Posts tagged with Medicaid

Report: Obama health law a good deal for states

By Ricardo Alonso-Zalvidar, Associated Press States will receive more than $9 in federal money for every $1 they spend to cover low-income residents under President Barack Obama's health care law, according to a nonpartisan analysis released Monday.

Expanding Medicaid to cover about 20 million more low-income people will cost over $1 trillion nationally from 2013 to 2022, said the joint report from the Kaiser Family Foundation and the Urban Institute. But the analysis found that states will pay just $76 billion of that, a combined share of roughly 7 percent. The feds will pay the other $952 billion.

Republican governors have resisted the Medicaid expansion, saying it adds an unacceptable burden to already strained budgets. And the Supreme Court handed the governors a victory this summer, ruling that states are free to reject the Medicaid deal.

Medicaid is one of the two main ways that Obama's law expands coverage to most of the 50 million uninsured U.S. residents. As a broader Medicaid safety net picks up more low-income people, new health insurance markets called exchanges will offer subsidized private coverage to the middle class. Both parts of the strategy take effect in 2014, at the same time that most Americans will be required to carry health insurance or pay a fine.

The new analysis was unlikely to change the minds of state leaders who have already rejected the Medicaid expansion, but it may help shape the debate in a majority of states still on the fence.

Among those refusing are Texas Gov. Rick Perry, South Carolina Gov. Nikki Haley, and Louisiana Gov. Bobby Jindal. For most others, the choice will come into sharp focus early next year as state legislatures meet.

"It's hard to conclude anything other than this is pretty attractive and should be pretty hard for states to walk away from," said John Holahan, head of the Urban Institute's Health Policy Research Center and the main author of the study, which used computer models of population, income and insurance coverage.

Under the law, Medicaid will be expanded to cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. It's mainly geared to low-income adults with no children at home, who currently cannot get Medicaid coverage in most states. Washington pays all of the cost for the first three years, gradually phasing down to 90 percent.

Some of the main findings:

— States that reject the expansion could still face a substantial increase in their Medicaid costs, as people already eligible for the program but not currently enrolled are prompted to sign up.

— States will save $18 billion from no longer having to offset the cost of charity for low-income uninsured people.

— Some states will actually come out ahead. New York, Massachusetts, Wisconsin and others that already cover low-income childless adults will be able to reap a more generous federal matching rate than they currently get.

— Texas, the state with the highest percentage of uninsured residents, would see a 6 percent increase in Medicaid spending. About 2.4 million residents would be added to the Medicaid rolls.

Medicaid is a federal-state partnership that varies from state to state. So the consequences for state budgets will be different in each case.

Not so for the uninsured, said Alan Weil, executive director of the National Academy for State Health Policy, an independent research and policy group. "This is more than a fiscal exercise," said Weil. "There is a human dimension that needs to be part of the discussion far beyond just the dollars."

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Brownback allies thwart pleas from advocates for those with developmental disabilities to stay out of KanCare

BY SCOTT ROTHSCHILD

An effort to remove the management of care for those with developmental disabilities from Gov. Sam Brownback's Medicaid privatization plan was thwarted in the House on Thursday.

The dustup occurred when legislators considered House Bill 2789, which would have set up a legislative committee to oversee Brownback's move to contract with private insurance companies to handle the state's $2.9 billion Medicaid program. Under Brownback's plan, the program, which covers health care for the poor, elderly and disabled, would be called KanCare.

State Rep. Jim Ward, D-Wichita, tried to amend the bill to remove those with developmental disabilities from KanCare and maintain their current network of assistance.

Ward was acting on behalf of parents and advocates of those with developmental disabilities who have pleaded with Brownback to leave them alone, saying that the needs of those with developmental disabilities don't fit the managed care system provided by insurance companies.

But Brownback has rejected those pleas and promised that services will improve under KanCare and cost less.

A bi-partisan group of legislators, however, said they were skeptical of those claims and supported Ward's amendment.

"My constituents have been begging for this," said state Rep. Ron Worley, R-Lenexa. "They are not simply concerned, they are scared to death."

State Rep. Ed Trimmer, D-Winfield, said the parents of children with developmental disabilities fear having to fight insurance companies over assistance for their sons and daughters.

Brownback administration officials were on the floor of the House busily talking with legislators.

State Rep. Brenda Landwehr, R-Wichita, and chair of the House Health and Human Services Committee, said if the care of developmentally disabled Kansans wasn't turned over to KanCare, state funds may not be available and services would have to be cut. She was joined by state Reps. Marc Rhoades, R-Newton, who is chair of the House Appropriations Committee, and David Crum, R-Augusta, chair of the House Social Services Budget Committee.

Crum made the motion to send the entire bill back to committee, which caused Ward to leap up in protest. "Keep your big boy pants," he urged House members. "Today's the day." But the motion to send the bill back to committee was approved 69-54. Only Republicans voted for the motion.

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Two Lawrence residents named to new KanCare advisory council

Gov. Sam Brownback announced today members of the new KanCare Advisory Council. Its first meeting will be later this month.

KanCare is what the state is calling its new managed care system for Medicaid, which is scheduled to begin Jan. 1, 2013. Under KanCare, the state will pay three for-profit companies to operate the system that provides services for 383,000 low-income elderly, disabled and low-income families and children.

“This advisory council will continue to provide the administration with ongoing insight and recommendations as we move forward with the implementation of KanCare,” Brownback said in a news release. “I look forward to working with such a diverse group to ensure the best person-centered care coordination model in the country.”

Here's the list of council members:

• Andy Brown, Lawrence, representing children’s advocate network.

• Randy Johnson, Lawrence, representing mental health care Medicaid consumers.

• Dr. John Calbeck, Garden City, representing substance abuse providers,

• Bernie Mayse, Overland Park, representing physically-disabled Medicaid consumers.

• Rep. Brenda Landwehr, Wichita, representing the Kansas House of Representatives.

• Dr. Craig Concannon, Beloit, representing medical providers.

• Dave Geist, Dodge City, representing area aging agencies.

• Sen. Vicki Schmidt, Topeka, representing the Kansas Senate.

• David Sanford, Wichita, representing primary care providers.

• Dr. Kevin Bryant, Wichita, representing nursing facility providers.

• Audrey Schremmer-Phillips, Wamego, representing independent living centers.

• Sen. Alan Schmidt, Hays, representing the Kansas Senate.

• Larry Martin, Valley Falls, representing senior Medicaid consumers.

• Mary Barba, Topeka, representing developmental disabled Medicaid consumers.

• Collin McKinney, Valley Center, representing developmental disability service providers.

• Mike Conlin, Topeka, representing community pharmacists.

• Steve Kelly, Newton, representing hospitals.

• Rep. Jerry Henry, Cummings, representing the Kansas House of Representatives.

• Susette Schwartz, Wichita, representing health clinics and tribal organizations.

• Walt Hill, Hays, representing mental health care providers.

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Dental-related emergency room visits on rise at LMH, nationally

Emergency personnel reload an ambulance after bringing a patient to Lawrence Memorial Hospital on Wednesday, Feb. 16, 2011.

Emergency personnel reload an ambulance after bringing a patient to Lawrence Memorial Hospital on Wednesday, Feb. 16, 2011. by Mike Yoder

Toothaches and other dental problems caused at least 17,500 emergency room visits in Kansas in 2010, according to a national report released this week by the Pew Center on the States.

The number is likely significantly higher because 30 of the state’s 142 hospitals did not provide data on dental-related ER visits.

Dr. Toni Reynolds, who works in the emergency room at Lawrence Memorial Hospital, said the numbers are not surprising.

“It’s a common problem. I’ve seen it everywhere I’ve ever worked,” she said of dental emergencies. Among the common problems are pain from cavities and tooth abscess. She said they can provide pain relief and antibiotics in the ER, but they can’t pull teeth.

“We can provide kind of a bridge until they can get to a dentist. They still need to see a dentist for definitive care,” she said.

Last year, there were 488 ER visits at LMH with a principal diagnosis of a dental problem, up 50 percent from 325 in 2006. One patient was hospitalized last year and two were hospitalized in 2010.

Reynolds said typically people with dental issues show up in the ER because they can’t find care and they just can’t take the pain anymore.

The report, “A Costly Dental Destination,” estimates that across the country, preventable dental conditions were the primary reason for 830,590 ER visits in 2009, up 16 percent from 2006.

It’s concerning because of:

Costs. Emergency rooms are the most expensive places to receive care, and taxpayers pick up most of the tab through Medicaid and other public programs. The average cost of a Medicaid enrollee’s inpatient hospital treatment for dental problems is nearly 10 times more expensive than the cost of preventive care delivered in a dentist’s office.

Treatment. Emergency rooms are just a temporary fix and unlikely to provide lasting relief to the underlying oral health issue. Often these patients end up back in the ER.

According to the report, the problem is a lack of dentists who accept Medicaid patients and then that problem is exacerbated by a dental shortage.

In Kansas:

• 93 of the 105 Kansas counties do not have enough dentists to serve their residents.

• 12 Kansas counties have no dentist at all.

• 60 counties don’t have enough dentists who accept Medicaid or help the uninsured and Douglas County is one of them.

There are about 60 licensed dentists in the county; of those, only about two dozen are registered to accept the approximately 9,000 Douglas County residents on Medicaid.

But few of these dentists do. The Douglas County Dental Clinic, 315 Maine, is one of the few. It provides care for about 1,300 Medicaid patients annually.

Julie Branstrom, executive director of the dental clinic, said there is an eight-week wait for an appointment at the clinic. She said it leaves several appointments open for emergencies and they typically are filled.

“The vast majority of people that we see kind of operate in crisis mode,” she said.

The problem is that they aren’t able to operate 24/7. She said people have come banging on the clinic’s door when they are closed seeking care because they are in so much pain, and her only option is to send them to the ER.

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Kansas attracts 5 bidders for 3 Medicaid contracts

By JOHN HANNA, Associated Press

TOPEKA — Kansas officials announced Wednesday that five companies have submitted bids for three contracts to manage Medicaid, but skeptics of Gov. Sam Brownback’s plan to overhaul the state’s $2.9 billion-a-year program saw it as another sign of potential problems.

The bidders all are out-of-state companies or Kansas affiliates of out-of-state firms. Potential contractors are being asked to provide managed care programs for the poor, disabled and elderly Kansans covered by Medicaid, while controlling costs for the state and improving the overall health of participants.

Brownback’s efforts to overhaul Medicaid represent the first time the state has attempted to cover the disabled and the elderly, including those in nursing homes, with a managed-care program. His administration expects to issue the contracts this summer, have them start Jan. 1, 2013, and have each company operate statewide so Medicaid participants have a choice of coverage.

“We are encouraged by such broad interest and quality bidders,” Lt. Gov. Jeff Colyer, a surgeon who led the team developing the Medicaid plan, said in a statement.

Some legislators in both parties and advocates for the needy, disabled and elderly have questioned whether the Republican governor is moving too quickly. They’re skeptical that private companies can make an adequate profit while fulfilling the administration’s goals.

Sen. Dick Kelsey, a Goddard Republican who has called on the administration to delay the contracts for six months, said he expected more bidders. Initially, 15 companies expressed enough interest to send representatives to a mandatory conference for potential bidders in December, and Kelsey called five bidders “not very many.”

“It suggests that there are more problems with the situation than what is being acknowledged,” Kelsey said.

But House Majority Leader Arlen Siegfreid, an Olathe Republican, said five bidders are more than enough to provide a competitive selection process. And, in the past, the state has struggled to attract interest from potential managed-care contractors because its market is relatively small, compared with other states’.

“It suggests that people who are bidders see this as good for them and, hopefully, good for the state,” Siegfreid said. The bidders include Amerigroup Corp., of Virginia Beach, Va., and United Healthcare, of Minneapolis, Minn.

Another bidder is Coventry Health Care of Kansas, based in Wichita, affiliated with Coventry Health Care, of Bethesda, Md. The state also received a bid from Sunflower State Health Plan, of Topeka, a subsidiary of Centene Corp., of St. Louis. Also among the bidders is WellCare of Kansas, affiliated with WellCare Health Plans Inc., based in Tampa, Fla.

Some legislators were disappointed that Blue Cross and Blue Shield of Kansas, the state’s largest health insurer, did not submit a bid. Blue Cross officials announced earlier this month that the company wouldn’t, saying the decision wasn’t a criticism of the Medicaid overhaul but an acknowledgement that participating would require Blue Cross to make major changes in its business model by next year.

Sen. Laura Kelly, of Topeka, the ranking Democrat on the budget-writing Senate Ways and Means Committee, said the number of bidders indicates that companies could have difficulty living with the requirements of the contracts.

But Colyer and other administration officials have said the overhaul will lead to better coordination of services for high-need Medicaid participants and will eliminate duplication. State medical programs provide services for an average of 383,000 people a month, and the bulk already receive state health coverage through private contractors.

By bringing the disabled and elderly into a managed-care system, the state would add Kansans who need relatively expensive long-term services.

Legislators have a relatively small role in the overhaul because the Brownback administration is pursuing the effort through private contractors. Legislators could block an executive order Brownback issued earlier this month to reorganizing three state social services agencies, and some lawmakers have talked of forming a special oversight committee.

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Developmental disability advocates raise concerns about Medicaid privatization

Lawrence resident Grant Miller was born with Down syndrome, which mostly affects his thinking abilities and makes it hard for him to communicate. He says only a few words at a time.

Despite his intellectual disability, he has graduated from high school and worked full-time at Cottonwood Inc. performing a variety of jobs like assembling packages, putting labels on boxes and putting the finishing touches on greeting cards.

In November, at age 26, Miller moved from his parents’ house and into a home with two other men who also have developmental disabilities. He was able to do that because he moved off the state’s waiting list of 3,224 people to receive Medicaid funding for the support he needs to live independently.

“It’s been a great move,” his father, Jim Miller, said. “He’s very happy and he’s just been involved in a lot more activities. It’s enriched his life immensely.”

Grant Miller pays for housing, food, clothing and activities, and he’s on his father’s health insurance. He sees a primary care doctor once a year, gets an annual flu shot and is in good physical health. His dad said that he doesn’t receive mental health services and no one has ever suggested that he needs them.

Justin Moore, residential supervisor for Cottonwood, said he spends time with Grant Miller and his housemates during the weekends and on weekday evenings. He takes them to activities like swimming, bowling, theater performances, and basketball games, and makes sure they are taking their proper medications and eating well. They don’t understand money, so he watches their finances when they are shopping. Miller also has a part-time job rolling silverware at 23rd Street Brewery.

“They are super independent,” Moore said. “They all like to get out of the house and stay busy. They rely on us to get around.”

Advocates for developmental disabilities don’t want to see such long-term support change, and that’s what they fear will happen when the state’s Medicaid system becomes privatized Jan. 1, 2013.

“We aren’t a medical model,” said Jill Baker, administrator of services at Lawrence-based Cottonwood, which employs and provides services for about 300 individuals with developmental disabilities. The primary source of its funding is Medicaid. “We take care of people’s medical concerns by referring them to doctors but we don’t provide medical care here.”

Under the state’s plan to privatize the Medicaid system called KanCare, the state will pay three for-profit, out-of-state companies to operate the system that provides services for 383,000 low-income elderly, disabled and low-income families and children. Of those, 8,193 have developmental disabilities.

Grant Miller, 26, Lawrence, who has Down syndrome, place ribbons on cards while working at Cottonwood Inc., 2801 W. 31st. St. Miller also works part-time at 23rd Street Brewery. Miller is now living independently thanks to residential services that are funded through Medicaid.

Grant Miller, 26, Lawrence, who has Down syndrome, place ribbons on cards while working at Cottonwood Inc., 2801 W. 31st. St. Miller also works part-time at 23rd Street Brewery. Miller is now living independently thanks to residential services that are funded through Medicaid. by Mike Yoder

Health-home concept

Shawn Sullivan, secretary for the Kansas Department on Aging, said the goal of KanCare is to reduce costs of the $2.8 billion Medicaid program and provide integrated care with better outcomes. That means providing a “health home” for all Medicaid consumers that will take care of their medical, mental and long-term care needs. The state estimates it will save $853 million in the first five years.

He believes KanCare can provide better health outcomes for people with developmental disabilities because a majority see a primary care physician at least once a year and 64 percent have mental health conditions. He pointed to a 2008 study done by the Kansas University Medical Center’s medicine and pharmacy schools that found poor management of diabetes and chronic conditions among those with physical or developmental disabilities. It found that Kansas failed to meet national standards for cancer screenings, flu shots and diabetes care.

“The system is not working like it should because of the very poor health outcomes,” he said and added that the average life expectancy for an individual with developmental disabilities is age 60.

Sullivan said that the administration has put in place statutes and regulations that ensure all existing benefits and services will continue for Medicaid beneficiaries, like Grant Miller, and that no provider rates will be reduced.

He also said consumers will be able to have their same providers and case managers. They want to make it as seamless as possible.

Personal, emotional care

But Cottonwood Inc., Kansas Advocates for Better Care and others remain concerned that managed care companies will cut services and funding once the contracts are signed this summer.

“The state will have a set amount to pay these companies, but then it’s going to be these companies managing their bottom line, and who’s going to be at the bottom of the power heap? I think it’s going to be us, the consumers and the families,” said Baker, of Cottonwood.

Advocates of those with developmental disabilities say services can’t be cut or changed because they are life supports; they aren’t tests or surgeries that can be put off. They also say those with developmental disabilities have built personal relationships with their providers and case managers and they don’t want to see those ties severed.

Barbara Bishop is executive director of The Arc of Douglas County, which provides advocacy, education and support to people with developmental disabilities. It serves about 120 people, including Miller, who receives case management. Bishop said the organization wants the developmental disability population carved out of the KanCare system because she fears these companies don’t know how to provide such specialized care. She said it’s apparent from the letters that she has been receiving from them that they don’t understand the services.

“It’s a much more personal kind of service and it’s not medical. It’s social and emotional and it’s not something that they know or understand,” she said. “We really are their eyes to the world.”

Grant Miller, 26, Lawrence, who has Down syndrome, lives independently thanks to services that are funded through Medicaid. Advocates fear that the state's plan to privatize Medicaid will disrupt services for individuals with developmental disabilities, like Grant, who depend on them for daily living.

Grant Miller, 26, Lawrence, who has Down syndrome, lives independently thanks to services that are funded through Medicaid. Advocates fear that the state's plan to privatize Medicaid will disrupt services for individuals with developmental disabilities, like Grant, who depend on them for daily living. by Mike Yoder

State moving forward

Sullivan said the state is reviewing company bids, and that includes providing services for those with disabilities. He said each company will have an advisory council composed of consumers and providers. He also said the state is withholding 3 percent of the contract amount until the end of the first year of operation and that to get the money, the companies must meet six measures. One of them is how well they respond to consumers and providers.

“We felt like that was an important measure to put in year one. So we are incentivizing them to do well with responding to providers and consumers,” he said.

As for the waiting list that Grant Miller was on, Sullivan expects that to work much like it does today where if one person goes off the system, it opens the door for someone to go on; however, he believes there will be some greater flexibility with services that can be provided while on the list.

Sullivan said there are organizations like the Kansas Medical Society that support including the developmental disability population in KanCare.

Jerry Slaughter, executive director of the Kansas Medical Society, said his organization supports the KanCare model because it’s the best option on the table to curb the escalating costs of Medicaid and improve health outcomes. He said Kansas is projected to have 500,000 people on Medicaid in two years.

“If you do nothing, then the only option is to cut benefits, cut eligibility, cut provider reimbursement and none of those — they’ve tried them all — none of them improve outcomes, improve care, improve access,” he said.

In 2010, there was a 10 percent cut — or $22 million — in Medicaid reimbursements, and dental services were cut in 2008.

Slaughter said the best way to improve outcomes is to provide better coordinated and integrated care for the entire Medicaid population.

“We believe of all the suggestions and plans and options that were suggested during the yearlong process that taking a comprehensive approach that involves all of the populations served by Medicaid makes most sense.”

On Feb. 22 the state will release how many companies submitted a proposal and who they are. Contracts will be signed in June and the system is expected to be implemented Jan. 1, 2013.

Sullivan said the proposals received include how to serve the developmental disability population and that they are moving forward with them.

“The administration’s belief is that in order to achieve better outcomes that DD (developmental disability) needs to be continued to be carved in to the KanCare system,” he said. “We continue to seek input and talk to providers and consumers about how the system can best work.”

The administration is mailing letters this week to family members and guardians of individuals with developmental disabilities.

Grant Miller’s father said he’s not sure how the KanCare system will work because he’s heard conflicting information. He just hopes his son continues to receive the same care and services that he does now.

“He’s not going to stop needing the support. His Down syndrome is not going to be cured. He’s not going to suddenly be able to manage his money. It’s going to be ongoing for his life,” he said.


TOWN HALL MEETING

Cottonwood Inc., which employs and provides services for people with developmental disabilities, will host a public meeting about KanCare, the state’s plan to privatize the Medicaid system, from 5:15 p.m. to 6:30 p.m. Thursday at the Holiday Inn Lawrence, 200 McDonald Drive.

For more information, contact Cottonwood at 785-842-0550.

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Health care providers can apply for Electronic Health Records incentive payments at KDHE website

http://wellcommons.com/photos/2009/nov/02/180587/

The Kansas Department of Health and Environment announced this week that health care providers can apply for Electronic Health Record incentive payments through its Health Information Technology and Health Information Exchange website.

The payments are being provided through the Kansas Medicaid Incentive Program.

“Kansas health professionals who have invested in meaningful use of electronic health records can apply for incentive payments from the federal government. It is a major milestone in implementing HIT/HIE in the State of Kansas. The use of EHRs (electronic health records) contributes to the safety of patients."

— Kari Bruffett, division director for Health Care Finance

Simply put, she said "meaningful use" means providers need to show that they’re using certified technology in ways that can be measured significantly in quality and in quantity. Meaningful use criteria includes enrolling in the Kansas Immunization Registry.

Providers must first register on the national Centers for Medicare and Medicaid Registration and Attestation website at: http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp.  

Once that is complete, eligible professionals can apply for Kansas Medicaid EHR payments online at: http://www.kdheks.gov/hcf/hite/default.htm.

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Kansas Department on Aging secretary to chat about Medicaid reform Feb. 6

Kansas Department on Aging Secretary Shawn Sullivan will be available Feb. 6 to discuss the state’s plan to privatize the Medicaid program or other policies regarding senior care.

He will be participating in an online chat at 3 p.m. on WellCommons.com. And, you can submit your questions anonymously at anytime at WellCommons/chats. Make sure to log back to WellCommons.com during or after the chat to see if your questions were answered.

Shawn Sullivan

Shawn Sullivan

Sullivan heads the Department on Aging which is responsible for administration of Older American’s Act programs, distribution of Medicaid long-term care payments, and regulation and survey processes for several different adult care home licensure categories.

Sullivan has been involved with aging services for 18 years. Before heading the Department on Aging, he was executive director of Kansas Masonic Home in Wichita, which received a state award for its efforts in culture change and person-centered care.

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Department on Aging secretary discusses Medicaid overhaul, Lawrence residents express concerns

Sharon Spratt, CEO of Cottonwood Inc., left, and Carl Locke, on the Cottonwood board of trustees, greet Kansas Department on Aging Secretary Shawn Sullivan on Friday, Jan. 13, 2012, at Free Methodist Church, 3001 Lawrence Ave. Sullivan spoke about the administration's plan to move to a managed care system for all Medicaid clients.

Sharon Spratt, CEO of Cottonwood Inc., left, and Carl Locke, on the Cottonwood board of trustees, greet Kansas Department on Aging Secretary Shawn Sullivan on Friday, Jan. 13, 2012, at Free Methodist Church, 3001 Lawrence Ave. Sullivan spoke about the administration's plan to move to a managed care system for all Medicaid clients. by Mike Yoder

About 50 people, including nonprofit health agency leaders, attended a presentation Friday afternoon by Kansas Department on Aging Secretary Shawn Sullivan about the state’s plan to privatize the Medicaid program by January 2013.

Sullivan handed out a seven-page information sheet and went over the basics of the plan called KanCare. He said the goal is to reduce costs of the $2.8 billion Medicaid program that serves 340,000 low-income, elderly and disabled residents by providing more integrated care with better outcomes. The state is projecting to save $853 million in the first five years.

The plan

Sullivan said currently the state pays thousands of providers, from doctors to nursing homes, to take care of Medicaid consumers. Under KanCare, every Medicaid consumer will be enrolled in one of three managed care companies, and the state will pay a set amount per month based on the type of client they are serving.

Those three managed care companies will be determined this summer and then they will contract out to the thousands of providers that will be in their network. Sullivan said the only way these companies can make a profit is by achieving better outcomes such as fewer people in nursing homes, lesser rate of institutionalization and better followup care.

“We’ve put dozens of incentives and penalties into the RFP (request for proposal) and contract to ensure that the only way these three vendors will make it financially is by serving the consumers better than what we do now,” he said.

For example, Sullivan said he had an uncle who lived in another state and was on a similar Medicaid program as the one Kansas has now. He had liver problems, diabetes and mental health needs. He saw various specialists, counselors and doctors, and they were prescribing him different medications.

“There wasn’t one entity or care coordinator to help him coordinate all of those things, to make sure the mental health counselor was talking to the primary care physician who was talking to the diabetes specialist,” Sullivan said.

As a result, his uncle was in and out of the emergency room 29 times in the last 18 months of his life.

Sullivan believes by having a care manager under the KanCare system, his uncle would have received better care.

The goal is for all Medicaid clients to be enrolled in one of the managed care companies by January 2013. He said the majority of clients will have the same providers whether it’s a nursing home, doctor or case manager.

Sullivan also said there are provisions in the proposal that require the managed care companies to establish Kansas offices and hire Kansas employees.

He said he believes that the planning time has been sufficient for the size of Kansas, but he admits they are still making adjustments and seeking input.

“This is a huge system and we are trying to roll it out as seamlessly as possible. We will make changes over the next year to make sure that this works well for those that we serve,” he said.

Kelly Evans, executive director of Trinity In-Home Care in Lawrence, center, joined other health care provider in attending a public meeting Friday, Jan. 13, 2012, about the administration's plan to privatize Medicaid.

Kelly Evans, executive director of Trinity In-Home Care in Lawrence, center, joined other health care provider in attending a public meeting Friday, Jan. 13, 2012, about the administration's plan to privatize Medicaid. by Mike Yoder

Local concerns

Sullivan met earlier in the week with Sharon Spratt, CEO of Cottonwood Inc., which provides services and employment to individuals with developmental disabilities. Spratt is concerned that services and reimbursement could be cut under KanCare.

She has researched other states that have moved to a managed care system, and she said Wisconsin has reported that there have been cuts to providers between 5 and 35 percent.

“Insurance companies like to figure out ways to not pay for things, so who knows,” she said.

She added that when it comes to medical care, sometimes you can forego a test or surgery, but that’s not the case with services for people with disabilities.

“They have life-long needs, so it’s not like they are ever cured. There are varying levels of supports they need to live their lives,” she said.

Cottonwood hosted the presentation at nearby Free Methodist Church, 3001 Lawrence Ave. Sullivan said it was one of about 50 presentations that he’s made around the state in the past couple of months.

After the presentation, several community leaders said they were unsure how the overhaul would affect their agencies and clients, but they were concerned.

Stacey Hunter Schwartz, executive director of Independence Inc., which provides services to people with disabilities, said the state is implementing the overhaul too quickly, and she expects it will be a costly process to implement. She said Independence Inc. is constantly trying to keep up with regulations that are changing, which causes her case workers to do two to three times the work.

She is upset that the KanCare proposal didn’t address collecting money from clients who use home- and community-based services, yet it addresses the issue for nursing homes who won’t have to have the responsibility because the managed care companies will be required to do it for them.

“It is a difficult issue because it’s a lot of money for some of our consumers to come up with, so we’re placed in a position of being their advocate but also their bill collector if you will, and that has not been addressed and that’s a concern of mine,” Hunter Schwartz said.

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Kansas’ Medicaid leader Andy Allison resigns to lead Arkansas program

Kansas Department of Health and Environment Secretary Robert Moser announced today the resignation of Andy Allison, director of the Division of Health Care Finance.

Allison has accepted a job as Arkansas’ Division of Medicaid Services director. Kari Bruffett, KDHE’s assistant secretary for Policy and External Affairs, will serve as interim director of Health Care Finance.

“Andy has served the State of Kansas admirably and we wish him the best,” Moser said in a news release. “This agency has benefited greatly from his nearly 20 years of Medicaid experience.”

Andy Allison

Andy Allison

Allison was the executive director of the Kansas Health Policy Authority before the agency merged with KDHE on July 1.

“The reforms Kansas announced last week are the right direction for Kansas and those receiving services. Implementing KanCare’s essential reforms will ensure long-term stability of the program through improved outcomes for Kansans,” Allison said. “The opportunity to work near family in my wife’s home state of Arkansas is an opportunity I could not let pass.”

Allison’s last day with KDHE is Nov. 22. He plans to begin work in Little Rock on Dec. 5. Bruffett will maintain her role as assistant secretary while also serving as interim director for Health Care Finance until the agency finds a permanent replacement for Allison. 

Kari Bruffett

Kari Bruffett

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Lawrence health leaders offer their priorities for the upcoming legislative session

http://www2.ljworld.com/photos/2008/apr/26/145684/

The Lawrence-Douglas County Health Department’s top legislative priority is to preserve the smoking ban.

Dan Partridge, director, said the ban saves the state money in health care costs and, more importantly, it saves lives.

“It’s nonsensical in my mind to even go there,” Partridge said.

The department also supports preservation of the Affordable Care Act. Partridge said he hopes legislators discuss how to implement the bill rather than how to repeal it because it contains much-needed changes. He said the state needs to continue to be proactive in applying for federal grant money and in setting up its own health insurance exchange.

“I hope we, as a state, don’t take a short-sided view of this and try to prove a point politically at the expense of people’s health care,” Partridge said.


David Johnson

David Johnson

Mental health

David Johnson, CEO of Bert Nash Community Mental Health Center, agrees. One of the hallmarks of the Affordable Care Act is going to be more equal treatment for mental illnesses.

“I hope they don’t spend too much time trying to derail health care reform because I don’t think it will happen,” he said.

Johnson was encouraged to hear Gov.-elect Sam Brownback talk about reforming Medicaid.

Johnson said changing Medicaid to more of a managed care program would save money and provide better services.

About 50 percent of the people who get mental health services, first get them at an expensive state hospital because that’s what Medicaid pays for. If Medicaid paid for early intervention, education and prevention, then those high hospitalization costs could be reduced, he said.

When it comes to the budget, he hopes legislators take a look at the specific ramifications of any cuts they make. He said reduced mental health services can cause growing jail populations. It also can affect the economy as workers are unable to get help for their illnesses.

Johnson said mental health services have been cut year after year, and he’s getting an indication that 2011 will be no different.


Mitzi McFatrich

Mitzi McFatrich

Senior care

Mitzi McFatrich, executive director of Kansas Advocates for Better Care, hopes the Legislature doesn’t cut funding for any long-term care services.

She said elders and individuals with disabilities thrive when they have the supports and services that allow them to maintain their highest level of independence and ability. Unless a person requires 24-hour care, in-home services are more economical than care in a nursing home.

McFatrich said a lot of times the Legislature cuts the home health services because they don’t fall under an entitlement program, like nursing homes.

“It just allows people to have more independence, more freedom, and the ability to stay within their social network. That’s where most of us want to get our care, instead of going to a nursing home,” McFatrich said.

Last year, the state passed a nursing home provider fee assessment. The federal government matches $3 for every dollar that is collected on the assessment. She expects it to generate $60 million. She hopes the money is used to increase nursing staff who provide direct care to residents. Nursing homes provide access to care 24/7, but are only required to provide care two hours a day.

“You don’t have to talk to very many people to understand that sometimes they wait 15 minutes and sometimes they wait 45 minutes for somebody to answer their call bell if they need help to the bathroom, getting dressed, or anything else,” she said.

McFatrich also would like to see that two-hour minimum requirement, which has been in place for about 20 years, raised. The U.S. Government Accountability Office did a study and suggested 4.15 or 4.85 hours of care per day per resident.

She also would like to see the state implement an ombudsmen program for community- and home-based services. There is a federal and state mandate that nursing home residents have access to an ombudsman, but that’s not available to people who receive services elsewhere.

McFatrich also would like the Legislature to implement regulations regarding nursing home residents who have a felony background. Currently, nursing homes don’t have to separate the populations or notify other residents. So, a resident may have shot, raped or beaten someone, and others don’t know. McFatrich said other states have taken up the issue legislatively.


Janet Williams

Janet Williams

Home health

Janet Williams, founder of communityworks inc., also hopes funding isn’t cut for home- and community-based services. These services help people get the training to become more independent and, as a result, reduce health care costs.

For example, she said the state is required to pay for traumatic brain injury rehabilitation, which is $25,000 a month more in a hospital than in the community or at home. There are 22 people with brain injuries receiving care at a hospital outside of Kansas. The state is paying about $350,000 a year for each of them.

“So, every time someone comes home or comes out of one of those expensive hospitals, we provide the services in the community and that’s when they get the assistance they need at a much lower cost,” she said. I believe people can come home sooner and even avoid going at all if there is a concerted effort to make it happen. That is one cost saving idea I plan to share with the new administration.”

Williams believes Gov.-elect Sam Brownback understands the importance of home health agencies.

“I think the greatest challenge is going to be educating all of the new legislators about the good that these programs do,” she said.


Gene Meyer

Gene Meyer

Hospital

Lawrence Memorial Hospital President and CEO Gene Meyer hopes the state adequately funds Medicaid, especially with the health reform initiatives and expansion of eligibility for Medicaid.

He said health care providers and the hospital already are not adequately reimbursed for the costs of providing care to Medicaid patients.

“This is huge because if they don’t, the availability of providers who will accept Medicaid becomes limited, thus creating significant backlog in the system,” Meyer said.

Tort reform is another concern. Currently, there is a case before the Kansas Supreme Court that challenges malpractice limits. If the current limits are found to be unconstitutional, he said the Legislature may be forced to make some changes that would expand the limits of awards. And that, he fears, would create significant increases in malpractice premiums for providers.

“Kansas has been able to recruit physicians because of what’s termed a favorable malpractice climate. If this becomes not so favorable by legislative activity, it’s going to be another big problem with development of providers to meet future needs.”

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Health beat: Medicaid bonus, gift of blood, award-winning agency, national spotlight

Here’s a dose of health news from WellCommons, around town and elsewhere:

Medicaid bonus

U.S. Health and Human Services Secretary Kathleen Sebelius awarded $206 million to 15 states for making significant progress in enrolling uninsured children in Medicaid.

Kansas was one of them, receiving $2.6 million.

Funding for the “performance bonuses” was included in the Children’s Health Insurance Program Reauthorization (CHIPRA) legislation signed into law by President Obama in February 2009.

The CHIPRA established two sets of performance goals that states must meet to qualify for a bonus:

  1. Taking specific steps to streamline their enrollment and renewal processes to make it easier for families with eligible children to gain coverage.

  2. Documenting a significant increase in the number of children enrolled in Medicaid.

Peter Hancock, of the Kansas Health Policy Authority, said they were working on a press release about the award.

Kansas received the least amount of money, and Alabama received the most with $54 million.

For the complete news release, click here on the HHS website.


Gift of blood

The Community Blood Center is having a blood drive from 3 p.m. to 6 p.m. today — Dec. 28 — at Lawrence Masonic Center, 1301 E. 25th St.

To make an appointment or for more information, visit www.esavealifenow.org and use sponsor code lawrencemasonic or contact Jerry Collie at 856-0528. All registered donors will receive a gift-boxed ornament.

The Community Blood Center supplies blood to Lawrence Memorial Hospital and other regional hospitals.


Janet Williams, founder of communityworks inc., receives the first Governor's Excellence Award from Gov. Mark Parkinson in November during a ceremony at the Statehouse.

Janet Williams, founder of communityworks inc., receives the first Governor's Excellence Award from Gov. Mark Parkinson in November during a ceremony at the Statehouse.

Governor’s award

Janet Williams, founder of communityworks inc., received the first Governor’s Excellence Award last month.

The award recognized the home health agency for its exceptional commitment to assisting and empowering Kansans with disabilities.

(To learn more about its services, visit my story on how it is helping a 50-year-old woman return to her Lawrence home after being in a nursing home.)

Williams said she was surprised by the award and joked about the irony of the situation. She said Gov. Mark Parkinson was not her favorite person because he cut the Medicaid reimbursement rate last year by 10 percent, which is how the agency was primarily funded.

“The plaque helped a little bit,” she said, with laughter.


National exposure

Laura Bennetts, owner and director of Lawrence Therapy Services, was interviewed recently by a national publication about upcoming reductions in insurance reimbursement in Kansas for physical and occupational therapy.

The article is in the December 2010 issue of ADVANCE for Physical Therapy & Rehab Medicine.

Know of something happening on the health beat? Send me a tip at kbritt@ljworld.com.

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Health beat: Willow stats, health board, body donation, dentist’s feedback, holiday safety

Here’s a dose of health news from WellCommons, around town and elsewhere:

INCREASED DEMAND

The Willow Domestic Violence Center saw the need for its services increase during the past year. Kathy Perkins, board president, said that, unfortunately, an increase in domestic violence is common during times of national economic uncertainty.

Statistics for the center’s fiscal year — July 1, 2009 to June 30, 2010 — were released last week during its annual meeting:

1,683 — Crisis calls answered.

1,483 — Community-based service recipients.

148 — Women sheltered.

118 — Children sheltered.

316 — Adult and children group counseling sessions.

4,390 — Volunteer hours of service.

$693,756 — revenue.

$582,978 — expenses.

Also, the center honored three volunteers:

Sarah Campbell — for designing and implementing its website.

Gordon Fitch — for providing his expertise in organizational development.

Maurice Joy — for providing expertise in financial management.


HEALTH BOARD

The Lawrence-Douglas County Health Department board meets at 5:30 tonight on the second floor of the Community Health Facility, 200 Maine (across from the LMH emergency room). Its meetings are open to the public.

Trish Unruh is scheduled to give a report about LiveWell EatWell.

Also on the agenda: LiveWell Lawrence, Berry Plastics, Family Planning grant, 2010 year-end financial projection, local legislative pre-session hearing, 2 percent cost of living adjustment for 2011.

23rd Street Brewery offers several healthy entrées, including Tilapia Florentine. The dish is pan seared tilapia topped with toasted almonds and feta cheese, and served with sauteed spinach and artichokes. Such dishes are part of a new LiveWell EatWell intiative in Lawrence.

23rd Street Brewery offers several healthy entrées, including Tilapia Florentine. The dish is pan seared tilapia topped with toasted almonds and feta cheese, and served with sauteed spinach and artichokes. Such dishes are part of a new LiveWell EatWell intiative in Lawrence. by Richard Gwin


GIVE THE GIFT ... OF YOUR BODY?

I’ve done a number of stories about the importance of donating organs, but never the entire body ... until now.

Kansas University’s School of Medicine students depend on such donations to learn the human anatomy in great detail, and to practice procedures. Ultimately, body donations help patients like you and me.

To learn more, check out my story on WellCommons.

The cremated remains of bodies donated to Kansas University Medical Center for research and education purposes are buried at Oak Hill Cemetery in Lawrence. Several dozen cremains were buried about six weeks ago.

The cremated remains of bodies donated to Kansas University Medical Center for research and education purposes are buried at Oak Hill Cemetery in Lawrence. Several dozen cremains were buried about six weeks ago. by Mike Yoder


DENTIST'S FEEDBACK

Dr. Justin Anderson, a Lawrence dentist, called after reading my story about a state need for dentists and a proposal to introduce dental therapists as part of the solution.

He talked to me about why he doesn’t take Medicaid patients, his volunteer work, and his feelings about dental therapists.

Anderson said he accepted Medicaid patients when he first started practicing, but quit because of the high amount of paperwork and low reimbursement rate.

“It was just too much a hassle. You are better off doing it for free,” he said.

Anderson said his practice — Wilkerson, Saunders & Anderson at 831 Vt. — provides free services through the Kansas Foundation of Dentistry for the Handicapped.

Anderson also volunteers by serving on the Lawrence Memorial Hospital Endowment Assocation board, Bert Nash Community Mental Health Endowment Board and at Lawrence schools, among other things.

As for his thoughts on dental therapists: “As long as it provides more care at decreased costs for our patients but it doesn’t take away from the health of the patients, I think it’s great.”


HAVE A SAFE HOLIDAY

Reporter Shaun Hittle posted Lawrence-Douglas County Fire Medical’s safety tips on WellCommons.

Know of something happening on the health beat? Send me a tip at kbritt@ljworld.com.

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