KHI News Service

National Disability Council again urges CMS to hold off on Kansas DD carve-in

Follow-up letter urges several changes to state's plan before feds OK it

By Mike Shields | January 14, 2014

Officials at the National Council on Disability have sent a follow-up letter to federal and state officials urging them to hold off on including long-term supports for the developmentally disabled in KanCare.

The letter lists several steps the advisory group said Kansas should take before securing federal approval for its controversial initiative.


Second NCD letter to CMS

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The missive was delivered today to top officials at the Centers for Medicare and Medicaid Services and top officials at the lead Kansas Medicaid agencies.

In essence, the letter calls for Kansas officials to go back to the drawing board and develop a plan that includes more input from those who would be affected by the proposed changes.

The letter also recommends that the state operate a regional pilot program over the next 12 months before being allowed to launch its plan statewide.

The list of recommendations also repeated a concern raised earlier by the council that Kansas should not be allowed to include long-term DD supports in KanCare while excluding from KanCare the residents of the so-called intermediate care facilities operated by the state — Kansas Neurological Institute in Topeka and Parsons State Hospital and Training Center.

It also called for Kansas to create a "robust and independent" KanCare ombudsman's office with more resources than the state currently allows for it. The ombudsman's office is housed at the Kansas Department for Aging and Disability Services. The council and other critics of the current structure say the ombudsman shouldn't be directly employed by an agency that delivers or administers Medicaid services.

The council also called on CMS to require that the managed care companies hired by the state to run KanCare have at least one care coordinator per 40 Medicaid cases that involve developmentally disabled enrollees.

Jeff Rosen, chairman of the National Council on Disability.

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The letter was signed by Jeff Rosen, the council's chairperson, on behalf of the full board.

Ari Ne'eman, a council member from Silver Spring, Md., said the letter offered specific recommendations for Kansas but was intended to also communicate the council's thoughts on how Medicaid managed care might be implemented in other states.

The council's position is that managed care can offer benefits to Medicaid enrollees, if implemented in the right way.

"We look at Kansas as a bellwether on this issue for the rest of the country," Ne'eman said, "so while we focused in some sense on Kansas, we also articulated it with our broader vision for long-term supports and services in mind."

Ne'eman said the letter was issued now because the council was aware of ongoing discussions between CMS and Kansas officials and the council was hopeful its recommendations would be a helpful resource in the discussions, serving as a possible blueprint or rule of thumb for the way to handle long-term services for the disabled in a Medicaid managed care framework.

Former Kansas State Rep. Gary Blumenthal, now a Massachusetts resident, is one of the council members. The council is a federal agency that advises the executive branch and Congress on issues dealing with the disabled.

The council sent a letter in December to CMS and state officials urging delay of the Kansas plan. That came just after the council held two days of hearings in Topeka at the Kansas Statehouse.

Officials in the administration of Gov. Sam Brownback responded critically to both letters.

"The latest letter contains comments very similar to NCD’s earlier letter. Our the same as it was in December: that the NCD session on the I/DD waiver in Topeka was not an honest, objective process and did not result in objective recommendations," said Angela de Rocha, spokesperson for the Kansas Department for Aging and Disability Services.

"We have been having some very constructive conversations with CMS and our stakeholders over the past two weeks, and in fact CMS has received a number of letters from other national advocacy groups in opposition to NCD’s demands on the State of Kansas," de Rocha said.

The Brownback administration initially planned to roll long-term DD services into KanCare starting Jan. 1. But CMS withheld approval citing various concerns with the state's plan.

Administration officials say they working through those as part of ongoing discussions with the federal authorities and expect to have full sign-off from CMS in time to launch their planned expansion by Feb. 1.

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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