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KDADS chief describes lessons learned with KanCare

By Mike Shields | December 05, 2013

The chief of one of the state's main welfare agencies described lessons learned by the administration of Gov. Sam Brownback after it shifted about 380,000 Kansans enrolled in Medicaid into managed care plans operated by three national insurance companies.

"I have a whole host of successes and opportunities for improvement that I would be happy to highlight," said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, in opening remarks today to members of the National Council on Disability.

Kansas' major remake of its Medicaid program drew members of the council to Topeka this week, the first of four cities they plan to visit to gather information about Medicaid managed care, particularly as it relates to the disabled.

The council is a federal agency charged with advising the president, Congress and other federal agencies on disability policies.

"People nationally are watching Kansas on this," said council member Gary Blumenthal, a former member of the Kansas House of Representatives now living in Massachusetts. "They're asking: Is this the next wave?"

The council wrapped up the last of its two meeting days here by focusing solely on KanCare and Medicaid managed care. On Wednesday, the council heard panel discussions about the problems faced by disabled people living in rural areas and programs aimed at promoting employment.

Prairie Village man Finn Bullers fighting KanCare service reduction

Today they heard a variety of views about the KanCare program from state officials, KanCare enrollees, association leaders, insurance company representatives, some national experts, and others.

Most of what they heard from the Kansans who spoke was critical, though there was little new in that for administration officials or others already familiar with the program's transition problems.

Council members were told about the delays in payments and authorizations for services that have been reported by the various Kansas Medicaid service providers and from beneficiaries who said they have had trouble getting the full range of services they received under the old system.

They also were advised that many families of developmentally disabled Kansans remain worried about the administration's plan to extend KanCare to cover DD long-term services, starting Jan. 1, pending federal approval.

"I've been a strong opponent of KanCare and as a result a lot of people from around the state contact me," said Rep. Jim Ward, a Wichita Democrat who appeared with Sullivan in a morning panel session. "There's a great fear among family members, providers and advocates that this isn't going to work. They're very much afraid."

Sullivan and Ian Kuenzi, a young, disabled man hired by Sunflower State Health Plan, one of the managed care companies, provided most of the praise KanCare received at the meeting.

But Sullivan said one of the chief shortcomings of the way the program was rolled out was too little direct communication between state officials and those that Ward described as frightened: Medicaid beneficiaries and their families, especially those in the Medicaid waiver programs involving home- and community-based services.

"We need to get more creative in reaching out to people," Sullivan said, noting that many of those missed connections resulted from people being too busy with family and other obligations to attend some of the forums or educational events staged by state officials as part of KanCare's launch.

Sullivan also said the timing of a reorganization that eliminated the former Kansas Department of Social and Rehabilitation Services and moved most of the state programs dealing with the disabled or mentally ill into his agency added complications to the KanCare transition. The reorganization and merger occurred only six months before KanCare began.

Nor did it help, he said, that federal officials waited until Dec. 27, 2012 to approve the KanCare launch, which happened only days later on Jan. 1, 2013. He said many Medicaid service providers waited for the federal approval before entering contracts with the managed care companies which subsequently contributed to some of the billing and payment problems.

"That transition was challenging," he said.

But he said complaints about stalled reimbursements to providers have been overplayed and that "in aggregate, payments have gone well."

Merrill Friedman — left, a vice president with WellPoint, the company that bought Amerigroup soon after it won one of the Kansas managed care contracts — was among the panelists at today's forum, as was Kansas Health Institute Senior Analyst Scott Brunner. The KHI News Service is an editorially independent initiative of the Institute.

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He also said "one of the things we didn't think clearly about" was how a new telephonic monitoring system designed to record hours worked by personal care attendants for disabled people would connect with the billing systems of the managed care companies.

Nancy Thaler, executive director of the National Association of State Directors of Developmental Disability Services, later described Sullivan's comments about the problems experienced as "incredibly honest — and profound in a lot of ways — about what they now know, so other people don't have to make those same mistakes."

Merrill Friedman, a vice president with WellPoint, the company that bought Amerigroup soon after it won one of the Kansas managed care contracts, told council members that "with 30 plus states around the country looking at managed long-term services (for the elderly or disabled), this discussion couldn't be better timed."

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

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