In emotional testimony, providers and patient criticize KanCare system
10/08/2013 4:47 PM
10/08/2013 4:47 PM
A committee of Kansas legislators heard Monday from health-care executives who said claim denials and slow payments by the state’s KanCare managed care system threatens their businesses — and emotional testimony from a Johnson County man with muscular dystrophy who said KanCare cuts were threatening to destroy his family and his life.
At the first meeting of the Joint Committee on Home and Community Based Services and KanCare Oversight, representatives of hospitals and other health-care and disability service providers said the new system — proposed and promised to reduce bureaucracy — has substantially increased it by adding a layer of administration between them and the state.
But their testimony was emotionally overshadowed by Finn Bullers of Prairie Village, an unannounced witness who came to the hearing in an electric wheelchair with his respirator attached to the back.
Bullers said he is facing a planned reduction from 168 service hours a week to 40, “which my wife says will force her to file for divorce.”
Bullers, 49, worked as a journalist for The Kansas City Star until about five years ago. Since then, he has had home care 24 hours a day, seven days a week. It allows him to live at home with his wife and two children, ages 13 and 9, rather than going to a nursing home.
Bullers is almost completely paralyzed by his muscular dystrophy and said that without an overnight aide, his wife would have to lift him in and out of bed, take him to the bathroom and wake up every two hours to turn him over and check his respirator.
“They’re expecting my wife to work eight hours a day and then come home and be a 16-hour nurse to me,” he said. “This is what the state defines as ‘improved outcomes.’”
KanCare, which took over Medicaid administration on Jan. 1, is Gov. Sam Brownback’s program of privatizing services for impoverished, elderly or disabled Kansans.
Under KanCare, the state contracts with three managed-care insurance companies to administer health services and pays a flat rate per client, containing state costs.
The program will be complete Jan. 1 of next year, when KanCare takes over home- and community-based services for people with developmental disabilities.
Under questioning by lawmakers, Shawn Sullivan, the director of the Kansas Department of Aging and Disability Services, said he could not go into details of Bullers’ case but that he personally reviewed the case and agreed with the managed care company’s decision to cut the service hours.
“I have taken a look at Mr. Bullers’ plan of care and the reduction request, as have five of my staff,” Sullivan said.
Speaking of the entire system, Sullivan said KanCare is cutting hours for some home-care clients to avoid having a paid aide performing housekeeping tasks that should be done by able-bodied family members.
That had long been a state policy, he said, but enforcement had become lax under the old system.
Bullers was far from the only one complaining at the meeting.
Hospitals and other care providers have complained that the system is plagued with denials and delays that have increased bureaucracy, rather than reducing it.
“Any time you have a change this major, you’re going to see glitches,” said Tom Bell, president and executive director of the Kansas Hospital Association, said Monday.
But he added that some areas haven’t improved enough.
“They tend to boil down to … the process of approval or denial and ultimately payment,” he said.
A parade of providers provided examples where the three managed-care insurance companies denied legitimate claims and forced forcing the provider and patient to go through a lengthy process to get it fixed. They also said the companies have been underpaying and in some cases overpaying claims, forcing the providers to waste more work hours on corrections.
Marilyn Kubler, owner of Jenian Inc., a case management company in Shawnee, said she serves a handful of clients in KanCare now but all 128 clients will be in the system on Jan. 1.
“So far, I have been able to absorb the delay in payments and make my monthly payroll,” she said. But she questioned whether she’ll be able to continue in business once all the clients are on KanCare.
State officials gave presentations indicating that by their measures, KanCare appears to be going well.
They also emphasized that they hold back 3 percent of the managed-care companies’ payment to assure they meet quality measures.
Executives from all three managed care companies, Amerigroup, United Healthcare and Sunflower State Health Plan, defended their overall performance but acknowledged that things could be better.
They identified the problem as primarily one of better training for their own workers and the billing agents for health care providers.
“The implementation was a little bit bumpy and there were some issues that we had to work out and I think we worked through a lot of those issues,” said Jean Rumbaugh, president and CEO of Sunflower State, a division of Centene Corp. “I will tell you from Sunflower’s perspective that we did a system upgrade and we broke some of the things we had fixed earlier.”