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Less than 60 days remain: Officials prepare for next phase of KanCare

Various officials at work across the DD system with hopes of a smooth transition

By Mike Shields | November 04, 2013

With fewer than 60 days remaining before the second major phase of KanCare is scheduled to start, state and managed care company officials say they continue to lay groundwork for as smooth a launch as can be managed, though there are important details and major tasks that remain to be worked out or completed.

“It would be naive to think that come Jan. 1 there won't be issues,” said Jean Rumbaugh, chief executive of Sunflower State Health Plan, one of the state’s three KanCare contractors. “But we’re working very hard to identify them (ahead of time) and to make sure that when there are issues that we address them quickly.”

Among the major items on the to-do list:

  • The training of hundreds of community service providers and others in the workings and policies for long-term support services for the developmentally disabled under KanCare;
  • Completion of provider contracts and service networks; and
  • Loading care plans for about 8,500 developmentally disabled Kansans into the computer systems of the managed care companies that, beginning Jan. 1, will assume oversight of the clients’ long-term services.

KHI News Service

Sharon Spratt, chief executive of Cottonwood, Inc. in Lawrence, was among the people who came to the Kansas Statehouse during the 2013 session, urging legislators to keep long-term services for the developmentally disabled out of KanCare. Now, she says, she and other CDDO officials are working to make the transition easy as possible on their clients while providing "constructive diligence."

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‘A lot left to be done’

“I think there’s a lot left to be done,” said Sharon Spratt, chief executive at Cottonwood, Inc. in Lawrence, one of the state’s 27 Community Developmental Disability Organizations.

“We at Cottonwood and Interhab (the CDDO association) recognize that we're in this. So we’ve made a commitment to work with the state and the MCOs (managed care organizations) going into KanCare. While we're doing that, we're also going to be providing constructive diligence. We want to make sure we're attentive to details and always looking out for the individuals we're serving and make it as easy a transition as possible.”

Most of the CDDOs and families of the state’s developmentally disabled who rely on Medicaid fought for more than two years to keep long-term services excluded from KanCare. They succeeded in delaying the so-called “carve-in” for a year but ultimately lost the political battle, and the handwriting on the wall became obvious a few months ago.

Since then, representatives of the CDDOs have been working with state and MCO officials to prepare for the changes. A lengthy list of implementation recommendations prepared by a CDDO working group became part of annual CDDO contract negotiations with state officials in recent weeks and state officials said they have accepted most of them, though some items are still in discussion and final policies have not yet been made public.

‘Very leery’

“We’re very aware that some of the consumers are very leery and we're doing everything we can to provide them all the information they need so they're not taken by surprise,” said Angela de Rocha, spokesperson for the Kansas Department for Aging and Disability Services. “We want everyone to understand their role and how this is going to work.”

KanCare is the name given the Medicaid makeover launched by Gov. Sam Brownback on Jan. 1, 2013. The initiative moved virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: Amerigroup, a subsidiary of WellPoint; Sunflower State Health Plan, a subsidiary of Centene; and UnitedHealthcare. Long-term services for the developmentally disabled were excluded from the program in its first year but are scheduled to be added starting Jan. 1, 2013.

De Rocha said the results of the state’s negotiations with the CDDOs were still being finalized.

“It’s ongoing,” she said. “It’s a very fluid discussion. Soon as we can get them finalized, they’ll be up (on the KanCare website). People are working long hours to make sure they’re up and that people know about them.

She said the policies would be posted “soon,” but not this week.

Among the things to be finalized are policies defining the respective roles of the MCO “care coordinators” and existing targeted case managers. In the DD community, the case managers typically are the system representatives best known to the clients and their families.

State officials have pledged repeatedly that clients will be able to keep their current case managers, but in the managed-care world it is usually the care coordinator who makes the final decisions about what services a person receives.

How the MCO care coordinator and case manager will work together remains a matter of considerable concern. And all involved say the devil is in the details.

‘Ticking time bomb’

The chief complaints from providers of all types in the opening months of KanCare’s first phase have been about delayed or denied payments for services and the clinical and administrative burdens of getting MCO authorizations for various treatments.

Medical services for the developmentally disabled were included in KanCare from the outset and some DD providers have experienced enough of those problems to be wary of the program’s expansion into long-term services and supports.

A pilot or transition program intended to familiarize the MCOs and the DD providers with one another and their respective systems only began test billing in October and so far the results have been mixed with DD advocates noting the ongoing problems and state and MCO officials more likely to cite the progress or lessons learned.

“Early indications are that the billing process is not operating efficiently. The pilot project intended to develop and demonstrate the state’s best effort to install the new insurance industry machinery is not yet satisfactorily working,” said Tom Laing, executive director of Interhab. “For some, it is improving, but for others the performance of the reimbursement system is still very unsatisfactory.

Tom Laing, executive director of Interhab.

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“We are concerned that the billing and reimbursement process has come together too slowly, yet must be fully operational very soon,” Laing said. “It can be a ticking time bomb for providers of service who in the past had routinely received timely payments under the old system.”

Many of the so-called community service providers are small entities that work through affiliate agreements with the CDDOs. They don’t have enough resources or other revenue streams to keep them going absent timely Medicaid payments, say those familiar with the system.

“All community organizations could be hurt in this process, and small providers of service in particular will be in trouble if the state cannot make the MCOs pay their bills accurately and timely,” Laing said.

“The state needs to be contemplating what will happen if many smaller providers go under. How will the needs of the persons served be addressed? Sudden or unexpected changes of service providers can be terribly disruptive in the lives of many persons our organizations serve, and time would be required to plan for capacity expansion to serve an unplanned influx of persons for any surviving provider of services.”

Lessons learned

But state officials said they have learned plenty in the 10 months since KanCare phase one was launched and that will assure that KanCare phase two goes better.

“We’ve got a lot of those kinds of problems worked out,” said Gina Meier-Hummel, the commissioner who oversees home- and community-based services at KDADS.

MCO officials also said they've made use of the past few months to learn more about the state's existing DD system and smooth out rough spots encountered in the first months of the state's Medicaid makeover.

“There are concerns with providers on payment and authorization,” said Rumbaugh, the Sunflower CEO. “But I think we've learned a lot of lessons working with the state and CDDOs.”

Rumbaugh said her company and the other two KanCare MCOs were all working with the state on what is needed to have the “authorization files” loaded in their respective systems prior to Jan. 1, essentially assuring that existing plans of care are on record with the KanCare companies, streamlining approvals and payments for services.

Jean Rumbaugh of Sunflower State Health Plan

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Sunflower I/DD Care Model

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“We are working (reimbursement) claims through the pilot program,” Rumbaugh said, “and the whole purpose of that is to identify issues in claims payments. We've identified even in the short time (of that portion of the pilot) that there's some provider education issues on how to submit the bills.

“Ideally, through this DD pilot program we’ll be able to work through a lot of issues and make that transition as smooth as possible,” she said.

‘A very, very critical piece’

Rumbaugh said one of the biggest challenges remaining before Jan. 1 would be getting the service providers’ contracts submitted and approved soon enough before Jan. 1 that some of the billing and claim issues associated with stalled or tardy contracts can be avoided.

There are about 340 community service providers for the developmentally disabled. Under the current system, they must have an “affiliate” agreement with a CDDO.

In the new system, they also will need network contracts with each MCO that covers one of their clients. That means additional levels of complexity and greater need for ongoing communication between the CDDOs and the KanCare lead contractors.

“So, one thing all the parties are going to have to make sure we're working together on is making sure we have provider capacity,” said Chad VonAhnen, executive director of Johson County Developmental Supports and one of the CDDO negotiators in the state contract talks.

“Contracting is a very, very critical piece and one of the most critical thigns we're working on right now,” Rumbaugh said.

Some doubt the new complexities will produce the cost savings in the system that the Brownback administration has forecast, at least with respect to the developmentally disabled. Administration officials insist they can save the state and federal governments about $1 billion over five years.

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

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“There is apparently no way to triple the number of administrative entities and at the same reduce administrative complexities,” said Laing, the Interhab chief.

“The state has chosen a model that is far more complex, and for which there will be more money spent on administration than in the past. They are working with us to address these issues, but the early decision to break the Medicaid administration into pieces has resulted in a less efficient, more costly model,” he said.

But supporters of the new system say the new complexities also offer opportunities for better integration of care for the developmentally disabled, resulting in improved health and lower costs.

“Obviously, you have a lot more complexity,” Rumbaugh said. “I don't think I can say that working with three is easier than working with one. But what I can say is that there is a workgroup that the state, the MCOs and CDDOs have to see if we can work together better. What we're trying is to have dialogue about how to make it consistent whenever possible to make it easier for the providers and those are discussions that are in process. I don’t think we have a final decision.”

De Rocha said KDADS officials plan two more days of meetings with CDDO officials in anticipation of Jan. 1.

“We will have two full-day sessions to address the remaining items,” she said in an email to KHI News Service. “Most of those are related to systems readiness, readiness reviews, policy updates and communications plans.”

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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