Federal panel recommends delaying KanCare expansion

A presidential advisory panel is asking Medicaid to delay a scheduled Jan. 1 KanCare takeover of long-term services for the developmentally disabled and is suggesting that a Justice Department investigation might be warranted.

The National Council on Disability made those recommendations to the Center for Medicare and Medicaid Services less than two weeks after convening in Topeka to study the state’s KanCare privatized managed-care program for poor and disabled Kansans.

In a letter dated Friday, the council asked CMS for a one-year pause in KanCare expansion, saying the state hasn’t adequately considered concerns from clients, guardians and service providers about the planned Jan. 1 switch.

The council is asking CMS to hold off on granting Kansas a waiver, which the state has to obtain before Jan. 1 to move the disability services into KanCare.

“We find the start date … on January 1, 2014, with public comments open until December 17, 2013, and final CMS approval yet to be determined, suggestive of insufficient consideration, response, or interaction between stakeholders impacted by the proposed waiver amendment and CMS, and state officials,” the council’s letter to CMS said.

The council is appointed by the president to advise the administration and Congress on disability policy and laws.

Officials with the state Department for Aging and Disability Services said the panels’ concerns are misplaced.

“They parachuted in from the East Coast to tell us that,” said Angela de Rocha, a spokeswoman for the state agency. “They’re an advisory committee; they have no authority.”

De Rocha said she doesn’t know if the recommendations will have any effect on whether Kansas gets the waiver it wants from CMS.

Shawn Sullivan, director of KDADS, said he respects the council but criticized most of its recommendations.

The department has had plenty of interaction with the public in the more than two years since work began on KanCare, he said, adding that the current comment period is one of many opportunities to weigh in and that the department and CMS have held numerous meetings with service providers, families and other stakeholders.

He also said he doesn’t think the council spent enough time with Kansas to get the full picture of safeguards KanCare has in place to protect the rights of disabled people to continue to get the support they need to live active and productive lives in their homes.

Most of the recommendations appear to have sprung from a 90-minute panel discussion that included him and several anti-KanCare disability advocates, he said.

“I’m not sure they received an objective assessment of these programs,” he said, adding that Kansas has worked closely with CMS to craft the proposed program.

Under KanCare, the state contracts with three private insurance companies to administer Medicaid services for poor and disabled Kansans.

KanCare has been handling medical services since January of this year, and the addition of home- and community-based services for the developmentally disabled on Jan. 1 would complete the transition. The services at issue include attendant care to allow disabled people to live at home instead of institutions, along with day services such as nutrition, transportation and job training.

In two days of meetings in Topeka early this month, the council heard extensive testimony about delayed and denied payments to medical providers and concerns that the privatized care managers are planning to reduce services for some individuals with disabilities.

“The disability community shared their struggles with the implementation of KanCare, including some individuals facing substantial cuts to necessary care,” the council’s letter to CMS said. “Conversely, Kansas state officials largely praised KanCare, however also admitted that there were some challenges. Based on the testimony received, it is clear to NCD that many unresolved issues remain for people with disabilities.”

One such person was Finn Bullers, a former Kansas City Star reporter with muscular dystrophy and diabetes, who told the council that he and his family would suffer greatly if KanCare follows through with planned deep cuts to the 24/7 attendant care for which he currently qualifies.

“Such a variance in service recommendations seems suggestive of aberrant implementation or inappropriate external considerations such as MCO (Managed Care Organization) profit considerations over quality considerations,” the council letter to CMS said.

The council rejected an explanation given by KDADS Director Shawn Sullivan that the standards for qualifying for services hadn’t changed but are being more consistently applied under KanCare.

“Such a suggestion needs further investigation by CMS and possible referral to the Department of Justice Office of Civil Rights to determine if Kansas adequately administered its Medicaid program in the past or if the MCOs are using external or variant mechanisms to place cost savings or profit over quality for people with disabilities,” the council’s letter said.

Sullivan said one of the biggest changes his department has made is in working to eliminate conflicts of interest from the system.

In the past, it was not uncommon to have one business entity make the determination that a person was eligible for services and what services the person needed, and then to provide those services to the person.

“That is going to lead to inflated plans of care,” he said.

As for the recommendation of a CMS or Justice Department investigation, Sullivan said: “I would have no objection to that. We’re transparent about the changes we’ve made in the system.”

De Rocha said that less than 8 percent of KanCare consumers who receive home and community-based services, about 900 people, have seen reductions in those services.

In those cases, she said, “We’re simply doing a better job of implementing the policies that have been in place for a long time.”

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