunteer, but representatives from the state’s developmental disability organizations said doubts remain strong among their members about the pilot in particular and KanCare in general. It seems that nobody, including administration officials, expects a throng of eager participants.

“The advisory committee talked about really wanting, hoping to have a broad representation of providers (in the pilot), including different types of providers,” said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. “I don't know that it’s necessarily as important to have numbers as it is to have different types. I’m hoping to have five providers, at least.”

The administration of Gov. Sam Brownback originally sought to have long-term services for the developmentally disabled included in KanCare when the managed-care program was launched Jan. 1. But groups, including parents, that represent the developmentally disabled, persuaded legislators to postpone that for a year.

KanCare is the governor’s ongoing remake of the state Medicaid program. Since it was launched a few weeks ago, virtually all the state’s 380,000 Medicaid enrollees have been assigned to health plans run by three commercial insurance companies.

The same legislative proviso that delayed the administration’s push to roll long-term developmental disability services into KanCare also called for the pilot program. But disagreement between the administration and advocates for the disabled over what the pilot should try to gauge or accomplish went on for months after the 2012 Legislature adjourned and still hasn’t been fully resolved.

What kind of pilot?

Advocates for the developmentally disabled said they wanted a pilot that would test the administration’s still-unproven theory that the KanCare insurance companies could effectively manage long-term or “non-medical” developmental disability services, producing healthier customers while cutting government costs yet presumably earning profits.

That ambitious set of pledges is something that hasn’t been solidly demonstrated anywhere in the country and sounds “too good to be true,” as Maury Thompson, former director of Johnson County Developmental Supports, described it to an interim legislative committee in November when he was explaining the delay in getting the pilot program off the ground.

“You’re talking about freezing the overall budget, plus injecting the profit margin and it’s the non-medical services that the insurance companies really don’t understand,” he said.

Thompson since has been promoted to a different job within Johnson County government.

Work on the pilot’s development continued for almost three more months after Thompson’s testimony, but ultimately the advocates desire for a demonstration project that would reveal whether the KanCare companies could achieve the goals the administration set for them went unmet. Instead, by admission of all involved, the administration chose a pilot that paves the way for KanCare regardless of its results.

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Shawn Sullivan, (left) secretary of the Kansas Department for Aging and Disability Services, and KanCare Ombudsman James Bart.

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“Our plan is to run the pilot until Dec. 31 and then have full inclusion (of long-term developmental disability services in KanCare) in January ’14,” Sullivan said. “Some have said that the legislative intent was for this (pilot) to be a test...What I’m saying is, no, what this pilot is (about) is to help people get used to it, work out the bugs, and in my opinion 10 months is long enough to do that.”

Administration officials already are convinced KanCare will work, he said. Why? Because of the requirements the state has in its contracts with the managed care companies, Sullivan said, and because the program has been working relatively well for several weeks for other Medicaid populations with similarly high needs, including the physically disabled and the frail elderly. And by the time DD services are added, there will be that much more KanCare experience to draw from.

Sullivan said the first goal of the pilot would be to help those who choose to participate in it become more familiar with the workings of KanCare. Secondary goals would be to help the managed care companies gain a “broader understanding” of the state’s developmental disability service system and its “nuances” and to identify and “work through issues” before KanCare is expanded to the rest of the DD system.

Like Texas

Some outside the administration said they had wanted a pilot more like one done by Texas, which hired a consultant with expertise developing pilots and tested whether proposed changes in that state’s system would work.

“We're not against doing a pilot,” said Steve Gieber, executive director of the Kansas Council on Developmental Disabilities and a disappointed member of the advisory committee pulled together by the Brownback administration for the pilot planning. “But we would like to see a pilot that's real, one that tests the underlying assumptions and then make good decisions from that,” he said.

After only about six weeks of KanCare, it is too soon to say how well the massive changes will deliver on the administration’s promise of improved care for Medicaid patients, $1 billion in savings over five years for the state and federal governments, and all without meaningful reductions in the rates paid to the state’s Medicaid service providers.

But many people, including Sullivan and other administration officials, say the transition to KanCare is going smoother than they had expected.

“We’ve had 380,000 to 400,000 (Medicaid beneficiaries) that went through the transition and when we consider that the Governor's Office has had 15 concerns given to them from legislators and they've all been taken care of very expediently and that our KanCare ombudsman has had about 160 calls or concerns, and then less than 200 calls that have been noted on the (state’s KanCare issues log)....you add that together out of 400,000 people, I think it’s gone very well,” Sullivan said. “ I've heard from a lot of providers, from all types...who say it’s gone a lot better than they've expected.

“Not 100 percent would say it’s gone well,” he said. “But it is important for us to stay on top of those problems and makes sure we resolve them.”

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Tom Laing, executive director of Interhab, testifying to the House Social Services Budget Committee. "We must come to honest terms with the false premise of KanCare, i.e. that handing off the hard work of government to for-profit corporations will make everything better."

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Still unimpressed

Among those still unimpressed with KanCare are many who deliver or benefit from services for the developmentally disabled. A bill already has been introduced in the Legislature that would prevent long-term, developmental disability services from being rolled into the new program, though it is still unclear how much support the proposal might garner this year given the historic turnover resulting from the November 2012 elections.

Tom Laing, executive director of Interhab, the association that represents most of the state’s Community Developmental Disability Organizations, said his group would “absolutely” continue to oppose the administration’s planned KanCare inclusion and hopes to secure a permanent or at least an extended “carve-out.”

He said he and others would be working to make sure new legislators are familiar with the issue.

“The legislators we have talked to who are first-termers have routinely agreed that they have questions about the efficacy of KanCare,” he said. “Not all of them, but a lot of them. I talked with a Johnson County legislator who said next to schools the No. 1 issue that came up when he went door to door (soliciting votes) was KanCare. Right out of the chute, it’s got enough challenges that legislators are wondering if they should add more.”

KHI News Service coverage of KanCare

Hutchinson Clinic's letter throws a curve to KanCare open enrollment (1/28/14)
National Disability Council again urges CMS to hold off on Kansas DD carve-in (1/14/14)
DD carve-in not approved for Jan. 1 launch (12/27/13)
National Council on Disability urges one-year delay of KanCare DD carve-in (12/13/13)
KDADS chief describes lessons learned with KanCare (12/5/13)
Other states watching Kansas as it implements ‘unprecedented’ Medicaid model (12/5/13)
KanCare reimbursement problems continue for providers (11/25/13)
Kansas dental program for children on hold because of KanCare MCO (11/11/13)
Kansas Medicaid providers complain to oversight committee (10/7/13)
Wichita hospital execs describe problems with KanCare (8/29/13)
KanCare to adopt “health home” model for treating mentally ill (7/22/13)
Kentucky’s rush into Medicaid managed care: A cautionary tale for other states (7/18/13)
DD groups largely reconciled to KanCare carve-in (7/15/13)
Advocates urge more government oversight of Medicaid managed care (7/8/13)
Independent pharmacists push for KanCare contract enforcement (7/1/13)
Payroll agents for the disabled on Medicaid say they are struggling under KanCare (6/3/13)
Personal Care Attendants: KanCare's unheralded workers (5/20/13)
House GOP leaders pen letter backing DD supports in KanCare (5/17/13)
More than 1,000 rally at Statehouse for DD carve-out (5/8/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
As KanCare continuity of care period ends, problems persist; legislators starting to hear about it (4/8/13)
Advocates raise concerns over possible reductions in KanCare services (3/28/13)
Conferees agree on KanCare oversight committee (3/28/13)
DD advocates push to extend KanCare "carve-out" (3/20/13)
Safety-net clinics struggling with KanCare (3/4/13)
Major medical provider groups ask for longer KanCare transition (2/13/13)
Lawmakers and providers assess KanCare transition (1/28/13)
Five-part series: "Lower cost and better care: Can KanCare deliver?" (1/14/13)
Independence of KanCare ombudsman questioned (1/7/13)
KanCare special terms and conditions spelled out by CMS in a document (12/28/12)
KanCare workforce shift hampering local agencies (12/10/12)
Governor announces KanCare approval by feds (12/7/12)
More KanCare implementation details outlined (12/3/12)
Federal officials say they hope to act soon on KanCare waiver request (11/28/12)
New KanCare info included on state website (11/20/12)
Groups call for KanCare delay (11/8/12)
Go/no-go date looms this week for KanCare (10/15/12)
KanCare benefit packages outlined (9/26/12)
Provider groups nervous about lack of KanCare details (9/13/12)
KanCare Confidential (9/10/12)
KanCare contracts awarded (6/27/12)
KanCare plan panned again at public hearing (6/20/12)
Wichita KanCare forum draws more than 200 (6/19/12)
Medicaid makeover: Can Kansas learn from Kentucky? (6/11/12)
Hundreds protest inclusion of disability services in KanCare (4/25/12)
Counties weighing in on KanCare (4/9/12)
Hospital administrator to chair KanCare Advisory Council (3/29/12)
Brownback Medicaid makeover an “ambitious” plan (3/28/12)
KanCare bidders heavily courting Medicaid providers (3/19/12)
Legislators push to delay KanCare start (3/7/12)
Brownback announces managed care for all in Medicaid (11/8/11)
Kansas Medicaid makeover in the works (3/7/11)


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