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Feds approve KanCare DD carve-in

By Mike Shields | January 30, 2014

Kansas officials said they have received formal approval from federal authorities to include long-term services for the developmentally disabled in KanCare.

The approval document included "special terms and conditions," spelling out federal expectations of the program's expansion, which has been resisted by most of the state's providers of developmental disability services.


DD Carve-in Approval Letter

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DD Carve-in Terms and Conditions

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Gov. Sam Brownback, who launched his administration's Medicaid makeover on Jan. 1, 2013, called the inclusion "an important step forward for KanCare" and the 8,500 developmentally disabled people who receive Medicaid services.

He said the KanCare expansion, which is scheduled to begin Feb. 1, would "further enhance the care provided to them, improving both their physical well-being and their quality of life.”

Medical services for the developmentally disabled have been included in KanCare since the program was launched.

KanCare moved the state's Medicaid enrollees into managed care plans run by three insurance companies working under contract to the state: Amerigroup, UnitedHealthcare and Sunflower State Health Plan.

"No commitment this large has been made to Kansans with intellectual disabilities since the Developmental Disability Reform Act of 1995. We're raising the standard of expectations for outcomes, and increasing access to care. This is monumental,” said Lt. Gov. Jeff Colyer.

'Extremely disappointed'

But the leader of the organization that represents most of the state's Community Developmental Disability Organization said the decision by the Centers for Medicare and Medicaid Services was a setback for the long-established system already in place.

"I'm extremely disappointed that the thousands of hours spent by families, providers and advocates didn't count for more at CMS," said Tom Laing, executive director of Interhab. "The philosophy of this (KanCare) program is a setback for the system we have for serving the disabled in this state and it will be a setback for some time. It places the interests of the bureaucracy above the interests of the people the bureaucracy was intended to serve and I think that's sad."

Medicaid providers of all sorts ranging from pharmacists to hospitals and doctor clinics have reported ongoing problems with the managed care companies, mostly surrounding treatment authorizations and getting timely payments from them.

Those problems have heightened concerns among the providers of services for the developmentally disabled, especially since most of them rely entirely or almost entirely on Medicaid payments to support their operations.

'Little room for error'

Kansas legislators have had earfuls about the problems.

Sen. Dan Kerschen, R-Garden Plain. "There's very little room for error at this point," Kerschen told Brownback administration officials on Wednesday during a KanCare update given to the Senate Ways and Means Committee.

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On Wednesday, two conservative Republican supporters of the governor's initiative warned administration officials that promised safeguards against those problems for the DD providers had better work after the so-called "carve-in" starts.

"I think we're doing the right thing," said Sen. Dan Kerschen of Garden Plain. "But there's very little room for error at this point."

Sen. Jim Denning of Overland Park told Brownback officials that his "patience would be zero," if DD providers experience the troubles other Medicaid providers have run into. He also asked why the expansion couldn't be postponed until March 1 so everyone involved could better prepare for it.

But administration officials said they were ready to go and that the KanCare companies were already footing the cost of extra employees hired specifically to work with the developmentally disabled. The administration had initially planned to start the expansion Jan. 1, but the federal approval was held up.

The Brownback official who oversees Medicaid programs for the disabled struck a conciliatory tone in his prepared comments about the approval, which were released together mid-afternoon with statements from the governor and lieutenant governor.

“I want to thank all of the individuals served, family members and guardians, and providers for their continued engagement in this transition, said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. "I know that they will hold us accountable to the protections that we have built into KanCare for persons served and their providers. I welcome the ongoing involvement of all to make this a system that provides needed access to services, quality services and supports, a good transition from school to adult life and support for families that is flexible and that meets their needs.”

Underserved waiting list

As part of the approval process, Kansas officials agreed to eliminate the so-called “underserved” waiting list. The “underserved” list includes about 1,400 developmentally disabled people who are receiving some but not all of the Medicaid services they need.

In the CMS approval letter, which was signed by Director Cindy Mann, federal officials said, "one of the key benefits anticipated by Kansas in pursuing the opportunity to redirect a portion of savings from managed care improvements to increase access to community based long term services and supports."

The state also agreed to some changes in the operation of the KanCare ombudsman's office that will require it to beef up its reporting and staffing. CMS officials said they would review the office's operations in a year to see if it is meeting the terms of the approval.

The National Council on Disability, a federal agency that advises Congress and the executive branch, had asked CMS to postpone for a year approval of the Brownback administration's request.

Former Kansas State Rep. Gary Blumenthal, now living in Massachusetts, is a member of the council.

"It is a decision that will have national consequences and will create tremendous performance expectations for the Brownback administration," Blumenthal said after the decision came down. "I continue to believe it is not a wise move. For-profit insurance companies are well equipped to handle managed care with regard to health care. They have no experience or expertise working with people with community programs that address residential and employment programs."

Blumenthal said the KanCare managed care companies "would be under the microscope to not reduce services and supports."

He also predicted it would be difficult for the companies to find cost savings unless they cut services.

"Such an approach could cause chaos and tragedy in the lives and families of people with developmental disabilities," he said.

The disability council had urged CMS to move slower on the DD carve-in, saying that it was groundbreaking and likely could end up being a model for other states. Council officials said they saw some potential merits in managed care for the disabled but only if done right.

Brownback officials have been pushing for two years to include DD services in managed care and the approval granted today will make Kansas the first state to do it statewide.

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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