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.
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.
The financial toll of untreated mental illness in Kansas is $1.17 billion annually, according to new research released today by the Health Care Foundation of Greater Kansas City.
In the KC metro area, the cost is $624 million per year — about $287 million of which is also included in the statewide Kansas tally.
About one in 10 adults in Kansas and Kansas City has at least one of the serious mental illnesses considered in the research: major depression, anxiety disorder, schizophrenia and bipolar disorder, said Jessica Hembree, the foundation's policy officer. About 40 percent of those go untreated, she said.
The financial consequences of untreated mental illness is spread across the economy, according to the research, but the lion's share was shouldered by individuals and employers.
Hurting the bottom line
"We were surprised by how many of those costs are borne by individuals and by private employers," Hembree said. "I think it's a wake up call to the business community that the lack of funding for mental health is affecting the bottom line of businesses just as much as the pocketbooks of taxpayers. The costs are showing up in the places we don't want them to show up, which is job development and business creation."
The study reinforced what advocates have been telling the Legislature for a number of years, said Rick Cagan, executive director with Kansas Chapter of the National Alliance on Mental Illness.
"You can cut funding for mental health centers — and (legislators) have substantially over the last four or five years — but you can't make these people go away," Cagan said. "These are life-long chronic illnesses and they need treatment. They're going to show up as a cost on somebody's ledger."
Kansas spending for mental health services dropped by more than $14 million — or 16.4 percent — between fiscal years 2009 and 2012, according to a recent report by the national NAMI organization. Only six states made steeper cuts during that same period.
→ Continue reading and download full report at khi.org.
Phyllis Gilmore's appointment is drawing heat from some families of foster children.
Parents and grandparents of children who’ve been in the state’s foster care system are urging their senators to vote against confirming Phyllis Gilmore as secretary of the Kansas Department of Social and Rehabilitation Services.
“We need a person in that position who’s above reproach,” said Marlene Jones, a Wichita woman whose grandson was removed from her daughter’s home in 2005.
Jones said she and other parents and grandparents have been sending emails to their senators.
The emails were mentioned several times during Gilmore’s confirmation hearing Monday before the Senate Ways and Means Committee.
“We’ve all received these emails,” said Sen. Kelly Kultala, a Kansas City Democrat.
The emails accused Gilmore, a former executive director at the state Behavioral Science Regulatory Board, of not having done enough to investigate parents’ and grandparents’ complaints that social workers had lied in court or conspired against their families.
Gilmore said the complaints were misguided, noting that the decisions not to act on the complaints were not hers to make but were made by the board.
“I was not a decision-making person as it related to the board,” she said. “I carried out the board’s wishes and worked with licensees in that capacity.”
Social workers are licensed by the regulatory board.
Gilmore also told the committee that decisions to remove children from their homes are made by the courts, not by social workers or SRS.
In other testimony
Gilmore, a former Kansas legislator, also said she was comfortable with a recent policy change that led to more than 1,000 children being dropped from the state’s food stamp program.
State hospitals for the mentally ill and the developmentally disabled have not replaced many employees who’ve quit or accepted Gov. Sam Brownback’s invitation to take early retirement.
At the same time, the number of patients at the hospitals has remained flat or increased.
That means fewer workers caring for more patients.
The governor’s budget proposal for the coming fiscal year would allow for 2,298 full-time positions at the five state hospitals, or 311 fewer slots than there were in fiscal 2011 and about 100 fewer than the current fiscal year.
Democratic members of the House Appropriations Committee said this week that the reduced hospital workforce was causing problems.
“At Osawatomie State Hospital we have 55 fewer FTE’s (full-time equivalent employees) than we had in the fiscal 2011 budget and we’re running over (patient) capacity,” said Rep. Bill Feuerborn of Garnett, the committee’s ranking Democrat.
Feuerborn said 13 employees at Osawatomie took the administration’s offer of early retirement. Only three of those positions were refilled. The additional vacancies occurred from people quitting or otherwise leaving the hospital’s roster.
Feuerborn’s district includes Osawatomie State Hospital, the largest of the state’s three hospitals for the mentally ill.
The committee, dominated by Republicans, debated four of the five state hospitals’ budgets on Monday, approving all four in line with the governor’s spending recommendations.
“I’m hearing from several employees who are concerned about safety issues and mandatory overtime,” Feuerborn said. “They work eight hours and then they’re told they mandatorily have to work another eight hours. But they’re not paid overtime. They’re given comp time that they have to be given permission to use.”
Feuerborn told KHI News Service he thought the arrangement might be a violation of labor laws.
“These are people who are working under a lot of stress,” he said.
Officials at the Kansas Department of Social and Rehabilitation Services said it was legal to require employees to work double shifts.
Feuerborn also said the other state hospitals were not replacing employees who had been fired or quit.
“We have 58 fewer employees at Parsons State Hospital than we did two years ago,” Feuerborn said.
The hospitals are under the broad supervision of SRS, but the individual hospital superintendents manage each somewhat differently.
Parsons State Hospital, for example, has reported that its overtime costs increased 139 percent in the current fiscal year, which began July 1, 2011.
Budget documents provided to legislators also showed Kansas Neurological Institute in Topeka losing 16 full-time positions in the proposed budget for fiscal 2013.
KNI and Parsons State Hospital care for people with severe developmental disabilities.
“Across the board, about a hundred positions at the state hospitals have been lost” in the past year, said Rep. Jerry Henry, a Cummings Democrat.
Henry, echoing concerns he said he heard from hospital workers, said the facilities were “OK when nobody’s sick or on vacation, or there’s a holiday. But when somebody is sick or on vacation or there’s a holiday, we’re in trouble.”
→ Continue reading at khi.org.
The system that helps more than 6,000 physically disabled Kansans across the state live in their own homes instead of long-term care facilities is undergoing sweeping changes that have been launched by the administration of Gov. Sam Brownback.
Administration officials say the shake-ups ultimately will result in a more efficient and accountable system with potential for helping more people.
But those who deliver the services at the local level through the state’s 12 regional independent living centers say they don’t see how those outcomes will be possible given the problems associated with implementing the changes.
They also complain that they are being asked to simultaneously deal with multiple initiatives, any one of which could be difficult to execute while coping with budget cuts unlike any they have experienced since the system began developing in 1978.
“They (Brownback officials) think they have all these great ideas, and they may be great ideas,” said Shannon Jones, executive director of the Statewide Independent Living Council of Kansas. “But they're flying at 40,000 feet, and when it comes to implementing (the changes) in the field they don't get it. They think because it’s a great idea it’s just going to magically work.”
Administration officials have acknowledged some of the centers' concerns and say they are working as quickly as possible to resolve them.
"I recognize that many aspects of providing supports and services for persons with disabilities is undergoing change," Secretary on Aging Shawn Sullivan told members of a House committee last week. "Change is often challenging."
So many changes, so fast
Directors at various centers for independent living told KHI News Service that they are operating with deficits or tapping financial reserves even as they reduce staff or trim services and plan for additional cutbacks.
“We’ve never been in the situation we’re in now in the 18 years I’ve been in business,” said Shari Coatney, executive director of SKIL, the state’s largest independent living center based in Parsons. “This is the most dramatic that I’ve ever seen. So many changes coming so fast with so little cooperation with the people actually delivering the services, based on the idealisms of the new folks in town.”
“Our financial projections are dire,” said Audrey Schremmer-Philip, executive director of 3Rivers, an independent living center in Wamego that serves people in 10 counties and American Indians on the Prairie Band Potawatomi Reservation. “We are currently running a deficit, utilizing agency savings to operate, while the management team and board try to determine the best plan of action. With extreme changes to how we will do business in the future, we are unclear if we should keep fully staffed … or reduce staff by a third and start a waiting list for services.”
With so many changes thrown at them at once, some of the center directors are convinced they are being punished by state officials for encouraging complaints to federal officials about the lack of services available for the disabled in potential violation of the Americans with Disabilities Act.
Last week, the state’s top welfare officials appeared before the House Health and Human Services Committee to answer charges that they had “retaliated” against the centers.
That allegation was made by Jones in a Jan. 26 email to center directors, a copy of which ended up in the hands of Rep. Brenda Landwehr, the Wichita Republican who heads the committee. Jones later told KHI News Service that the email was not intended for a wider audience and that “retaliation” was perhaps not the best word to have used.
“I was totally blindsided by that,” she said of Landwehr’s disclosure of the email.
“Those are serious charges. I thought they (administration officials) deserved an opportunity to respond to them,” Landwehr said of the hearing about the email, which featured testimony from Sullivan and Michael Donnelly, director of rehabilitation services at the Kansas Department of Social and Rehabilitation Services.
Also at the hearing was acting SRS Secretary Phyllis Gilmore, though she did not speak.
Not a conspiracy
The two men each offered detailed responses that refuted the claim of retaliation, and Donnelly talked about the charge at length in an hour-long follow-up interview with KHI News Service.
→ Continue reading at khi.org/CILs.
Members of the Senate Ways and Means Committee today grilled a top welfare official about a controversial change in policy that has resulted in at least 1,000 children being dropped from the state’s food stamp program.
"Can you tell me how this fits in the governor's roadmap to take children out of poverty?" Sen. Laura Kelly, a Topeka Democrat, asked Michelle Schroeder, director of public policy and legislative relations at the Kansas Department of Social and Rehabilitation Services.
"This is a policy that's based on equality in the system," Schroeder said. "We had to look at the policy in totality as it affects every household."
"Which is easy to do when you're sitting in an office in Topeka dealing with them in the aggregate," Kelly replied. "It's a little harder to do when you're back home and can't go to the grocery store."
The previous policy for determining eligibility for the Supplemental Nutrition Assistance Program (SNAP) allowed households headed by non-citizens to earn, on average, about $900 more per month than households headed by citizens and still qualify for benefits, said Schroeder, repeating what she told a House committee last week.
Kelly said that rationale seemed to be flawed. She pointed to a document with four scenarios under the previous formula where all-citizen households fared better than the same household with an undocumented member.
"The premise that households with an undocumented resident (were) being treated better, that doesn't appear to be the case," Kelly said.
Prior to October, food stamp eligibility for Kansas children of undocumented parents — as in most states — was determined by a formula that counted a fraction of the household income to account for the parents’ ineligibility.
For example, if the non-citizen parents in a five-person household — two parents, three U.S.-born children — earned $2,000 a month, that $2,000 was divided by five and multiplied by three to determine whether the family met the program’s income threshold and to decide the amount of food aid it would receive. In this example, the monthly household income would be counted as $1,200, making the three children together eligible for about $365 a month in food stamps, or about $121 per child.
By contrast, if the parents were U.S. citizens, the five people in the household would be eligible for a total household benefit of about $425 a month, or about $85 per person.
SRS officials concluded that the potentially greater per-person benefit under the old “prorated” formula was unfair even though the total household benefit was less for the family headed by undocumented parents.
With the new policy, all household income is counted but only the number of citizens in the house is used to determine eligibility.
The change resulted in 1,042 children losing benefits in households with at least one undocumented parent, according to SRS.
Federal regulations do not allow illegal immigrants to apply for food stamps for themselves. They are, however, allowed to apply on behalf of their minor children, if the children were born in the United States. Citizenship is automatic for U.S.-born children regardless of the status of the parents.
SNAP, funded by the federal government but managed by states, is still commonly referred to as the “food stamp” program, even though beneficiaries now use a government-issued electronic swipe card to purchase groceries. About 141,000 households in Kansas receive SNAP benefits.
One of four states
Kansas is the fourth state to adopt the current eligibility requirements — Arizona, Utah and Nebraska are the others. The other 46 states use the eligibility formula previously used by Kansas, which changed its policy in October 2011.
"Why are only four states using this program?" asked Sen. Terrie Huntington, R-Fairway.
"I can't answer that," Schroeder said.
→ Continue reading, and view the document cited by Sen. Kelly, at khi.org/foodstamps.