The KanCare Puzzle: Evaluating the Pieces – One clearly does not fit:
By: Jerry Michaud
President/CEO – Developmental Services of Northwest Kansas (DSNWK
On April 11, the Hays Daily printed an editorial on KanCare (the overhaul of Kansas’ Medicaid system affecting 380,000 people). The author understood the gravity and complexity and gave insight about the stories of those who have rubbed shoulders directly with KanCare, providing a common sense call to action for Community Services for people with Intellectual and Developmental Disabilities (I/DD) and their Long Term Services and Supports (LTSS). I’ll use the acronym (I/DD–LTSS) for easier reference to these services. As a general reference, these are the residential, day and other services provided by Developmental Services of Northwest Kansas, Inc. (DSNWK) each and every day of the year.
With gratitude to the Governor’s Administration for delaying inclusion of these services in to KanCare, the delay expires December 31, 2013. The plea for permanent ‘Carve Out’ of I/DD–LTSS from KanCare has not lessened. Most people may not realize that DSNWK’s Intermediate Care Facilities/Mentally Retarded (ICF/MRs) and our WORK/Working Healthy programs were NOT delayed and DSNWK was among the I/DD—LTSS providers expected to ‘report for duty’ under KanCare in January, 2013.
Since the late 80’s, partnering with the State in the closure of Norton State Hospital, DSNWK has been providing and billing for ICF/MR services ever since. In anticipation of the shift to KanCare, ICF/MR providers met in December to talk about the details. During the meeting, our jaws dropped at the question from a representative within the new KanCare model. The question, ‘What does the acronym ICF/MR stand for?’, was a deep and concerning early indication of the unfamiliarity of the KanCare model and the I/DD–LTSS system slated to begin in a few weeks.
As an experienced provider, we went from ‘straight-forward’ to ‘complex and confusing’ and from a billing process taking mere minutes a week to complete, to a continuous process requiring perseverance and hours each day under KanCare. Delayed payments from MCOs surpassed $130,000 for us in early March. I/DD—LTSS providers in the state have had to borrow money to cover payroll. Seeking remedy, we contacted legislators and the administration. Although we are appreciative of their support, getting paid should not require such ‘acts of congress’. As for the contracting process with the three MCOs, this has been a frustrating and costly process and we remain without contracts. Below are additional pieces of the KanCare puzzle:
o A perplexing price tag or “Fiscal Note” of nearly $100 million to “Carve Out” I/DD–LTSS from KanCare. Carving out – providers like DSNWK would continue doing what they have been doing. With no rate adjustments since 2008 and a flat funded Governor’s budget for FY 2014 and FY 2015, this is a puzzling equation to understand. ($100 Million represents the Administration’s budgeted savings, or anticipated cost cutting, within the I/DD-LTSS Carved In).
o Savings are touted to be the result of ‘better care and outcomes’. This is difficult to understand when the cost of providing community services has been held nearly flat for almost two decades, is underfunded by the State’s own rate studies. The I/DD State Institutions are ICF/MR services and have been permanently carved out of KanCare by the Administration from the very beginning.
o A consultant with NewPoint, a pro-managed care healthcare advisor, revealed troubling insights regarding inclusion of I/DD–LTSS into KanCare on 3/20/13. The consultant report identified that savings for I/DD services under managed care (in Kansas that is “KanCare”) come by way of de-institutionalization. Kansas’ has by and large already ‘been there and done that’ with its community partner organizations, like DSNWK, all across Kansas.
o Finally, if you were not aware, there has been an effort from within the legislature this session to make radical changes to the Developmental Disability Reform Act, landmark law established to manage this community I/DD—LTSS system in Kansas.
Many community advocates have expressed the desire to work with the Administration on the implementation of KanCare for the medical and behavioral health side of the lives of the people we support. We have repeatedly expressed deep concerns with I/DD–LTSS being included into KanCare, overseen by for-profit insurance companies, an idea with a mismatch of expectations, experience and philosophy.
I believe there are sensible thinkers in Topeka who see the clear warning signs. The majority view of the community service system has untiringly advocated and educated the Administration not to gamble by force-fitting I/DD–LTSS into KanCare.
Decades ago, parents of individuals with I/DD, families and community leaders and advocates wanted better results and outcomes for their children and friends with I/DD. From this, the community service system was born. These desires and dreams evolved into the strong mission-focused organizations in Kansas today. I am proud to say, DSNWK is one of them. Now the next generation of parents, families and advocates are joining these pioneers in crying out again to our Legislators and the Administration, to protect the community service system. The I/DD–LTSS is a piece that does not belong in the KanCare puzzle. The actual test drive of KanCare for I/DD—LTSS, along with peripheral points noted here, is enough to convince sensible minded people everywhere to politely hand the keys back to the sales person with a clear, ‘No thank you – this is not the right vehicle for our most vulnerable Kansans’.
The Community service system urges you to do the right thing and protect the I/DD-LTSS system by Carving It permanently out of KanCare.
Respectfully,
Jerry Michaud
President/CEO – Developmental Services of Northwest Kansas (DSNWK)