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DD groups largely reconciled to KanCare carve-in

But worries and questions remain

By Mike Shields | July 15, 2013

After opposing the move for nearly two years, many providers of long-term services for the developmentally disabled say they now are largely resigned to the state’s plan to fully include their system in KanCare. But that doesn’t mean all the questions and worries about the proposed changes have gone away.

Chief among them seems to be this: How will the whole thing work?

“There was that whole debate this past (legislative) session and last year’s session about whether it’s good for people with DD to be in this (KanCare), but that debate is behind us now,” said Jerry Michaud, president of Developmental Services of Northwest Kansas, Inc., (DSNWK) a nonprofit Community Developmental Disability Organization that serves about 500 developmentally disabled, or DD, people in the state’s 18 northwestern-most counties.

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Kay Soltz, a Wichita mother of a developmentally disabled adult son, was one of about a half dozen people who spoke during a public hearing about the state's proposed KanCare expansion. All expressed opposition or concerns about the plan, though one, Colin McKenney, president of the Interhab board, said "it appears the train is on the tracks." Soltz said she was happy with the current DD system and didn't see how the changes could make things any better for her son.

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Guidance to States using 1115 Waivers for Managed Long Term Services and Supports Programs

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“And so now, it’s how do we set up a system that's going to work and not wait until the first day to realize there are some major hiccups,” Michaud said.

Public comment

State officials this week held two public hearings on an application they plan to file with federal authorities, probably in mid or late August, seeking approval for the KanCare expansion and some other Medicaid program changes.

However, state officials said they believe they already have all the authority they need for the so-called “DD carve-in” as a result of the initial federal sign-off on KanCare in December 2012, just days before the KanCare initiative was launched on Jan. 1.

Kansas officials said federal officials have been urging states to broaden their Medicaid managed care programs so that various services can be better coordinated. And key spokespersons for the state's developmentally disabled service groups said they don’t expect the federal Centers for Medicare and Medicaid Services to block the expansion once they receive the state’s Medicaid waiver request.

But there are a number of key questions about how the changes scheduled to begin Jan. 1 will be accomplished and whether or not some of the problems experienced by KanCare providers in the past few months will have been smoothed out so that the new expansion is relatively easy or seamless for the developmentally disabled and those who assist them.

State officials have said for two years that they intend to leave the current, time-honored service delivery system in place. But the nature of the working relationship the providers will have with the state’s three KanCare contractors and their myriad subcontractors is still being sorted out.

“We are meeting two times a week with the MCOs (the KanCare managed care companies) and the different provider work groups to make sure we get this correct and to make sure we have this exactly correct the first time out,” said Aquila Jordan, director of Home and Community Based Services for the Kansas Department for Aging and Disability Services (KDADS), the agency that oversees the state’s Medicaid DD programs.

Aquila Jordan, director of Home and Community Based Services for the Kansas Department for Aging and Disability Services.

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Chad VonAhnen, executive director of Johnson County Developmental Supports in Lenexa.

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Implementation committee

Jordan is the point person for the state on a committee put together to help implement the KanCare expansion. She works from the agency’s headquarters in Topeka. Point person for the DD providers is Chad VonAhnen, the new executive director of Johnson County Developmental Supports in Lenexa.

Michaud’s organizations is one of the handful of DD service providers that already has had some its clients fully “carved in” to KanCare.

DSNWK has an Intermediate Care Facility for Individuals with Mental Retardation (ICFMR) that serves 11 people in Norton. Residents of the state’s ICFMRs were fully included in KanCare from the outset.

Michaud said the organization had some major problems with the program, including some that are ongoing. He said in the first months of KanCare, his agency had trouble getting paid by the KanCare contractors and ended up about $130,000 in arrears. The payment problems since have mostly been resolved, he said.

But as of last week, DSNKW was still waiting for the KanCare companies to approve the operating contracts, which Michaud said the agency first submitted in November 2012.

“We're 180 days into this and we still don't have contracts,” he said.

He said the agency incurred significant costs for an attorney and in staff time in the first months of KanCare trying to work through the payment and contracting problems. He said he is hopeful that the working groups, the implementation committee and the pilot or transition program that KDADS is developing will spare DD providers some of the jolts that DSNKW experienced with KanCare for its ICFMR clients.

State officials said that is their hope, also.

“We learned a lot from the launch in January, so we're hoping not to repeat some of the bottlenecks we ran into then,” said Angela de Rocha, a KDADS spokesperson.

And KDADS Secretary Shawn Sullivan said he expected the state would have a preliminary billing system in place by August to test claims and payments with the KanCare contractors, using 25 DD service providers that are taking part in the state's pilot program. He said his agency also was focusing on resolving the "contracting and credentialing" concerns that have been raised by DD providers so that the expansion can move smoothly on that front.

Wichita meeting

On Monday, about 80 people attended the first of the two public hearings. Except for the state officials who provided updates on the status of KanCare and their planned expansion of the program, all who spoke described their concerns and opposition to the idea of adding long-term DD supports to the program.

Among those who spoke were mothers of developmentally disabled children and the owner of a firm that provides case management services for the disabled.

'Grand experiment,' but why?

Sally Farenthold of Wichita, mother of a 50-year-old developmentally disabled daughter, criticized the planned expansion as "change for change's sake."

Standard medical services for the developmentally disabled have been part of KanCare from the start and Farenthold said that part of KanCare already has been disruptive for her daughter.

"I'm finding the medical plan is not working for us," she said. "My daughter is still listed with the wrong provider. We've contacted the MCO (managed care company) many, many times."

Kay Soltz, also of Wichita, and the mother of a 29-year-old developmentally disabled son, said she saw no reason to change the current system.

"To me, it seems like a grand experiment. To me, the current system is excellent beyond compare," she said. "It's all working, so why would we want to change it? I don't get it. I don't imagine how it could be better. I know you've given us all these promises, but how are you going to save money and bring in these for-profit MCOs. To do what?"

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Rep. David Crum, R-Augusta

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Two state legislators were in the crowd, Reps. David Crum, an Augusta Republican, and Jim Ward, a Wichita Democrat.

The two have been on opposite sides when it comes to KanCare and the developmentally disabled.

Crum, chair of the House Health and Human Services Committee, has supported the administration's plan.

Ward introduced a bill earlier this year that would have excluded DD services from KanCare. His bill got a hearing, but then failed to get out of committee for consideration by the full Legislature.

Ward said he once again was struck by the difference between what he hears from the public about problems they have with KanCare versus the rosy descriptions of the program he hears from Brownback administration officials.

Rep. Jim Ward, D-Wichita.

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"It's like they're living in some bizarro world," Ward said of the administration.

But Kari Bruffett, director of the Health Care Finance Division at the Kansas Department of Health and Environment, said she was encouraged that turnout and comments at today's meeting exceeded those at a previous, recent forum on KanCare in Topeka.<a name="topeka"></a>

She said the meetings signaled to her that people were still "engaged" and willing to co-operate with state officials on making the program work.

Topeka meeting

About 80 people attended the second public comment session Tuesday in Topeka and others participated via teleconference.

State officials made opening remarks at the event.

"It would have been politically and programmatically easier to stay with the status quo," said KDADS Secretary Sullivan. "But we don't believe that's the way to go."

He said state officials were convinced they could cut costs and improve health outcomes for people with developmental disabilities and also decrease the percentage who are unemployed or living in settings with more than three residents.

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Holly Lofton of Lindsborg, mother of an autistic son. She was one of several people who spoke at a KanCare public comment session Tuesday in Topeka.

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Interhab Comments

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He said the state's Medicaid DD population was getting older and as a consequence was more susceptible to chronic illnesses. He said the current system wasn't well suited for "chronic care management."

Holly Lofton of Lindsborg, mother of an autistic son, told state officials that she thought their goal of of finding more employment for the developmentally disabled was "commendable." But she said she was skeptical much progress could be made. She said her son had managed to hold a job now for four years, but that he was an exception in part thanks to a very helpful and understanding employer.

"The DD waiver population is very difficult to employ because of their needs at work," she said.

She said she had worked briefly for the state as a contractor helping disabled persons find jobs. But she said she had to give it up because of the stress and the fact she was losing money. She said her son was the only one she worked with who had been able to keep a job.

Tom Laing, executive director of Interhab, an association that represents most of the state's 27 Community Development Disability Organiztions, described a number of problems that DD providers already have experienced with KanCare but said his group would try to help the initiative succeed.

"The good news in all of this is that we do believe the state’s intentions and efforts are as focused as ours on making the new world work as good or better than the old world worked," he said. "We are resolved to do everything we can to work with the state and the MCOs to assure that quality services and supports are available for persons with (intellectual and developmental disabilities)."

But he also urged state officials to develop a prompt and responsive grievance process for settling complaints and to minimize administrative complexities so that "precious resources aren't wasted on bureaucratic confusion."

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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