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DD advocates push to extend KanCare “carve-out”

About 300 converge at Statehouse saying KanCare "not worth the gamble"

By Mike Shields | March 20, 2013

About 300 people came to the Statehouse today, urging legislators and the governor to keep long-term support services for the developmentally disabled outside of the new KanCare program.

Some had made large signs to resemble poker chips or wore T-shirts printed with the slogan: "KanCare DD - Not Worth the Gamble."

"KanCare is a sustained threat to the legitimacy of treatment for vulnerable children in Kansas and will result, if unchecked, with permanently damaged lives and the death of the credibility of our excellent network for persons with disabilities," said Bill Craig, chief executive of Lake Mary Center, a 64-bed facility that specializes in treating developmentally disabled children who also suffer mental illness.

Lake Mary is near Paola, which is south of Kansas City. It is the only facility of its type in the state and one of the few in the region.

'Canary in the coal mine'

Craig said it was the "canary in the coal mine," because unlike most of the state's DD programs or facilities it came fully into KanCare when the program was launched Jan. 1 and since has experienced a succession of problems, among them:

Many people wore red T-shirts sporting a slogan warning that KanCare was "not worth the gamble."

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DD and KanCare signs meant to resemble giant poker chips.

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  • Slow payments from the managed care companies beginning in January forced Lake Mary to borrow $500,000 to "make payroll" in February, he said.
  • The managed care companies had assigned some of the Lake Mary patients to primary care doctors who were miles away or otherwise were not good matches because of the nature of their practices.
  • A major hospital serving Paola has not contracted with one of the KanCare companies so patients assigned to the company are admitted to the hospital through the emergency room.
  • The managed care companies have begun "interfering" with medication decisions "things such as dosage, liquid versus capsule, generic versus brand name..these are the kind of things which you would think of as a doctor's decision being called by the (managed care organizations) MCOs," Craig said.
  • Staff are required to spend hours each day discussing patients needs with MCO workers as part of weekly case reviews. Before KanCare, the reviews happened once every 30 or 60 days, leaving staff more time to work directly with the children. One of the MCOs has indicated it will not pay for children to have extended stays at the center.

Medical services already in

Medical services for the developmentally disabled already are included in KanCare, the initiative by Gov. Sam Brownback that moved virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene.

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But the inclusion of long-term, DD support services in the program was postponed until Jan. 1, 2014 after legislators last year responded to complaints from families, service providers and others who said - among other things - that the insurance companies didn't know enough about dealing with DD clients to handle the changeover.

Brownback officials have said they expect to improve care for the developmentally disabled by including all their services within KanCare, thereby saving money, reducing waiting lists, and perhaps protecting against loss of services due to future funding cuts.

"We believe with state oversight, contractual protections and private-sector resources to help us better coordinate and manage all services that (developmentally disabled) consumers will benefit from KanCare," Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, told KHI News in an email. "There will be savings without sacrificing what works in the system today. The goal of KanCare is to reduce costs by improving quality of care and outcomes. The (KanCare) contracts reflect a commitment to members that they will not lose the services they need."

But spokespeople for the developmentally disabled said they remain unconvinced, in part because they've not seen evidence that the managed care companies can deliver what administration officials seek.

Barbara Ladon, a consultant who said Kansas officials should reconsider their plan to extend KanCare to include long-term services for the developmentally disabled. Landon appeared at the Statehouse on Wednesday on behalf of Interhab, the association that represents most of the state's Community Developmental Disability Organizations.

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Consultant's analysis

Among the speakers today was Barbara Ladon, a Colorado-based consultant, who said there was no "outcomes" research available on managed care for DD long-term services.

She recommended Kansas officials do a limited pilot program to see how it might work before taking it statewide. She said the pilot program being put together by KDADS "was quite different from pilots in other states" because it doesn't include a means of "outside, independent evaluation," and because it was set up to prepare the participants for KanCare rather than testing the soundness of the plan.

Ladon is managing director of Newpoint Healthcare Advisors and is a former director of Colorado's Children's Health Insurance Program. She also once worked as a vice president for UnitedHealthcare, the managed care company. She prepared a nine-page analysis on behalf of Interhab, the association that represents most of the state's 27 Community Developmental Disability Organizations.

Ladon recommended that Kansas officials "at a minimum" postpone inclusion of DD long-terms services into KanCare until a "true" pilot program had been in place for a year so they could determine what savings might result and how they would be achieved.

She said the state also should develop "performance objectives" and "benchmarks" based on the specific needs of the developmentally disabled. The current KanCare performance measures, she said, were too broad to effectively serve that purpose.

Legislative response

About a half dozen legislators sat in on Ladon's morning presentation. Those who spoke seemed to support keeping long-term DD services out of KanCare or at least further delaying their inclusion.

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Reps. Don Hill, R-Emporia, and Dr. Barbara Bollier, R-Mission Hills, were among the legislators who sat in on a presentation by consultant Barbara Ladon.

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Rep. Don Hill, an Emporia Republican, said Ladon hadn't provided any new points but had "affirmed" some already made in the course of the debate over KanCare.

He asked Tom Laing, executive director of Interhab, whether there was any indication the Brownback administration might agree to extend the so-called "carve-out" of DD long-term services.

"We have felt all along that there are members of the administration who support us completely," Laing said. "I'm hopeful this kind of stuff will make a difference" in persuading others.

He urged family members and community service providers to talk with their legislators, many of whom are new this year and perhaps unfamiliar with the issue.

"I think the House and Senate have great potential to move this with their 165 bully pulpits," Laing said.



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