Two of the state's leading medical provider groups - the Kansas Medical Society and the Kansas Medical Group Management Association - have asked state officials to extend the transition period for KanCare another 90 days, saying more time is needed to work out a lengthy list of problems with the massive Medicaid makeover initiative that was launched Jan. 1 by the administration of Gov. Sam Brownback.
State officials in order to meet expectations of federal Medicaid officials and to smooth implementation of KanCare, required that the three KanCare contractors allow previous plans of care for Medicaid patients to remain in place until April 2, an attempt to assure that services provided before the KanCare changeover would stay intact until the new system was fully established.
Medical groups' KanCare letter
KanCare problems list
The 90-day transition period also allows patients to see medical providers not enrolled in networks of the KanCare managed care companies' health plans without seeing reductions in their payment rates.
26 problems detailed
The medical society and the physicians' group association detailed 26 ongoing problems with KanCare as an addendum to the letter sent to Dr. Susan Mosier, the state's medicaid director. They asked that the "continuity of care" period be extended 90 days past April 2, which is when the current transition period is scheduled to end.
The Feb. 8 letter was signed by Ruth Cornwall, director of health care finance for the medical society, Suzann Wright, president of the medical group association, and Jill Jones, chair of the KMGMA insurance focus group.
Wright told KHI News Service that the groups were concerned that if the transition period isn't extended, "patients may or may not be able to access their primary care physicians."
The state began sending notices to the state's 380,000 Medicaid enrollees last November assigning each of them to one of the three KanCare plans. Officials said they used a computer algorithm that was intended to match each enrollee with their known primary care providers. But there were many cases - how many remains undisclosed - of enrollees who were not matched with their preferred or known providers.
'Put together so quickly'
"I think this whole process was put together so quickly, I don't believe there was time for the state to exercise their algorithm correctly for proper placement," Wright said.
She said her association has about 400 members and they were seeing problems with the patient/provider match-ups and the other listed issues "pretty much across the board."
State officials previously have made statements to the Legislature and the media that they believe the KanCare rollout has been going better than they had expected.
Many of the problems that state officials have listed as "resolved" on the "issues log" maintained on the state's KanCare website resemble those outlined in the letter sent by the medical groups. State officials have acknowledged that they mark issues resolved once they notify the insurance companies of them, though the problems may persist.
Representatives of the KanCare companies and state officials have acknowledged that there have been some delays or problems getting Medicaid providers credentialed and listed in their networks, but have attributed that mostly to contracts not being completed before the KanCare launch.
Wright said that wasn't the case with her members.
"Our providers submitted contracts in October and November, so it's not an issue of watiing until January to sign contracts," she said. "Most of our providers did complete them."
No plan to extend
Kari Bruffett, director of the Health Care Finance Division at the Kansas Department of Health and Environment, and the administration's point person on KanCare implementation, told KHI News Service that state officials do not intend to "automatically extend" the transition period.
"The state is monitoring all aspects of the transition to KanCare," she said in an email message, "including ongoing network development, and continuity of care for members has been a key principle in guiding policy decisions. While we do not intend to automatically extend the 90-day period, we have secured assurances from each KanCare plan that they will continue to treat providers as in-network, even beyond the initial 90 days, as long as they are actively engaged in the contracting process."
Bruffett said administration officials appreciated the "active engagement" of the medical provider groups in the KanCare transition and "look forward to continued opportunities to identify and resolve issues with them."
Wright said this morning that state officials had not yet responded to the letter she and the others sent last week but were hoping to hear back sometime this week.
Jerry Slaughter, executive director of the Kansas Medical Society, which has about 4,500 members statewide, said the organization supports KanCare and that he expected the transition problems eventually would be resolved.
"If you look at the program from 30,000 feet, we're not getting a lot of complaints from the physician community about problems that are insurmountable," he said. "We very much want to make this work. The state's made a big commitment to it...We still feel like the state and the MCOs (managed care organizations) by and large are doing the best they can under the circumstances, having to move that many people into a brand new program very quickly and I think the issues have been identified."
Slaughter said historically almost 90 percent of medical society doctors have participated in the Medicaid program to some extent or other. He said it was too soon to know how many would participate in KanCare but that he expected it would continue to be a high percentage.
Here is an excerpt from the letter sent to Mosier, the full version of which is included with this story as an attachment:
"Due to the limited time frame in which this program was implemented, coupled by the unforeseen enrollment issues, it is felt that continuity of care is currently being jeopardized, as the state’s algorithm for patient assignments cannot be fully realized until the existing contracting and provider enrollment errors are resolved.
"Extending the deadline will allow providers and MCOs (managed care organizations) to continue to work together to address existing issues and problems. It is our belief that this extended time frame will also ensure that all state MCO recipients will have additional time to be correctly assigned to their existing provider (s) of care through extending the timeframe for which patients can be reassigned to the appropriate MCO."
CORRECTION: An earlier version of this story incorrectly stated the number of problems detailed in the letter sent by the Kansas Medical Society and the Kansas Medical Group Management Association to Dr. Susan Mosier, state Medicaid director.
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)
→ Full Medicaid and KanCare coverage
The KHI News Service is an editorially independent initiative of the Kansas Health Institute. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. All News Service stories and photos may be republished at no cost with proper attribution, including a link back to KHI.org when a story is reposted online. An automatically updated feed of headlines and more from KHI can be included on your website using the KHI widget. More about the News Service at khi.org/newsservice or contact us at (785) 233-5443.