Shawn Sullivan and Robert Moser: Integration of I/DD care going smoothly so far

04/17/2014 12:00 AM

04/16/2014 5:54 PM

It has now been more than two months since the 8,600 individuals with intellectual and developmental disabilities (I/DD) served through the home- and community-based services (HCBS) program were integrated into Kansas’ managed-care system known as KanCare. In the interest of transparency, and because of the high level of public interest in this transition, we are providing an update.

Our first priority in this transition is to ensure that individuals served continue to receive first-rate services and supports. Our state agencies are closely monitoring the impact of the KanCare changes to the level of services and supports that individuals receive. In fact, we are required in law and by the federal government to review and approve any proposed reductions to services.

Our experience in 2013 with other HCBS programs for seniors and individuals with physical disabilities was that more people received increases in services than experienced decreases. It is too early to judge the transition’s impact on those with intellectual and development disabilities because assessments and new integrated service plans are in the process of development.

However, we can say that no one on the I/DD HCBS waiver has had services involuntarily reduced thus far. We can also report that the care coordinators in the managed-care organizations are working closely with local case managers and providers to assess whether services can be provided in a more creative and innovative manner.

One example of this flexibility is Becky, an individual served through the I/DD KanCare program with complex needs. In KanCare, all members of her previous support team are involved, including her local case manager and day and residential provider. New resources were added with her managed-care organization’s care coordinator and clinical team in order to better coordinate and integrate her services. The team working with Becky was able to determine that a medication change, along with more flexible, individualized long-term services, would better fit her needs. The changes are occurring, and Becky is living a more independent, individualized and happy life.

The second priority in this transition is to ensure that our I/DD providers are paid timely and accurately by the three managed-care organizations. As of April 11, a total of $45 million had been billed to the companies in the I/DD HCBS program, and nearly $41 million had been paid. Payments in process accounted for another $4 million in claims. The remaining claims were denied mainly because of duplicate claims submissions.

The average claim denial rate is 2 percent.

The average turnaround times for submissions of billing claims to payment to providers by the companies is 5.7 days. This data for provider payments for the first 2 1/2 months is tracking similar to what it was before KanCare.

The main issue we hear from providers relates to the need to improve the accuracy of “client obligation” withholding from payments, and we are working with the companies to address this.

We would like to acknowledge the hard work and dedication to this transition made by the state’s community developmental disability organizations, community service providers and targeted case managers. Their commitment to those they serve is unparalleled. The need for continued partnership is crucial, as is the need for scrutiny, oversight and vigilance to get this right.

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