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June 25, 2013
TOPEKA State officials today held the first public forum since KanCare was launched Jan. 1. But it was mostly a non-event. Only two people offered comments. One was a Medicaid enrollee and the other was a provider of Medicaid services.
"My quality of life is going down. My own experience is not positive, so far," said Michele LeMoine, a Topeka resident who said she had been enrolled in Medicaid for about 30 years.
But Beth Simpson of Heartland Home Health Services rose to praise officials at the Kansas Department of Health and Environment for going "above and beyond in being very helpful," to her as she tried to work through the changes in pharmacy services resulting from KanCare. "The experience overall has been really great."
Simpson said Heartland provides pharmacy services for Medicaid enrollees in long-term care settings in Wichita and Lawrence.
The main reason for the forum, said KDHE Secretary Dr. Robert Moser, was to hear the public's view on the progress of KanCare. But there was more of that after the public comment period from some members of the KanCare Advisory Council. They sat through the hour-long forum before holding their own final meeting.
The council is dissolved as of today but will be reformed later this summer with new and maybe some former members reappointed by the Governor's Office, said Dr. Susan Mosier, the state Medicaid director.
The council members heard reports from the local executives for the three insurance companies that manage the state Medicaid program, which is called KanCare, and asked questions about problems they said they had seen or heard about from various Medicaid service providers about delayed or rejected payments from the insurance companies or, in the case of small pharmacies, reimbursements that failed to cover the pharmacies' costs.
"I'm hearing a lot of issues from the provider side," said Steven Kelly, chief executive of Newton Medical Center in Newton and the council's chairman.
He elaborated later in an interview with KHI News Service, saying that his hospital and Newton doctors and nursing homes were experiencing various problems with the new system, chief among them being the amount of time it takes to get "prior authorizations" or approvals from the insurance companies for patient services such as MRIs and other procedures and treatments.
He said the lag in payments for services to Newton Medical Center was still a problem but that "it's better than it was," in February and January, the first two months of KanCare during which there were widespread complaints from providers about stalled payments.
Larry Martin of Valley Falls, a representative for consumers on the council, told the insurance executives that he was hearing complaints from small pharmacy owners - particularly one in Leavenworth County that provided him documentation, which he offered to share - about payments from the managed care companies that failed to cover the druggist's costs for prescriptions.
"That's tough for the smaller pharmacies to absorb," Martin said. "That could be a real problem in smaller, rural communities."
State officials said they were keeping tabs on that problem.
"That's something we're very involved in and keeping track of," said Kari Bruffett, director of the Division of Health Care Finance at KDHE, the state's lead Medicaid agency.
The insurance executives told council members that specialists at each of their companies also were looking at their pharmacy reimbursements or at least could be contacted in the event of problems.
Before KanCare, the state set the maximum rates the Medicaid program would reimburse pharmacists for particular drugs. That role now rests with the managed care companies, each of which has is own rate sheet, which may or may not cover a pharmacists' actual purchasing costs.
State officials also announced they were preparing a Medicaid waiver amendment for consideration by federal officials in order to complete the transition of developmentally disabled Medicaid beneficiaries into KanCare. The developmentally disabled currently are "carved out" of the program, but state officials intend to expand KanCare to include them effective Jan. 1. A transition program involving more than 500 developmentally disabled persons is partly underway and has been since March, said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.
Two public comment session are scheduled as part of the waiver amendment process. State officials said the first would be held at 2 p.m., July 15 in Wichita at the WSU Metroplex, 5015 S.E. 29th St. The second is scheduled for 10 a.m., July 16 at the Downtown Ramada Inn in Topeka.
Besides state officials and KanCare managed care company executives there were about 50 people at the forum and subsequent council meeting, each of which was held in the same state auditorium. Most who attended were professionals paid to monitor Medicaid or government-related activities.
→ 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)
→ Full Medicaid and KanCare coverage
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