KHI News Service

KanCare continuity of care period ends

Various problems persist with program and legislators are starting to hear about it

By Mike Shields | April 08, 2013

Editor’s note: This is the latest in an ongoing series of stories looking at how the transition to KanCare has been going for different segments of the state’s providers and Medicaid population.

TOPEKA — The first 90 days of KanCare have passed, which means the transition period during which the state's 380,000 Medicaid beneficiaries could switch managed-care health plans this year is over.

That is important — for among other reasons — because many KanCare enrollees may find themselves in situations where the medical providers they are accustomed to using are not in the network of the KanCare plan to which they were assigned or chose themselves before the changeover period ended April 4.

And as the 90th day was marked last week, many Medicaid providers continued to report persistent problems with the program that was rolled out Jan. 1 by the administration of Gov. Sam Brownback.

'Number of issues'

"We still have a number of issues that pharmacists have to deal with," said Michael Larkin, executive secretary of the Kansas Pharmacists Association. "In the big picture, our number one concern is assuring that the managed care organizations adhere to the contracts signed (with the state) back in June."

Larkin said the contracts called for the KanCare companies to use a "transparent" process for determining the reimbursement rates for pharmacy services. In the association's view, he said, those contract provisions have been ignored by the KanCare companies "across the board."

Here are the enrollment figures for the three KanCare health plans as of the end of March, according to KDHE:

Amerigroup - 119,950 enrollees, or 32.1 percent of the total.

Sunflower - 134,514 plan members, or 36.1 percent of the total.

UnitedHealthcare - 118,654 members, or 31.8 percent of the total.

"And also the managed care organizations when they do change their pricing are supposed to notify us, let it be known to everyone that the pricing has changed. I don't know that they're doing that either," Larkin said.

He said a meeting was held last month with KanCare company representatives to try to resolve the concerns but that the problems continue apparently because "the wrong people were in the room to discuss that."

Larkin said he was trying to set up another meeting that also would include state officials.

Association members also are reporting reduced or delayed payments from the KanCare companies for durable medical equipment.

"They're having trouble getting proper reimbursement and knowing, if in fact, they will be reimbursed before the equipment goes out the door," Larkin said.<a name="continued"></a>

Lt. Gov. Jeff Colyer.

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Administration officials acknowledged some ongoing problems but said on whole they are pleased with the program's progress.

"It's been very workmanlike," Lt. Gov. Jeff Colyer said of the transition.

He also repeated what administration officials have said since the first month of KanCare: "There haven't been as many bumps in the road as we expected. Everybody's been very committed to working with people who are having issues."

Larkin said from the pharmacists' perspective the problems have been "something in between a bump in the road and grave concern."

"We're hopeful things will turn out for us. So far, it hasn't happened," Larkin said.

Administration officials and others say there has been progress on some of the more serious problems reported in the first two months of KanCare.

Because the state's KanCare companies weren't paid until February, Kansas government spent less on Medicaid in January than any in previous month of the 2013 fiscal year, according to figures from the Kansas Department of Health and Environment. In December 2012, the last month before KanCare, the state spent about $248.4 million on Medicaid services. In January, the first month of KanCare, the state paid out about $140.3 million. Then in February, after the state paid the managed care companies for January services, Medicaid spending rose to $260.7 million.

Delays in payments from the KanCare contractors to Medicaid providers have started to catch up. The managed care companies continue to add to their provider networks. And officials say that state and KanCare company teams are working diligently to fix problems as they are brought to their attention. The state’s troubleshooting teleconferences with Medicaid providers were increased to three times a week as the transition period neared completion, a schedule that officials say will continue at least for the short term.

“The rapid response calls have been beneficial in the work of all parties involved,” said Miranda Steele, a spokeperson for KDHE, the state’s lead Medicaid agency. “We’re able to maintain an issues log, and help as many people as we can during the early stages of any issue, which also allows other people and provider groups to see what the state and the three health plans are working to resolve that might be applicable to them.”

Photo by Sean Steffen, Pittsburg Morning Sun.

Krista Postai — right, chief executive of the Community Health Clinic of Southeast Kansas — talks with University of Kansas Chancellor Bernadette Gray-Little in 2009.

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'Second level of problems'

Krista Postai is chief executive of the Community Health Clinic of Southeast Kansas, a safety-net clinic headquartered in Pittsburg that was experiencing serious problems with the program 30 days ago, including a sharp decrease in Medicaid payments throughout January and February.

Postai said the payment situation had improved since the clinic's problems were publicized.

"We're about 80 percent caught up," on payments, she said, "which we envisioned would happen eventually, if (we) made enough noise."

Postai said clinic staff workers continue to exhaust hours on the phone getting authorizations from the KanCare managed care organizations (MCOs) to prescribe various medications for patients. She said the clinic also was trying to sort out which medical specialists in nearby Joplin, Mo. would continue to accept the clinic's patients.

"Basically, we're into the second level of problems," she said.

Others report ongoing problems with payment delays and frustrations with the complexity of the new system.

“We're running across various issues that have been delaying or denying payments,” for services, said Jessica Wood, chief financial officer for Cottonwood, Inc. in Lawrence. “This has taken up a good portion of my time and also the staff just to continuously contact people (at the MCOs) and follow the (claims) denials through the system and understand why they’re occurring.”

Legislative concerns

Early on in the transition, legislators said they were please with KanCare’s progress and some complimented the administration on the smoothness of it. But recently, more legislators began expressing concerns about the KanCare implementation, including some who previously had said they thought it was going OK.

"I'm hearing more and more concerns about KanCare in my community and from communities around the state," said Rep. Paul Davis of Lawrence, the Democratic leader in the House. "A lot of people seem to be complaining about the speed (or lack thereof) that some MCOs are providing reimbursement and putting a lot of providers in pretty difficult positions."

Earlier this year, Davis co-wrote an op-ed piece with Lt. Gov. Jeff Colyer, one of the Republican architects of KanCare, saying the initiative was going smoother than expected.

“I think this is a situation where a dialogue with the MCOs and the Legislature is necessary,” Davis said, “which is why we should have had an oversight committee in place already so they could come up and answer questions as to why there are issues with providing reimbursements and hear from the providers who are having a lot of problems as a result of this.”

Rep. Jerry Henry, a Cummings Democrat, said he thought the majority of KanCare “was probably working OK,” but “what I’m hearing from people back home is that there’s still a lot of glitches that need to be taken care of.”

Henry said one of the problems were “gaps in access” to major medical providers.

“The hospital that we use a lot in my district is in Missouri (Heartland Health in St. Joseph) and they're not interested in contracting at all (with the KanCare MCOs) so we're having some disruption of services like that…especially in Doniphan County, which has no hospital.”

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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