Posts tagged with Disabled

KC-area man says KanCare coverage fully restored on Christmas Eve

Finn Bullers and his family in Facebook posting announcing that his KanCare case manager visited his home on Christmas Eve to tell him his previous Medicaid coverage level had been fully restored.

Finn Bullers and his family in Facebook posting announcing that his KanCare case manager visited his home on Christmas Eve to tell him his previous Medicaid coverage level had been fully restored. by Phil Cauthon

Finn Bullers is a 49-year-old Prairie Village man who suffers from Muscular Dystrophy. Earlier this winter, Bullers testified several times about proposed cuts to his Medicaid service level before legislators charged with oversight of the transition to KanCare, the state's new managed care program overseen by three private insurance companies.

In a Facebook post early on Christmas morning, Bullers wrote:

"...On Christmas Eve day, my UnitedHealthcare case manager came to our home to tell us that her firm had reinstated my full-time care.

The sun had never shined brighter.

We're a big organization where change moves slowly, my case manager told me just before Christmas when asked why United had reversed course.

This is all new to us. We've learned a lot this past year, she said. We've learned that each case is unique and health care is not one size fits all.

What a Grand Canyon sigh of relief..."

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KanCare safeguards for proposed DD carve-in outlined by Brownback officials

Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.

Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. by Phil Cauthon

The head of the state agency that oversees programs for the developmentally disabled has outlined steps the state will take to assure payments aren't delayed to providers of DD services, if federal officials approve the state's request to include all DD services in KanCare starting next year.

But advocates for the developmentally disabled said the safeguards, described to them in private meetings earlier this week, failed to allay their concerns and instead signaled that administration officials anticipate significant billing problems similar to those experienced by other Medicaid providers after the first phase of KanCare was launched at the beginning of 2013.

'Sincere effort'

"I do believe it's a sincere effort on the part of the state to understand why their contractors can't get their bills paid...but I guess it's part of an all-hands-on-deck strategy since this thing is not working the way they thought it would," said Tom Laing, executive director of Interhab, the association that represents most of the state's 27 Community Developmental Disability Organizations.

Interhab has fought the administration's effort to pull long-term residential services for the developmentally disabled into KanCare, one of the signature initiatives of Gov. Sam Brownback.

KanCare was launched Jan. 1 this year when virtually all the state's 380,000 Medicaid beneficiaries were assigned to managed care plans run by three commercial insurance companies.

Long-term services for the developmentally disabled were excluded from the program in its initial phase after protests from DD advocates and families, but standard medical services for the developmentally disabled have been in KanCare from the outset.

Brownback officials earlier this year submitted a request to federal officials seeking to add the long-term DD services to the program beginning Jan. 1, but federal officials still haven't ruled on the proposal. Public comment on the plan continues through Dec. 24 and no decision from the Centers for Medicare and Medicaid Services is expected before then, which means if approval comes it will only be days or less before the state's planned launch of its expansion.

Billing safeguards

Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, also outlined the additional billing safeguards the state is preparing to use today during a public meeting of the KanCare Advisory Council, a reorganized group that last met in May.

Sullivan said the KanCare managed care companies were "putting billing edits in their systems to be ready for Jan. 1," and that the state was devising a monitoring system that would allow state officials to know quickly if payments by the KanCare contractors to some 400 DD service providers dipped significantly below sums historically paid the organizations.

"We are in the process of uploading each provider's average monthly payments from over the last couple of quarters," Sullivan said.

He said state officials could then work with the providers and the KanCare managed care companies to quickly determine the reasons for payment drop-offs should they occur.

Final documentation on the safeguard and flagging processes to be used should be completed within a couple of days, Sullivan said, once state officials have finalized the details with the managed care companies.

The state has been working the past few months with DD service providers in an effort to test the MCO billing systems prior to the tentatively planned Jan. 1 launch of the KanCare expansion.

But all involved with that pilot, or transition program, have acknowledged glitches or problems with the billing of the sort that have been a source of consternation for a wide variety of the service providers pulled into KanCare in its initial phase.

Pharmacists, hospitals, safety net clinics, nursing homes and others have all complained at some point over the past few months about stalled or delayed payments from the KanCare insurance companies. The delays fall particularly hard on smaller organizations that operate on thin margins and without large cash reserves.

Earlier this year, the managed care companies cut "emergency" checks to some of the state's safety net clinics after clinic officials complained to state officials that payment for services was lagging and jeopardizing their operations.

Laing said Sullivan had discussed the possibility of "pre-payments" to DD service providers as a way to assure they would continue to have enough operating cash, but he said it wasn't clear how or if that could be done.

"I can say he articulated several different things they will try to do to make sure the billing flows, which is a clear signal they anticipate the billing issues won't be resolved by January," Laing said.

ACCSES weighs in

Also today, ACCSES, a national association of disability service providers, filed comments with federal officials asking them to deny Kansas' request to include long-term DD services in KanCare.

"We oppose the carving of (the) services into KanCare because we believe that, as proposed, the changes threaten the ability of the LTSS (long-term service and support) system to maintain access to the services and programs for Kansans with intellectual and developmental disabilities," wrote Terry Farmer, the group's chief executive.

Continue reading this story, and related coverage, on KHI.org.

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DD advocates intensifying effort for KanCare “carve out”

Tom Laing, executive director of Interhab, speaking to parents of developmentally disabled children and advocates at a recent town-hall meeting in Overland Park.

Tom Laing, executive director of Interhab, speaking to parents of developmentally disabled children and advocates at a recent town-hall meeting in Overland Park. by Phil Cauthon

Push is again coming to shove in the struggle over whether the long-term care and support services received by Kansans with developmental disabilities will become part of KanCare or remain outside the control of the private companies hired by the state to manage the Medicaid program.

Advocates pushing for a permanent “carve out” of developmental disability services have circled May 8 on their calendars. That’s the day that the Kansas Legislature is scheduled to return to Topeka to wrap up its 2013 session.

“When you show up in numbers, it makes a difference in the legislative process,” said advocate Tom Laing, speaking last week to approximately 175 parents and advocates at a meeting sponsored by Johnson County Developmental Services.

“A lot of times when politicians do the wrong thing it’s because they haven’t heard from the folks who are the most impacted. If they don’t hear from you, we can’t succeed,” said Laing, executive director of Interhab, an association that represents most of the state's Community Developmental Disability Organizations.

Laing and other advocates said they are hoping that thousands of Kansans with developmental disabilities would turn out with their parents and guardians for a rally on the south steps of the Statehouse and to meet individually with legislators to make their case.

“I’m not a guy who believes in pitch forks and torches. We need to be persuasive, not abrasive,” Laing said.

'Carve in' date approaching

Medical services for the developmentally disabled already are part of KanCare, the reform initiative launched on Jan. 1 by Gov. Sam Brownback. It moved virtually all of the state’s 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: Amerigroup, United Healthcare and Sunflower State Health Plan, a subsidiary of Centene.

But yielding to pressure from advocates and service providers, the governor and legislators agreed last year to delay the inclusion of long-term, DD support services for a year — until Jan. 1, 2014. With the “carve in” date approaching, advocates are pressing their case again.

“We have to keep these services out of the hands of the profiteers,” said Bridget Murphy, director of the Downs Syndrome Guild of Greater Kansas City.

'Misinformation' fueling concerns

Murphy’s concern that the for-profit managed care companies will disrupt services now generally provided by a network of community-based, non-profit organizations is shared by many parents and advocates.

That frustrates Shawn Sullivan, the secretary of the Kansas Department of Aging and Disability Services, who has spent more than a year meeting with stakeholders to convince them they have nothing to fear from the new managed-care system.

Continue reading on khi.org.

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KanCare pilot project launched but opposition to DD “carve-in” persists

During the 2012 session, a bipartisan group of representatives and senators introduced a resolution attempting to delay the Jan. 1, 2013 launch of KanCare. The resolution failed, but lawmakers succeeded in persuading the Brownback administration to hold off a year on including in the program long-term services for the developmentally disabled. DD advocates say they will ask this year's Legislature to extend or make permanent that temporary "carve-out." Given the large numbers of new legislators following the 2012 elections and the administration's push to expand KanCare, it remains to be seen what will happen. Of the eight legislators shown in this file photo, only three are still serving.

During the 2012 session, a bipartisan group of representatives and senators introduced a resolution attempting to delay the Jan. 1, 2013 launch of KanCare. The resolution failed, but lawmakers succeeded in persuading the Brownback administration to hold off a year on including in the program long-term services for the developmentally disabled. DD advocates say they will ask this year's Legislature to extend or make permanent that temporary "carve-out." Given the large numbers of new legislators following the 2012 elections and the administration's push to expand KanCare, it remains to be seen what will happen. Of the eight legislators shown in this file photo, only three are still serving. by Phil Cauthon

After months of advisory committee haggling over what it should look like, state officials say they are ready to launch the pilot program that will pave the way for including long-term services for the developmentally disabled in the new KanCare program.

Now, all they need to start the pilot are participants.

A recruiting letter went out Friday, seeking organizations and individuals willing to volunteer, but representatives from the state’s developmental disability organizations said doubts remain strong among their members about the pilot in particular and KanCare in general. It seems that nobody, including administration officials, expects a throng of eager participants.

“The advisory committee talked about really wanting, hoping to have a broad representation of providers (in the pilot), including different types of providers,” said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. “I don't know that it’s necessarily as important to have numbers as it is to have different types. I’m hoping to have five providers, at least.”

The administration of Gov. Sam Brownback originally sought to have long-term services for the developmentally disabled included in KanCare when the managed-care program was launched Jan. 1. But groups, including parents, that represent the developmentally disabled, persuaded legislators to postpone that for a year.

KanCare is the governor’s ongoing remake of the state Medicaid program. Since it was launched a few weeks ago, virtually all the state’s 380,000 Medicaid enrollees have been assigned to health plans run by three commercial insurance companies.

The same legislative proviso that delayed the administration’s push to roll long-term developmental disability services into KanCare also called for the pilot program. But disagreement between the administration and advocates for the disabled over what the pilot should try to gauge or accomplish went on for months after the 2012 Legislature adjourned and still hasn’t been fully resolved.

What kind of pilot?

Advocates for the developmentally disabled said they wanted a pilot that would test the administration’s still-unproven theory that the KanCare insurance companies could effectively manage long-term or “non-medical” developmental disability services, producing healthier customers while cutting government costs yet presumably earning profits.

That ambitious set of pledges is something that hasn’t been solidly demonstrated anywhere in the country and sounds “too good to be true,” as Maury Thompson, former director of Johnson County Developmental Supports.

Continue reading on khi.org.

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100 physically disabled people to come off waiting list, officials say

KDADS Secretary Shawn Sullivan at the podium during Monday's press conference about the waiting list for home and community-based Medicaid services for the physically disabled. To his left is Lt. Gov. Jeff Colyer.

KDADS Secretary Shawn Sullivan at the podium during Monday's press conference about the waiting list for home and community-based Medicaid services for the physically disabled. To his left is Lt. Gov. Jeff Colyer. by Phil Cauthon

Top officials in the administration of Gov. Sam Brownback said today that they now have a list they accept as accurate of the 2,197 physically disabled persons who are awaiting home- and community-based Medicaid services.

Armed with the updated information, they said, they are ready to begin providing services to 100 people currently on the list by the end of the year.

"We now have a better handle on the waiting list and wlll be able to make better decisions about how to manage the waiting list and best utilize the funding provided by the Legislature for this program," said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.

Sullivan, joined at a Statehouse press conference by Lt. Gov. Jeff Colyer, said his agency won't propose additional funding to further decrease the waiting list but would instead wait to see what legislators would appropriate in 2013 to help deal with the problem.

Kansas has drawn attention from federal authorities due to its slow moving and relatively large waiting lists for home- and community-based services, which advocates for the disabled have said puts the state in violation of the federal Americans with Disabilities Act as defined by the U.S. Supreme Court's so-called Olmstead decision.

It wasn't immediately clear if today's announcement would influence the course of the U.S. Justice Department's review of Olmstead complaints filed by disabled Kansans and their advocates.

Feds continue monitoring

“We are continuing to monitor the state’s activities on all issues that may relate to any potential Olmstead violations,” said U.S. Attorney for Kansas Barry Grissom in an email statement to KHI News Service after the press conference

Brownback officials for months have said they doubted the reliability of the lists, particularly the one dealing with the physically disabled. So, today's announcement made clear the administration now has a list it considers fully valid.

As of July, the state's Centers for Independent Living, had reported there were 3,462 people on the list.

Sullivan and Colyer said the state hired Answernet, a firm based in Hays, to start making phone calls in July to check the list. After the company was only able to reach 377 of the people, state officials asked the Centers for Independent Living to double check the list.

That process resulted in 1,226 people being removed from the official backlog after it was found for whatever reason that they no longer needed the services or were not eligible. But it also resulted in another 250 people being added to the list.

Audrey Schremmer-Philip, executive director of 3Rivers, Inc., a center for independent living based in Wamego, said the 250 new names were of people for whom the state's centers for independent living previously had submitted paperwork to the state but for unknown reasons had never made the state's list of people needing services.

'Extremely concerned'

Rocky Nichols, executive director of the Disability Rights Center of Kansas, a Topeka-based nonprofit group, was critical of the administration's handling of the waiting list and its review of the backlog.

“We are extremely concerned that the state is creating a self-fulfilling prophecy that is having the net effect of unnecessarily kicking people off the waiting list for services," he said. "The perspective is all wrong here. Not only do you have to wait years to clear the waiting list in Kansas, now the state is saying if they can’t get ahold of you — due to you not having the money to add minutes to your pre-paid cell phone, or you had to move to make ends meet — that they are going to add insult to injury and kick you off services. It makes no sense.”

Continue reading on khi.org.

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Wichita KanCare forum draws more than 200

Gov. Sam Brownback's plan to remake the state Medicaid program got a chilly reception Monday at the first of two scheduled public forums on KanCare.

There were nearly two hours of comments and questions from a crowd of more than 200 people gathered at a Wichita State University auditorium. Most of the response was negative.

There were 40 comments — officially capped at three minutes each, though many went much longer. Most came from relatives of the elderly, disabled and mentally ill or from medical providers who cater to those groups.

They would be the groups most affected by the administration's KanCare plan, which aims to expand fixed-cost managed care to include virtually all the 380,000 Kansans currently on Medicaid.

The comments mostly touched on one or more common concerns:

The timeline to implement the plan in January was too fast Fear that patients' existing providers couldn't be kept under the plan That managed care would result in loss of services, Some people also expressed worries that the Brownback administration was setting up Kansas for problems experienced by other states under managed care.

'Soft science' Commenter Richard Harris said attempts to reform Medicaid have been based on "soft science and limited evidence."

"The concerns I have boil down to the evidence. Most managed care operations cut services and do not significantly cut expenses," he said. "I challenge the governor and lieutenant governor to name for us any state in which the system you are proposing has worked and has provided a higher level of service across the board at a lower cost to the state."

For the most part, comments and questions were accepted without direct answers from the Brownback administration. Officials present included: Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, the agency which administers Medicaid through its Health Care Finance division; Health Care Finance Director Kari Bruffett; Kansas Department on Aging Secretary Shawn Sullivan; and Gary Haulmark, deputy secretary at the Kansas Department of Social and Rehabilitation Services. At least three legislators also attended: Sen. Dick Kelsey, a Goddard Republican, Sen. Oletha Faust-Goudeau, a Wichita Democrat, and Rep. Steve Alford, a Ulysses Republican.

During two, 15-minute presentations before the comment period, Moser and Sullivan attempted to address common concerns they said they already had heard. Sullivan said the alternative to KanCare was not the status quo.

'Huge cuts looming' "The alternatives to the changes we're making are continued cost increases, the risk of reimbursement rates to providers that threaten the quality of care provided, (and) huge cuts for Medicaid that are looming at the federal level probably to the tune of hundreds of millions of dollars," he said.

"The one thing we are not doing that often gets reported...is that we're turning this Medicaid system over to private contractors. That's not our intent at all. We already have 73 percent of those we serve in Medicaid on a managed-care type system," Sullivan said.

"We have not turned over the contracting of Medicaid to those vendors to just do whatever they want. We have extremely stringent performance standards, pay-for-performance measures, there will be very distinct outcome and accountability measures that the state will build into this. This will be a partnership between the state and vendors."

Continue reading on khi.org.

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Lobbying prohibition aimed at Centers for Independent Living

A spokeswoman for the Kansas Department of Social and Rehabilitation Services said language meant to tighten restrictions on using state and federal funding to influence the Legislature is only being added to the agency's contracts with organizations that serve the physically disabled.

It won't be added to contracts with groups that serve the poor, developmentally disabled, mentally ill or children in foster care.

“There is lobbying language specific to the CILs (Centers for Independent Living) contracts, unique to the CILs contracts,” SRS spokesperson Angela de Rocha wrote in an email to KHI News Service.

Asked why the centers had been singled out, de Rocha said: “I cannot discuss that language, nor the contracts, because they are still being negotiated.”

SRS added the wording to its proposed contracts with the state’s 12 centers for independent living centers last month.

The new language reads:

“No funds allowed under this agreement may be expended by the recipient of the grant to pay, directly or indirectly, any person for influencing or attempting to influence an officer or employee of any agency, a member, or employee of a member of the United States Congress or the Kansas Legislature.”

If signed, the contracts would take effect July 1, the start of the state’s fiscal year.

Continue reading on khi.org.

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Governor’s claim of waiting list progress challenged

Federal officials have not responded to Gov. Sam Brownback’s assertions that his administration is in full compliance with the Americans with Disabilities Act.

But advocates for the physically disabled say the governor’s recent open letter to federal officials asserting his administration is doing enough to help people with physical disabilities live in community settings should not go unchallenged.

“The state’s own numbers don’t support the governor’s position,” said Shannon Jones, executive director of the Statewide Independent Living Council of Kansas. “If you go back three years and look, there were 7,200 (physically disabled) people receiving services. Today there are 6,100. That’s not an increase, it’s a decrease.”

Jones’ group has been at the forefront of the state’s ADA-compliance issue, encouraging hundreds of disabled people to file complaints with federal authorities over a prolonged waiting list for services that has been growing since at least 2008.

An investigation

Officials at the U.S. Department of Health and Human Services responded to the complaints in 2009 by opening an investigation.

Then last month, Leon Rodriquez, director of the HHS Office of Civil Rights, announced that efforts to get the Brownback administration to reduce the waiting list for home- and community-based services had stalled and that the case had been turned over to the U.S. Department of Justice.

The decision increased the likelihood the state would be sued in federal court, similar to actions that the Justice Department has taken in other states with growing frequency under the administration of President Barack Obama.

Brownback responded to Rodriguez with a public letter expressing disappointment with the agency’s decision.

Underlying the dispute is a 1999 decision in a U.S. Supreme Court case, Olmstead v. L.C., which found that states have an obligation to ensure that Medicaid-funded services for people with physical and mental disabilities are provided in the most integrated settings appropriate to their needs.

Subsequent rulings involving other states have found that stalled or slow-moving waiting lists constitute violations of the ADA, which became national law in 1990 in large part thanks to then-U.S. Sen. Bob Dole of Kansas, who was left disabled for life by serious wounds suffered in World War II.

Assigning blame

In his letter to Rodriguez, Brownback, a Republican, argued that his administration had inherited the waiting list from former Gov. Kathleen Sebelius, who in December 2008 “implemented a freeze on new beneficiaries” and in March 2009 amended the policy to allow one person to begin receiving in-home services for every two who exited the program.

Sebelius, a Democrat, left Kansas to become HHS secretary in April 2009.

Brownback noted that in May 2009, HHS informed Sebelius’ successor, then-Gov. Mark Parkinson, also a Democrat, that the agency had started investigating the waiting list complaints.

“Effectively, Secretary Sebelius decided upon joining the Obama Administration that Governor Sebelius and her policies were in violation of federal law,” Brownback wrote.

Continue reading this story, and download Brownback's letter, at khi.org.

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KanCare waiver application completed, submitted for fed review

As part of its effort to remake the Kansas Medicaid program, the administration of Gov. Sam Brownback has completed its 1115 Medicaid waiver application.

Lt. Gov. Jeff Colyer and other top administration officials fielded questions about it today during an hour-long Statehouse press conference.

The application was posted Thursday without fanfare to the website of the Kansas Department of Health and Environment and also submitted to the federal Centers for Medicare and Medicaid Services.

"We sincerely appreciate the accessibility and candidness of CMS throughout this application process," Colyer said.

The administration earlier this year gave federal officials a concept paper roughly outlining what would be in the full waiver application. Brownback officials need the waiver approved in order to move forward with their plan to shift the state's 350,000 Medicaid beneficiaries into managed care plans operated by three insurance companies.

The administration currently is reviewing bids from five companies. According to the timeline attached to the waiver application, administration officials intend to have the final three companies chosen by May with contracts signed by June. State officials said they expected CMS to approve the contracts sometime in August.

Town hall meetings to inform Medicaid clients and providers about how the plan would work are scheduled to begin in July.

The new program would be launched Jan. 1, 2013, assuming the federal approvals are secured and the managed care companies have been certified ready to go.

The waiver application included information about the administration's recent agreement to postpone until January 2014 the inclusion in KanCare of long-term services for the developmentally disabled.

The greatest opposition to the KanCare plan has been from families of the developmentally disabled and their service providers.

Had the administration not submitted its application by today, it would have been required to meet new federal regulations regarding public input on 1115 waiver applications.

Colyer said the application wasn't submitted to meet that deadline and that administration officials felt they met most of the new requirements anyway because of the various forums and public meetings they have attended or held while developing their Medicaid makeover plan.

The new requirements, effective today, would require that state officials hold at least two public hearings and allow comment on an application 30 days prior to submitting it for federal review.

Federal officials now will allow a 45-day public comment period before acting on the application.

Among those planning to comment to federal officials is Kansas Action for Children, a Topeka-based advocacy group.

Shannon Cotsoradis, the organization's chief executive, said KAC has several concerns about the KanCare plan, including the fact that it doesn't spell out how those currently enrolled in the state's HealthWave program will be moved into KanCare.

HealthWave provides medical services to low- and moderate-income children and pregnant women who are eligible for Medicaid or the Children's Health Insurance Program.

"We have 238,000 Kansas children that rely on HealthWave and there doesn't seem to be a clear and transparent process for transitioning them to KanCare," Cotsoradis said.

Under KanCare, Medicaid clients would be automatically assigned to one of the three managed care companies. The clients then would have 45 days to decide if they wanted to be enrolled with another company.

Cotsoradis said she feared the "auto assigning" of clients could disrupt relationships some children or families have developed with doctors or other Medicaid providers, if it turns out that the providers are in the network of a company other than the one to which the family has been auto assigned by the state.

She said many families likely wouldn't learn that they had been put in a new plan until they tried to go to the doctor and that might not happen within the 45 day window for choosing a different plan.

"So all that work that's been done over years to see that that kid has a medical home could be disrupted by the auto assignment," she said. "That can be a huge thing for those with special health care needs. Disruption in the relationship can be very problematic."

Administration officials have said they intend to auto assign equal thirds of the state's Medicaid population to each of the three managed care companies to assure that each company has enough clients to sustain a statewide operation. The KanCare plan requires that each of the companies provide services statewide, as opposed to operating in a specific region of the state or city. Officials have said that component of their plan is essential to assuring quality services in all parts of the state, including the more remote, rural counties.

Download a PDF of the Medicaid waiver application and find related stories on the KanCare plan at khi.org.

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House leader preparing proviso for KanCare carve-out

Services for developmentally disabled wouldn't be included in KanCare until 2014.

House Majority Leader Arlen Siegfreid is preparing a budget proviso that would "carve out" until 2014 long-term services for the developmentally disabled from Gov. Sam Brownback's Medicaid makeover plan.

The proviso has been cleared with the Governor's Office, according to sources in the Legislature and the administration, which means it likely will move through the Legislature with little or no opposition.

A large number of legislators, including a majority in the Senate, already have signaled their desire to see the planned Jan. 1 launch of KanCare delayed until July 1, 2013. It is unlikely many will oppose delaying until 2014 what has been the most controversial part of the governor's plan.

It would be the first major change to the governor's KanCare proposal since it was announced in November. The inclusion of non-medical, long-term services for developmentally disabled Medicaid clients has produced the biggest opposition to the governor's plan at the Statehouse and in county seats across Kansas.

For example, Johnson County commissioners today joined their counterparts from more than 30 other counties in approving a resolution asking the governor to exclude the developmental disability services from the plan. Earlier this week, Jim Rice, chairman of the Seward County Commission, published an open letter in the Liberal newspaper taking the Brownback administration to task on the issue, comparing KanCare to Obamacare.

Word of the pending proviso traveled fast after Siegfreid discussed it with Rep. Bob Bethell, an Alden Republican who chairs the House Aging and Long-term Care Committee. Bethell said Siegfreid told him he could share the news with other legislators. Word spread from there.

Continue reading on khi.org.

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KanCare bidder settles with U.S. Justice Department

A company that is among the five bidding on the state’s Medicaid managed care contract has agreed to pay $137.5 million to settle claims it defrauded Medicaid programs in nine states.

The U.S. Department of Justice announced the settlement with WellCare Health Plans Inc. last week.

It was the second settlement the company agreed to after federal prosecutors in 2006 launched criminal and civil investigations stemming from complaints filed by whistleblowers.

In 2009, the company entered a deferred prosecution agreement and paid $40 million in restitution and forfeited another $40 million. WellCare’s former chief executive, Todd Farha, is scheduled to go to trial in January.

The settlement announced last week will be divided among the federal government and the Medicaid programs in Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio.

Sean Hellein, a former financial analyst with WellCare, will collect more than $20 million, federal officials said. He filed the initial whistleblower claim that prompted the investigation.

WellCare officials said the settlement wiped the slate clean for the company.

“The company acted swiftly upon learning of the wrongdoing in 2007, took action to separate the individuals involved, and cooperated fully with state and federal authorities in their investigations. These matters are now resolved and a new leadership team has been put into place,” WellCare spokeswoman Denise Malecki told KHI News Service.

She said the company would bring high standards to its Kansas operations if it wins a contract to help implement KanCare, Gov. Sam Brownback’s Medicaid makeover plan.

“Today, WellCare's commitment to transparency and ethical behavior will be unparalleled in providing quality, cost-effective health care to the members of the KanCare program,” she wrote in an email.

As part of the settlement with the Justice Department, WellCare agreed to enter a corporate integrity agreement that allows the U.S. Department of Health and Human Services' Office of the Inspector General to oversee its “rehabilitation” for three years.

Sherriene Jones-Sontag, a Brownback spokesperson, said the qualifications of WellCare and other KanCare bidders would be thoroughly reviewed by the administration.

“The state conducts thorough evaluations to ensure the selection of qualified bidders who meet the requirements of the KanCare program, including financial sustainability,” she wrote in an email. “The contracts for the KanCare program will include mechanisms such as performance bonds and parent corporation guarantees as well as significant reporting requirements and ongoing reviews of the financial conditions of KanCare contractors.”

WellCare isn’t the only KanCare bidder that has been ensnared in a federal whistleblower lawsuit.

Amerigroup paid $144 million in damages and $190 milllion in fines after losing a whistleblower case in Illinois in 2008.

Wall Street analysts remained bullish on WellCare after last week’s announcement.

“It's conceivable that the company could double its revenues in the next couple of years," Tom Carroll, an analyst at Stifel Nicolaus, told Florida Health News, a partner of KHI News Service.

According to financial analysts, the company had $6.1 billion in revenue last year and has more than $300 million in cash on hand.

But the claims raised against WellCare in the lawsuit were alarming to some in Kansas who already have concerns about the governor’s Medicaid plans.

“I am deeply troubled and shocked by the contents of this settlement agreement, and I believe it underscores the need to slow down the process of implementing KanCare,” Shannon Cotsoradis, chief executive of the advocacy group Kansas Action for Children, wrote in an email to KHI News Service. “Thoroughly vetting potential contractors is a critical component of the implementation process and it must happen to protect the children and families in our state. I don't think this is the kind of Medicaid ‘reform’ we are looking for.”

Among the things cited in the case, WellCare:

• Created a wholly owned reinsurance subsidiary that inflated the company’s premiums in a way that made profits look like expenses;

• Hid information that would have caused the company to send money back to the Illinois Medicaid and Florida Healthy Kids programs;

• Falsified encounter and performance data;

• Rewarded physicians and clinics for referring healthy, low-cost patients to WellCare and sending sick, high-cost patients to competing health plans;

• Engaged in marketing and enrollment practices that discriminated against patients with chronic illnesses;

• Collected premiums on patients who were dead; and

• Operated a “sham” special investigations unit that allowed the company to “seek excessive reimbursement from the providers.”

The fraudulent activity was alleged to have occurred between 2002 and 2007.

Find the latest coverage of KanCare, including Brownback's agency reorganization announcement today, at khi.org.

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Counties weighing in on KanCare

County officials across Kansas are raising doubts about KanCare, Gov. Sam Brownback's plan for letting insurance companies manage the state's $2.8 billion Medicaid program.

"Before the administration gets to the point of signing contracts with these companies, it should let the Legislature, a special committee or the public know what's in them so we can have the professionals on the ground tell us where the potholes are. We shouldn't be putting our vulnerable populations at risk," said Ed Eilert, a Republican member of the Johnson County Commission and a former Overland Park mayor, a post he held 24 years.

Johnson County is Kansas' most heavily populated county. Eilert said he expected the commission there soon would pass a resolution urging the governor to "carve out," or exclude from KanCare, the long-term care services Medicaid provides for people with a developmental disability.

According to local officials contacted by KHI News Service, at least 20 counties have passed similar resolutions asking the governor to reconsider the reach of KanCare. At least three more are considering a resolution.

The first resolution was jointly endorsed March 5 by commissioners in Marion and Harvey counties. The Topeka-based Kansas Association of Counties later distributed copies of the document to the state's other 103 counties. Within a month, 18 other counties approved their own resolutions and more are expected to follow.

It's not clear if the resolutions will change the administration's approach. When the Legislature returns April 25 for its wrap-up session, lawmakers are expected to debate a proposal that would exclude long-term services for the developmentally disabled from KanCare.

An effort to debate the measure on the House floor was stymied by a procedural move at the end of the regular session, but supporters have pledged to bring it up again.

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Civil rights enforcers meet with governor on waiting list issue

Four civil rights enforcers from the U.S. Department of Health and Human Services met privately today with Gov. Sam Brownback and top Kansas welfare officials to discuss the state's long waiting list for services to the disabled.

Federal officials for several months have been reviewing complaints filed against the state by disabled persons and their advocates and now seem poised to take some sort of legal action, if Kansas doesn't move to remedy the problem.

Federal courts have found states in violation of the Americans with Disabilities Act for not providing adequate services to the disabled and federal officials have warned for months that they would act if the state didn't move to shorten the lists.

In Georgia, the state has had to spend close to $100 million over the past three years on additional services for the disabled as the result of a settlement with the federal government.

“Kansas had better be paying attention,” said Deirdre O’Brien, an advocate of the developmentally disabled in Georgia. “Let me tell you, the Department of Justice isn’t fooling around on this. They’re pretty serious.”

Leader of the federal visitors was Leon Rodriguez, national director of the HHS Office for Civil Rights in Washington, D.C. He was joined by Frank Campbell, the agency's regional director for civil rights. Also in the group were Mary Giliberti, a ranking HHS civil rights analyst and Robinsue Frohboese, a top civil rights litigator for HHS.

Neither Kansas nor federal officials would comment on the record about the details of the meetings.

But Brownback administration sources said the federal officials made clear they were prepared to take action unless movement is seen in the waiting lists.

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Kansas officials to sit down with feds over waiting list concerns

Advocates for disabled say feds poised to act on alleged Kansas Olmstead violations.

Advocates for the disabled say they believe the federal government is close to taking action against the state of Kansas for violating the Americans with Disabilities Act.

Federal officials for months have been reviewing complaints filed by disabled Kansans and they are scheduled to meet later this week in Kansas City with state officials to discuss the issue and their findings, a step that often precedes federal action.

The disabled consider the ADA a civil rights landmark and a major highlight of the legislative legacy of former U.S. Sen. Bob Dole, a celebrated Kansas Republican who himself was disabled by grave wounds suffered as an infantryman in World War II.

For years, Kansas had the reputation of being a leader among states in providing services to the disabled, and sometimes was cited in court cases elsewhere in the country as an example of how things should be done.

But since the late 1990s, Kansas has had a growing waiting list for services. And many believe that has put the state at odds with the federal law at a time when the U.S. Justice Department has stepped up its enforcement of the disabilities act.

Since President Obama took office, the U.S. Department of Justice has joined or filed more than 25 lawsuits alleging discrimination against the disabled in 17 states.

In Georgia, the state has had to spend close to $100 million over the past three years on additional services for the disabled as the result of a settlement with the federal government.

“Kansas had better be paying attention,” said Deirdre O’Brien, an advocate of the developmentally disabled in Georgia. “Let me tell you, the Department of Justice isn’t fooling around on this. They’re pretty serious.”

Might Kansas be next?

Turning point

Seven months ago, U.S. District Attorney Barry Grissom said the U.S. Department of Health and Human Services was weeks away from citing Kansas for not doing enough to help disabled people live in community settings rather than in institutions.

The state, he said, either would have to expand its network of home- and community-based services or face the likelihood of his office filing a lawsuit in federal court.

“This is a big deal guys,” Grissom said, addressing a July 21, 2011, meeting of the Topeka Human Relations Commission. “It’s a really big deal.”

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