Bill sets up potentially disruptive split in client care for hundreds of the developmentally disabled in Sedgwick County

03/23/2013 6:58 PM

03/23/2013 6:59 PM

About 40 percent of developmentally disabled people who receive support services in Sedgwick County would have to change either the person who guides their care or the provider who gives them services under a bill scheduled to come before the state Senate on Monday, officials said.

Senate Substitute for House Bill 2155, proposed as a way to eliminate potential conflicts of interest in disability services, would require clients to get their case management from one organization and their care services from another.

The bill contains language encouraging disabled people to seek case management services from one of three insurance companies under contract to the state through the new KanCare managed-care health program.

In practice, the bill would force a change onto 702 developmentally disabled people in Sedgwick County who now get their case management and assistive services from a single provider, said Dee Stoudt, director of the county’s Community Developmental Disability Organization.

That represents about one in four of the 1,800 developmentally disabled people currently receiving case management countywide, Stoudt said.

The bill will “interject some chaos into the system that is unnecessary,” she said. “A lot of our persons served don’t do very well with change.”

That was on full display Saturday morning as some angry and frustrated parents and advocates voiced emotional pleas to kill the bill during a South Central Kansas Legislative Delegation forum.

“I have a 34-year-old son, he’s literally a 5-year-old,” James McNulty told lawmakers. “If you’re going to pass that (bill), then just euthanize him. Legalize euthanasia so he and I can just walk into the chamber together.”

Sally Fahrenthold, mother of an autistic 51-year-old daughter, told lawmakers the existing system “is not broken and doesn’t need to be fixed.”

“The service system allows my daughter – who has a 50 IQ, they say – to work, to live semi-independently, to have good social relationships, to do so many things for herself,” Fahrenthold said. “We don’t want to see this change.”

Last week, the Senate Public Health and Welfare Committee advanced the bill to a floor vote by stripping an earlier House bill of its contents and replacing it with the more controversial provisions from another bill.

Sen. Michael O’Donnell, R-Wichita, the only area member on the committee, said the impetus for the bill was concern over potential conflict of interest if the same company or agency is deciding what services a disabled person needs and then is providing those services.

After hearing from parents at Saturday’s meeting, he said he would be willing to consider delaying the change until an audit could be done to determine whether the system is actually being abused.

Stoudt said she doesn’t think there’s a problem with conflict of interest because disability care is much like any other medical service.

“If you’re a physician, you diagnose a condition and you treat it,” she said.

Sedgwick County currently has a three-step system for connecting developmentally disabled people to services they need to live without hospital or nursing care:

• The Community Developmental Disability Organization, a county government agency, acts as the first contact with the system and makes the initial evaluation of a person’s eligibility and overall need for services.
• The client, or his or her guardian, then selects a case manager to determine what services are needed for that person to live as independently as possible, such as placement in a group home, help with daily living tasks in his or her own home, employment training and/or job placement.
• The client then selects from a menu of service providers based on which would best meet his or her needs. At present, he or she could use the same organization that employs the case manager, or he or she could choose a different provider.

Under HB 2155, the CDDO, case manager and service providers would all be required to come from separate and unaffiliated organizations.

Of the 702 people who would be affected in Sedgwick County, about 500 don’t have a legal guardian, so “their targeted case manager is very important to them,” Stoudt said. Often, that relationship between a case manager and a client is developed over a period of years, she added.

The effect of change could be even more disruptive in low-population counties where service providers and choices are few, she said.

In some communities where there’s only one combined case management/service provider organization, the developmentally disabled person would most likely be forced to work with an out-of-area case manager, Stoudt said.

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