KHI News Service

Work in progress: KanCare problems persist for providers

Nine months into the state’s Medicaid makeover, small hospital execs and others cite ongoing problems

By Mike Shields | September 23, 2013

KanCare apparently looks different here than it does in Topeka.

“The process has not gone as smoothly as the people at the Statehouse would have you believe as far as the implementation is concerned,” said Allen Van Driel, chief executive of Smith County Memorial Hospital, a small, rural facility near the Nebraska border. “The party line is that the managed care plans are working and that KanCare is a huge success, that it’s processing claims and all that. But that's simply not factual.”

Van Driel said his hospital, which includes a small nursing home where 50 percent of the residents are on Medicaid, has had ongoing problems with the new system since it was launched Jan. 1 by the administration of Gov. Sam Brownback.

Nine months into the initiative, Van Driel said, his hospital still has trouble getting fully paid for its services, particularly for those related to long-term care.

He said one of the three KanCare managed care companies hadn’t made a single, correct payment to the hospital since the program was launched.

“Initially, they couldn't even tell us why we weren't getting paid,” he said. “They’d say things like ‘there's a bug in the system.’”

Then a couple weeks ago, he said, it seemed there was some progress. The managed care company “hired an individual who seemed to have good knowledge of the claims processing problem,” Van Driel said.

The company rep told Van Driel the hospital should resubmit its claims dating back to Jan. 1 and everything would get worked out.

“But the problem is their claim resubmittal process doesn't work,” he said. “The place where you're supposed to be able to submit a corrected claim on their website, it’s not there. The links don't work and when we pointed this out to them, the eventual response we got was to submit the claims through (Kansas Department of Health and Environment) and they would pass them along to the MCO (managed care company). The result is we're nine months in and we still haven't gotten paid.”

Rosier picture

Brownback officials have tended to paint a rosier picture, particularly when describing the program to the broader public.

Lt. Gov. Jeff Colyer when asked recently about some of the problems said the KanCare initiative was going “better than expected.”

Steve Kelly, CEO of Newton Medical Center and a former member of the KanCare Advisory Council, says he has an idea that might make KanCare implementation easier for all concerned. He suggests the state mimic a Medicare mechanism that allows providers to be paid the historical rates they've received under Medicaid with adjustments made every quarter or at the end of the year in the event of overpayment or underpayment. That would assure hospitals enough money to continue their services while the "mechanical" problems of KanCare were being resolved.

"I don't think we give the processes a fair chance when our livelihood depends on the perfection of those (KanCare) systems. They're an experiment. They're ongoing. If our ability to perform (due to payment delays) wasn't compromised, we would have time to work out the kinks and it wouldn't be so detrimental to our system."

He testified to Congress last week, calling for a delay in the implementation of Obamacare, the federal health reform law, citing KanCare as an example of the things states could do to improve the U.S. health care system, if left to their own devices.

“We overhauled our entire Medicaid system,” he said. “We did not throw anybody off. We saved $1 billion and got additional services for people and are starting to look at long-term health outcomes.”

Problems like those reported by Van Driel and others have been described by Colyer and other Brownback officials as “bumps in the road,” of the sort to be expected with any large-scale change in a complex system.

But Kansas hospital officials have become increasingly vocal about the problems they are experiencing with the system changes.

‘Sometimes too much is too much’

Last month, Hugh Tappan, chief executive of Wesley Medical Center in Wichita, one of the state’s largest, met with area legislators and told them that KanCare was adding to Wesley’s administrative costs due to disputed claims for reimbursement. Officials at Via Christi, the state’s largest health care system, echoed his concerns.

And officials at the Kansas Hospital Association said the problems reported by the large, urban hospitals also were being experienced at the smaller, rural facilities.

“I know healthcare is about change, but sometimes too much is too much,” said Sandra Montes, the director of patient financial services at Southwest Medical Center in Liberal, describing the experiences she and others have had with KanCare.

Montes said the problems were fewer than in the earliest months of the program, but were still significant and time consuming. In February, she said, she would have scored KanCare at “at least 10 or 11” on a scale of 1 to 10 with 10 being “total chaos.” Now, she said, she would score it about 4.

“We sometimes feel like we're beating our heads against the wall,” she said, citing inconsistencies when dealing with the companies' representatives on billing or authorization issues. “There’s constant voice mails, emails, phone tags and sometimes you don't get anywhere.”

Montes and others in her department said they thought the state had implemented KanCare too quickly with too little input from the people who actually deliver Medicaid services.

Because of the meat plants in the Liberal area, the hospital deals with people of many nationalities, many of whom have children enrolled in Medicaid. She said hospital officials frequently end up as the intermediary on Medicaid patient issues because the patients have little or no direct contact with the KanCare managed care companies or state officials.

“They feel like we’re the only ones who can help them,” she said.

“I would say that if you want to implement something like that in the future you should have more input from people who do the day-to-day jobs,” Montes said, “because we know what the people in our community are like and need. We could definitely help them (state officials) fine tune and make the process go smoother for everyone.”

Working through the problems

A Kansas Hospital Association work group has been in regular consultation with state and managed care company officials to try to communicate the hospitals’ concerns and find solutions.

And the state has taken steps to try to ease the difficulties.

For example, in July officials from KDHE and the Kansas Department for Aging and Disability Services did an “on-site” review of the managed care companies.

One of the results from the reviews, according to KDHE Secretary Dr. Robert Moser, was that the managed care companies hired more provider relations and customer service staff and “enhanced and targeted their training to ensure consistent information is shared.”

He also said — in a letter sent last week to members of the hospital association — that regular provider calls had been arranged “to allow direct access“ to the KanCare companies’ management by Medicaid providers.

“We have also directed the plans to maintain robust issues logs that can be dependable resources for providers to research known issues and their resolution,” he said.

It remains to be seen if those steps will ease the concerns.

“We recognize this transition to a new delivery system has not been easy or without the need to make adjustments along the way,” Moser said. “We also recognize that during this time, there has been an impact to (hospital) administrative operations, and we continue to work with all parties in finding ways to improve processes and reduce administrative burden.”

Oversight committee to hold first meeting

The Lieutenant Governor’s Office also has been involved in the troubleshooting.

State Rep. Troy Waymaster, a Luray Republican whose district includes the Smith Center hospital, said when he hears about problems from hospital officials or other Medicaid providers in his district he routinely relays them to Colyer’s office.

KHI News Service

Rep. Troy Waymaster, R-Luray.

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“Whenever I've had those concerns, I've always been able to contact the Lieutenant Governor’s Office,” Waymaster said. “They’ve been handling all those issues and the Lieutenant Governor’s Office has been pretty good at resolving them in a pretty good manner.

“Delay of payment is pretty much the overwhelming concern that I have heard,” he said.

He said other area legislators he talks with reported hearing the same sort of complaints from providers in their districts.

The first meeting of the Legislature’s KanCare oversight committee has been scheduled for Oct. 7 at the Statehouse. An agenda for the meeting has yet to be made public.

Waymaster, is not a member of the panel, but he said he hopes the committee is made “aware of the problems that some of the hospitals and other providers are running into and how the Legislature can best address those issues.”

The first meeting of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight is scheduled for 8 a.m., Oct. 7, in Room 548-S at the Statehouse.

Van Driel, the Smith County hospital director, said he hopes the Legislature will understand the problems providers are having with KanCare so it can provide real oversight.

“From our standpoint now,” he said, “there's nothing we can do but try to work with the MCOs and KDHE. We have to be able to get our concerns routed to the people at the MCOs who can resolve them and pay the claims and we're not having great success with that. Are we at the point where we need to scrap the whole thing? I think that would be a hard sell to convince the governor that's what needs to happen. But obviously there’s a big problem some place and there should be accountability.”

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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