Services for developmentally disabled Kansans expected to shift to KanCare on Feb. 1
01/17/2014 12:03 PM
08/08/2014 10:21 AM
The state’s health and environment chief told a legislative panel Friday that he expects to shift long-term support services for the developmentally disabled to the state’s privatized health-care system on Feb. 1.
The change was supposed to have taken place Jan. 1, but was put on hold by the federal Center for Medicare and Medicaid Services. CMS balked at giving its approval after numerous disabled people and a federal council on disabilities questioned whether the state was ready.
Kansas Department of Health and Environment and other agencies in Gov. Sam Brownback’s administration want to shift the disability services to KanCare, a year-old program outsourcing administration of Medicaid to three private insurance companies that contract with the state as managed care organizations.
KDHE Secretary Robert Moser told a joint House-Senate committee overseeing Kancare that “substantial progress” has been made in discussions with the federal authorities on shifting disability services to KanCare.
Moser also outlined steps the state will take to ensure the insurance companies perform adequately.
The rollout of the medical side of the program last year was plagued by complaints of improperly denied claims, delayed payments and problems with customer service.
Developmentally disabled individuals on Medicaid already receive their medical services through KanCare.
The services remaining at issue include employment training, transportation, nutrition and aides to help disabled people stay in their homes.
The KanCare Oversight Committee also took testimony from about 20 consumers and advocates on their experiences with the program.
Rocky Nichols, executive director of the Kansas Disability Rights Center, complained that disabled people were systematically misinformed about their right to appeal insurers’ decisions.
Nichols showed handbooks and letters incorrectly telling disabled people that if they appealed a service cut and lost, they’d have to pay back the value of services provided during the appeal process. He said the state needs to take firm action to correct that misimpression.
“The damage has been done – it’s out there,” he said. “They’re feeling the cold of the chilling effect (on appeals).”
He said money saved from discouraging appeals doesn’t benefit the state, just the insurer.
Also testifying against KanCare was Nicholas Taylor of Wichita, who has a condition called arthrogryposis multiplex congenita.
He uses a powered wheelchair and has very limited use of his arms and hands.
“I am a professional wheelchair tennis player and have won gold medals in the last three Paralympics, but I am unable to hold a cheeseburger,” he told the committee.
He said his KanCare company informed him he’ll be getting about a 25 percent cut in the 360 hours of home-care services he gets now.
Taylor said the only explanation was a letter saying: “Personal care attendant hours are not provided for Instrumental Activities of Daily Living (IADL’s) if there is a capable person residing in the home of the member receiving services.”
Taylor said that doesn’t make sense.
“Since the IADL’s (shopping, housekeeping, money management and laundry) total only about 20 hours, I was – and still am – at a loss to understand why my hours had been reduced by 95 hours,” he said.
He said he’s trying to appeal the decision but even his lawyer has been unable to get answers.
All three KanCare insurance contractors arranged for satisfied customers to come to the meeting and testify on their behalf.
Several testified live, in writing or video that KanCare saved their lives because the previous state-run system didn’t cover heart and lung transplants or other procedures they needed.
Julie Rogers, a 28-year-old woman with the hereditary disease cystic fibrosis, had her testimony read into the record by her case manager, Latricia Caldwell of Amerigroup, one of the three KanCare contractors.
“I woke up one morning, I fainted, and I was rushed to the hospital,” Rogers’ testimony said. “My doctor determined a lung transplant was necessary to save my life. Thankfully the timing was in my favor as KanCare started covering lung transplants for adults in 2013.”
In March, “I received the gift that changed my life, a lung transplant,” the testimony said.
Rogers praised Caldwell for her help with travel, temporary housing and staying healthy enough to qualify for the transplant, which was done in a Dallas hospital.
Now, she said, she can breathe without the bottled oxygen she needed before the operation.
“My life is completely different than it was before the transplant and I am doing things I never thought I would,” the testimony said. “I look forward to being able to travel for the first time in my life. But I also relish the simple victories like being able to clean my house now.”
Anticipating the new Feb. 1 implementation date to add long-term services, KanCare officials have scheduled a conference call Wednesday for service consumers, their families, providers and other stakeholders.
The conference call will include state and CMS officials outlining actions they’re taking to address concerns raised by the disability community,
The call will be from 8:30-10:30 a.m. Wednesday. The first hour will focus on consumer and family issues. The second hour will address provider issues.
To participate in the conference call, dial 800-811-9422.
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