From NACDD's 2014 Annual Conference

1. KanCare
Managed Care Kansas
Style
Steve Gieber
Kansas Council on Developmental Disabilities
July 8, 2014

2. IDD Services Pre-KanCare
 27 (CDDO) Community Developmental Disability
Organizations DD Reform Act 1997 (Non-Risk Managed
Care)
 Determine eligibility
 Determine level of need $$
 1997-2014 over 250 + new for profit (CSP) Community
Service Providers
 Targeted Case Management provided by CDDO, CSP, or
Case Management Companies
 State-Wide Waiting List
 State paid the providers (FFS)fee for service

3. Kansas Manage Care Is:
 Capitated
 Per member-per month paid to MCOs
 Integrated (needs vs. wants)
 Both long term services and health services
 Managed by three different MCO’s with different rules
and process
 Billing
 Appeals and grievances
 Data Systems

4. Post KanCare
 CDDO’s Gatekeeper
 CSP Provide Service
 Case Managers Case Management
 The Waiver agency and the Medicaid Agency split
policy and oversight fragmented
 MCO’s
 Provide care coordination
 Pay the providers
 Determine level of service need with Case Managers

5. MANAGED CARE NO-NO’S
 Who Controls? Medical Model vs. Individual Directed
(PCP)
 Projecting savings without a track record
 Not addressing in the plan
 Not taking into account the learning curve
 Insufficient State Oversight (revolving door)
 Public (ICF) Intermediate Care Facilities and
Institutions not included in the plan

6. LTSS DD Carve-Out
 Families and Self-Advocates caused a carve-out for
over a year
 Individuals and families were afraid of loss
 Advocates were asking “How Can YOU Have It ALL”
 Better health outcomes
 Lower cost
 No cuts to services or rates
 While paying for another level of administration

7. Kansas Council on Developmental
Disabilities (KCDD) Initial Position
 Advocate for a delay in KanCare DD until
 pilot project test the premise
 establishment of effective oversight
 protect people’s current and future access to services.
 Advocate for proper legislative oversight
 Advocate for sufficient state agency oversight
 Advocate for Waiting List Plan

8. KCDD Current Position
 Belief vs. Fact or Truth
 Save money ($1 Billion over 5 years)
 better health outcomes
 No cut in services or rates
 Premise should be tested
 Pilot should test what is going to be implemented
 Decision based on fact not belief

9. Pilot Recommendations
 Based on a true test “ `Pilot one and two”
 “Pilot” was voluntary for both the provider and individual
 Individuals enrolled in the pilot services were the same
 MCOs/Providers were not paid to participate
 Reporting was only by the state agency
 MCOs were not at the table early enough
 Billing was not tested till late in the process
 Care Coordinators were not on board or trained
 Systems had not been developed to provide anything different

10. The Drone
 Participated in the “Pilot” that wasn’t
 Managed Care is different in each state
 KanCare is capitated, integrated care, managed by one
of three MCO’s
 The “Pilot” wasn’t capitated, wasn’t integrated and was
paid/managed by the state
 Providers experienced significant payment issues
during the “Pilot”

11. DD Council Changing Role
 From Funder to Collaborator/Influencer
 Served on the “Pilot” Committee
 Served on (CSI) Consumer/Systems Issues
 Commented on the Centers for Medicaid Services
Waiver Amendments
 Served on the Friends and Family Committee
 Encouraged past Partners in Policymaking Graduates
to serve on other committees.

12. DD Council Role
 Provide testimony to the Legislative Oversight committee and
other committees
 Provide & encourage comments to both the State and Federal
officials on the 1115 and 1915c waivers over 100 on first and over
50 on the carve in
 Research and share information with people with IDD, families and
providers
 Continue to identify areas that need additional safeguard and
protections for people
 Continue to monitor outcomes
 Advocate for system protections i.e. payment system loss of
service

13. Results of KCDD
& Advocacy Efforts
 Delayed implementation
 Removal of “edits” from the MCOs billing process
 Providers are currently getting paid
 Moved the problem into the future
 Many of the 1115 Waiver special terms and conditions
covered in the 109 pages are from advocacy efforts
 The elimination of the underserved Waiting List for 1,700
people
 Additional oversight and changes in systems
 Increase consumer involvement and input

14. Positives Outcomes from
Managed Care
 Some additional Dental Care Services
 MCO United Healthcare’s Foundation committed $1.5
million for employment over the next 3 years
 Willingness to break down some of the silos around
employment between the state agencies

15. Current Council
Activities on KanCare
 Systems work on employment barriers
 Engaging CSPs on preventing abuse, neglect and
exploitation
 Provide Self-Advocacy training on abuse, neglect and
exploitation
 Monitoring outcomes of Managed Care to make sure it
does no harm
 “Kansas Leadership Center” leadership training for self-
advocates to be more effective leaders

16. Key Provisions 1115 Waiver Special Terms
and Conditions
 State must allow enrollments up to cap
 Individual may change based on experience with MCO
 Independent Ombudsman
 Coverage model
 Resolving problems, services coverage access rights
 Earmark Cost Savings to increase number of slots
 1,700 people on Underserved List needs met within 6
months
 State must review Beneficiary Complaints Grievances &
Appeals

17. Websites to Watch
 http://www.kancare.ks.gov Kansas state site
 http://www.kancareddwatch.com funded and operated
by family members of people with IDD enrolled in
KanCare
 http://www.KCDD.org Kansas Council on
Developmental Disabilities website
 Please contact us to be added to our advocacy email list

20. Year one Summary 2013
 P4P
 Claims processing no payments
 Encounters ½ payment
 Customer service full payment
 Grievances and Appeals ¾ payment
 Average claim denied all services 15.58% highest
percentage in Hospital admissions and Pharmacy
 Value of services avoided $1.15 million 2 reporting

21. Medicaid Program Integrity
GAO-14-341 May 2014
 Increased oversight needed
 Systems in place to audit Fee for Service
 System lacking for auditing Managed Care Plans
 States need to audit payments made by and to MCO’s
 CMS current Payment Error Rate Measurement less than ½
of %
 MCO’s in Kansas turned edits off
 Fraud estimated at 5.8% or $14.4 billion in 2013
MCO’s identify fraud could reduce PMPM payments
MCO’s don’t want to appear to vulnerable
States are responsible for oversight and recovery

22. What We Know Right Now
 The state is claiming savings of $55-250 Million first
year.
 The three MCOs lost $110 million on the first year
 Millions of past due claims not paid from year one
 More difficult to get data/ Transparency Compromised
 The state is moving forward with a new assessment
tool to determine eligibility
 “in lieu of services” new term lacks transparency

23. Bottom line for DD Councils
 Be true to Disability Act VAULES
 Be open to adjusting ROLES
 Develop new partnerships and collaborations
 Continue to promote decision by FACT not BELIEF
 Support the “EMPLOYMENT PUSH”
Create opportunities to lead