Kansas health secretary pushes back on findings in federal audit

The head of the state’s health agency called a federal audit that found Kansas’ Medicaid program out of compliance flawed because it focused on processes rather than health outcomes.

The Centers for Medicare and Medicaid Services rejected the state’s request to extend authorization for its privatized Medicaid program, KanCare, last week after an audit by the federal agency concluded that the Kansas program had put patients’ health and safety at risk.

Kansas Secretary of Health and Environment Susan Mosier appeared before the Senate Public Health and Welfare Committee on Monday to rebut the federal findings and to discuss a path forward for the program, which provides health coverage to low-income families and disabled Kansans.

Mosier contended that the federal audit contained “statements of opinion rather statements of fact” and accused federal investigators of an overreliance on anecdotal evidence.

“There is no evidence of needed services not being provided...no evidence any consumer suffered harm,” Mosier told the committee.

She pointed to decreases in the state’s infant mortality rate and decreases in emergency room trips by KanCare enrollees as evidence that the program was bearing fruit.

Susan Jarsulic, a Shawnee woman whose 38-year-old disabled daughter is enrolled in the KanCare program, was frustrated with Mosier’s response after attending the hearing.

“She basically called CMS liars and I have a problem with that,” said Jarsulic, who is in the middle of fighting an appeal to preserve her daughter’s overnight care under KanCare. Her daughter has Rett syndrome, a neurological disorder that affects breathing and other bodily functions.

Mosier contended that the federal audit was rushed because of last week’s transition from President Obama to President Trump.

Mosier also criticized the media for reporting that CMS had denied KanCare’s reauthorization. She said the letter from CMS represented a delay rather a denial. However, the written testimony she submitted to the committee refers to the letter as a “Denial of extension.”

The state has to respond to CMS with a corrective action plan by Feb. 17.

Asked about the state’s response after the hearing, Mosier indicated that for many of the issues identified by federal officials the state would be responding with information rather pursuing policy changes.

“I think a lot of what you saw was there was incomplete information, that they didn’t have the time to review the 2,500 documents, the 40,000 pages…We had that information. What we’ll be doing is providing, where they made a statement where there was incomplete information, we’ll complete that information for them,” Mosier said.

Among the issues identified by federal investigators is that the state lacked a comprehensive system for reporting and tracking critical incidents for disabled beneficiaries.

Sen. Barbara Bollier, R-Mission Hills, raised concern that each of the privately-run managed care organizations with state contracts to provide coverage has a different system for recording incidents.

Brandt Haehn, the commissioner for Home and Community Based Services, told the committee that the state was in process of crafting a comprehensive system.

“Just because we haven’t reported on the adverse incidents doesn’t mean we aren’t tracking,” he said.

Mosier dismissed another problem brought up by federal investigators that managed care organizations had revised patient care plans without patient input or their signatures in some cases. Mosier said that sometimes waiting for signatures would delay access to care.

Haehn said that he was not personally aware of anyone filing a grievance because their care plan had been change. Sen. Laura Kelly, D-Topeka, the ranking Democrat on the committee, called that hard to believe.

Kelly and Mosier sparred about CMS’ finding that the state has often taken an adversarial approach when dealing with stakeholders.

Mosier rejected this as an example of incomplete analysis by CMS. “We did two rounds of stakeholder meetings going across the state this summer and they were not adversarial. The ones that I’ve been in – that I can speak to – they were not.

Kelly said that she had attended some of these stakeholder meetings and believes CMS was correct.

“You would field questions from participants in the meeting, but not respond in a way that would suggest that you empathize at all,” Kelly said.

Kevin Siek, an advocate for the Topeka Independent Living Resource Center who attended the meeting, said that CMS officials held public forums for KanCare beneficiaries last year and that many people spoke out about conflict with state agencies.

“They weren’t adversarial because there weren’t state officials there, but people felt free – because of that – they felt free to speak out without fear of retaliation about the problems they were facing,” he said.

Sen. Vicki Schmidt, R-Topeka, the committee’s chair, said she wanted more information before she could evaluate Mosier’s contention that CMS had overlooked information in its audit.

“I think all of us have heard from advocacy groups and certainly from individual patients and beneficiaries about issues in KanCare and it’s very important that they be looked into,” Schmidt said.

This story was originally published January 23, 2017 at 1:29 PM with the headline "Kansas health secretary pushes back on findings in federal audit."