KHI News Service

DD carve-in not approved for Jan. 1 launch

CMS and state officials continue to discuss various concerns with the state's plan

By Mike Shields | December 27, 2013

Kansas will not be able to move forward Jan. 1 as planned with its KanCare expansion intended to include long-term supports for the developmentally disabled.


Letter from CMS regarding KanCare DD carve-in

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Interhab memo

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KanCare Delayed Statement

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Instead, officials at the federal Centers for Medicare and Medicaid Services continue to talk with state officials about various concerns they have with the state's plan.

Officials said the lack of a CMS sign-off for the Jan. 1 start more likely would result in a delayed approval after various changes are made to the plan as opposed to outright rejection of what has been one of the more controversial components of Gov. Sam Brownback's ongoing Medicaid program makeover.

"They have told the state that they will not approve the 1115 waiver that carves in the DD folks on Jan. 1," said Sen. Laura Kelly, a Topeka Democrat who has been in contact with CMS officials. "My sense is that this will just delay the decision."

Kelly said there were four main areas of concern with the administration's plan as outlined by federal officials and others:

  1. The number of disabled people on the state's so-called "underserved list."
  2. Concerns about whether the state can guarantee prompt payments for services by the state managed care companies to DD service providers.
  3. The state's organizational structure for its KanCare ombudsman. Critics say the ombudsman should not be directly employed by a state Medicaid agency in order to assure greater independence.
  4. Concerns about "notices in the state's 1915C waiver and proposed 1115C waiver amendment."

Brownback officials subsequently issued a statement saying they would continue talks with CMS through Feb. 1 — a date not mentioned in the letter from CMS — in an effort to resolve or respond to the concerns that have been raised and, during that interval, develop a new implementation timeline for the KanCare expansion, to which they said they remain fully committed.

"Going forward, this administration aims to keep Kansans off the underserved list and reduce the (physical disability/developmental disability) waiting lists, and KanCare's integrated care coordination is key to solving that longstanding issue," Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, said in the prepared statement.

Administration officials said they would mail letters to DD consumers and providers to notify them "of this temporary postponement" of the state's expansion plan.

State officials said the delay also would allow adequate time for them and federal officials to review the latest public comments on the planned expansion.

Interhab, the association that represents most of the state's Community Developmental Disability Organizations, filed comments earlier this week with CMS, newly outlining that group's ongoing trepidations with the proposed carve-in of DD services.

The public comment period on the state's so-called 1115C waiver amendment proposal did not officially close until Dec. 24 after being extended because of an earlier glitch on the CMS public comment website.

Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.

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Interhab also sent a memo dated Dec. 23 to Sullivan at KDADS, urging the state to delay or cancel its plan to include DD long-term supports in KanCare due to — among other things — "too much detail work left undone."

Earlier this month, the National Council on Disability, a federal advisory panel, urged CMS officials to delay for one year the state's request to include long-term DD supports and services in the state's sweeping managed care plan. Medical services for the developmentally disabled were included in KanCare on Jan. 1, 2013, when virtually all the state's 380,000 Medicaid beneficiaries were moved into managed care plans run by three major, for-profit insurance companies.

Advocates for the disabled said they were pleased that CMS had withheld approval.

“We are extremely pleased that CMS has listened to Kansas stakeholders about the serious problems with KanCare, including but not limited to wrongly forcing over 1,700 people on the so-called underserved waiting list and the lack of proper notice regarding service reductions and appeal rights," said Rocky Nichols, executive director of the Disability Rights Center of Kansas.

"KanCare simply isn’t ready to take on the DD Waiver, and thankfully the federal government is getting that message loud and clear," he said.

Interhab Executive Director Tom Laing said the delay would allow the group to continue its appeals to the Kansas Legislature, which convenes again in January, to block the administration plans to carve in DD services.

File photo of Tom Laing, executive director of Interhab.

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"I think legislators — many of whom who were being assured by the administration that everything was fine — will now want to ask new questions," Laing said. "This wasn't ever a partisan issue. We had Republicans and Democrats and moderates and conservatives who had concerns about this. It's not a matter of adjusting a few nuts and bolts. However much the state might want to say otherwise, there are fundamental problems" with the expansion plan.

Interhab has long argued that long-term supports for the developmentally disabled should be left alone, saying they don't lend themselves to the commercial, medical models used by shareholder-owned insurance companies.

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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