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Leaders discuss the lessons of KanCare

12/11/2013

By MIKE SHIELDS

KHI News Service

TOPEKA -- The chief of one of the state's main welfare agencies described lessons learned by the administration of Gov. Sam Brownback after it shifted approximately 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 Tuesday to members of the National Council on Disability.

Kansas' 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 by focusing solely on KanCare and Medicaid managed care. Today, the council heard panel discussions about the problems faced by disabled people living in rural areas and programs aimed at promoting employment.

On Tuesday, 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 for administration officials or others already familiar with the program's transition problems.

Council members were told about 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 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. "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 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 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. 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 "in aggregate, payments have gone well."

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 "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."