KanCare reimbursement problems continue for providers

Special legislative oversight committee gets update on efforts to solve ongoing problems with state’s Medicaid managed care program

0 | KanCare, Medicaid-CHIP

Jean Rumbaugh, CEO of Sunflower State Health Plan, one of three managed care companies overseeing Medicaid administration in Kansas.

Jean Rumbaugh, CEO of Sunflower State Health Plan, one of three managed care companies overseeing Medicaid administration in Kansas.

— Nearly a year after the state’s transition to a Medicaid managed care program, hospitals and other providers continue to report problems.

“Several hospitals are still reporting reimbursement challenges that have resulted in difficulties in receiving accurate KanCare claims payment,” Chad Austin, a vice president for the Kansas Hospital Association said today in written testimony to the Robert G. (Bob) Bethell Joint Committee on Home and Community based Services and KanCare Oversight.

Hospitals and other providers first publicly aired their complaints about KanCare at the oversight committee’s initial meeting on Oct. 7. Since then, Austin said, a group of hospital representatives has been meeting with state officials and representatives of the three private managed care companies (MCOs) to address remaining problems with KanCare, which the Brownback administration launched to slow rising Medicaid costs and improve care.

“As we have stated before, we stand willing to be partners in helping the state achieve (KanCare's) vision,” Austin 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.”

Austin outlined three steps that should be taken by the MCOs and KDHE to address the problems that hospitals and other providers are continuing to have gaining authorization for services and obtaining timely reimbursements:

  1. Standardize and streamline prior authorization requirements,
  2. Send reports of claims denials to "a select number of hospitals to review," and
  3. Clarify reimbursement-related policies, including diagnosis-related groups, how critical access hospitals are paid in certain situations, and how claims are calculated for patients who are eligible for both Medicaid and Medicare.

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Rep. Jim Ward, D-Wichita

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KanCare was launched Jan. 1. With it, virtually all the state's 380,000 Medicaid enrollees were moved into MCO plans run by three large insurance companies: Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene. Beginning Jan. 1, 2014, the remaining Medicaid services for Kansans — long-term services and supports for those with developmental disabilities — will be rolled into KanCare.

Persisting problems

Rep. Jim Ward, a Democrat from Wichita, said the continuing problems were taking a toll on the financial health of hospitals in his community.

"Via Christi and Wesley (hospitals in Wichita) have been doing this for years and years and now all of a sudden they've run into a wall,” Ward said. “My fear is not only for them but for my small providers — they don't have the wherewithall to fight with (the MCOs) about it for a long period of time, nor do they have the cushion in their bank account that allows them to continue to fight for services."

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Thomas Killian, chief operating officer of Amerigroup.

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Thomas Killian, chief operating officer of Amerigroup, said that since the last KanCare oversight committee meeting his company had held some 40 on-site meetings with Kansas hospital officials in an attempt to address the continuing problems. He said one of the issues identified in those meetings was that Wesley Medical Center was submitting claims via a clearinghouse instead of directly to the MCOs.

"I think that will take a huge proportion of our problems out of play with them, and we look forward to seeing some of those issues resolved," Killian said. "It's a good example of the learning curve."

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Timothy Spilker, chief executive of United Healthealthcare.

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Timothy Spilker, chief executive of UnitedHealthcare, also said that progress was being made.

"New claims are paying correctly and we're working through the adjustments projects (from existing claims). That's really where providers will start to feel the relief as we work through those adjustments," Spilker said. "So as we clean those up in the next couple of months, we anticipate that providers should start to feel that relief, and we acknowledge that."

Kansas Cavity Free Kids and other issues

Among the other KanCare transition problems Spilker addressed was one that interrupted dental services to children in Head Start programs, as recently reported by KHI News Service.

"There has been some press on our Head Start service coverage, which is a good follow-up for this session. We've since met with the Head Start Association and are working with them to ensure that we have coverage in place for those services."

Regarding the imminent inclusion of developmentally disabled (DD) Kansans into KanCare starting Jan. 1, Spilker said the experience of providers may hinge on their familiarity with the claims system.

"It depends on the provider, their level of sophistication or comfort with the system," Spilker said.

Given the experience of a pilot project intended to help smooth the transition for DD patients, Sunflower CEO Jean Rumbaugh said work remains to be done. She said of the about 1,000 claims filed with Sunflower via the pilot, some 300 were returned as denials.

"Obviously a 30 percent denial rate is not what we want," Rumbaugh said. "One of the things we're implementing starting next week is a ‘Claims War Room,’ for lack of a better term.

"We have a lot of caring people, and they want to help, but sometimes they don't have the answers," Rumbaugh said. "So we're going to try to put everyone in a room and try to resolve some of those ongoing issues," she said.

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Finn Bullers — a 49-year-old Prairie Village man, who suffers from Muscular Dystrophy — says that after KanCare began this year, his managed care company notified him that it intends to reduce the around-the-clock care he now receives to 40 hours a week.

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Finn Bullers testifies today before the KanCare Oversight Committee. At far left is KDHE Secretary Dr. Robert Moser and (to his right) Kari Bruffett, director of Health Care Finance.

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Finn Bullers

Finn Bullers — a Kansas City resident and former veteran journalist in the metro area — has become something of a poster adult for the problems experienced in the transition to KanCare.

His testimony at the first oversight meeting has since received extensive coverage in the media. He appeared again Monday in his wheelchair — accompanied by two family members who recorded video of his testimony — along with several members of the media who don’t regularly cover Kansas legislative meetings.

Bullers again told legislators that he believes a planned reduction in the in-home KanCare services he receives is an example of how the state’s new Medicaid managed care program is failing needy citizens.

The 49-year-old Prairie Village man, who suffers from Muscular Dystrophy, said his managed care company notified him that it intends to reduce the around-the-clock care he now receives to 40 hours a week.

"It's as if my medical professionals are telling me that I need four apples to live and the state is willing to give me one apple to die,” Bullers said.

"I want this story told, not just for me, but for 12,000 other Kansans with long-term disability issues that this committee owes themselves to take a look at," Bullers said.

Shawn Sullivan — secretary of the Kansas Department for Aging and Disability Services — later told committee members that Buller's characterization of his proposed plan reduction was "not really the case at all."

"He equates (it) to being a 76 percent reduction. What has been proposed is attendant care of 42 hours of sleep cycle support...and then also seven hours of skilled nursing a week, which is one hour a day." Sullivan said, in total, that is closer to a 20 percent reduction proposed for Bullers' care.

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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