By Mike Shields, KHI News Service, January 12, 2012
TOPEKA — The state's top social service officials faced another round of tough questioning today from legislators during a second day of hearings on Gov. Sam Brownback's plan to privatize the Kansas Medicaid program.
The Senate Public Health and Welfare Committee is scheduled to continue the hearings on the proposed move to more managed care on Tuesday after the Martin Luther King holiday and continue for the next two days. The Senate Ways and Means Committee also has scheduled its own hearing on the issue for Tuesday morning.
"I see this being a nightmare for all providers," said Sen. Dick Kelsey, a Goddard Republican who owns three small group homes for teenagers with substance-abuse problems.
Kelsey said he thought the administration's plan to have Medicaid providers signed up in the networks of at least three managed care companies might produce an administrative maze so frustrating to providers that they would refuse to participate in the program.
"I've been a provider myself. We have the same concerns," said Dr. Robert Moser, secretary of the Kansas Department of Health and Environment. Moser is a former family practice doctor from the small, western Kansas town of Tribune. Moser later told the committee that Oklahoma had abandoned its Medicaid managed care initiative in part because the managed care companies had problems getting providers to participate.
Moser and Kansas Department on Aging Secretary Shawn Sullivan told the committee members that the administration's contract specifications included incentives designed to minimize the administrative problems providers would face with the changes.
Sullivan said surveys in states with Medicaid managed care programs had shown "increased customer satisfaction," because care was better coordinated. He said the same result was expected in Kansas.
"It will be a little more burdensome for providers," he predicted. "But we think better for consumers."
Kelsey also raised concerns about potential payment delays for providers and wanted to know who would collect the interest on money owed but not yet paid to them.
"I'm not sure I can answer that question," Moser responded.
Sen. Laura Kelly, a Topeka Democrat, said she doubted the plan would produce the $850 million in savings that administration officials have forecast over the next five years.
"I just can't come up with those figures," she said. "How did you arrive at those fairly substantial cost savings? These aren't widgets we're trying to put in different compartments. These are people."
Assistant KDHE Secretary Kari Bruffett said much of the savings were expected come from better and more appropriate care, which would result in fewer hospitalizations and more Medicaid clients living in their own homes instead of more expensive nursing facilities.
"We're going to reduce acuity because of better managed care and have fewer people in institutions," Bruffett said.
Sullivan told the committee that Kansas ranked fifth in the nation for the number of people in nursing homes. The state, he said, pays an average of $3,450 a month for a Medicaid patient in a nursing home versus $1,050 for one living at home with some level of outside assistance.
He said keeping more people out of nursing homes could produce significant savings relatively quickly.
Kelly and others also questioned the administration's plan to include services for the developmentally disabled in the managed care contracts. That element of the plan has drawn the most public opposition.
Sen. Vicki Schmidt, the Topeka Republican who chairs the committee, asked if administration officials would consider moving forward incrementally with their plan, perhaps phasing in managed care for various portions of the Medicaid population instead of expanding all at once statewide to include the elderly, disabled and the mentally ill.
"Would you consider a staggered implementation?" she said. "Or is it too late to stop the train. Is it on the tracks and already on the way out?"
Mark Dugan, chief of staff for Lt. Gov. Jeff Colyer, said the administration's request for contract bids had already been released.
"We think it is most prudent to stay on the current course," he said. "Our original discussion within the administration was to do this on a faster timeline, but that was pushed out."
Brownback officials have said they plan is to have the new managed care program in place by Jan. 1, 2013.
"I think it is incredible timing to roll this out on Jan. 1, when the Legislature convenes 10 or 11 days later," Schmidt said, noting that she expected legislators would receive waves of calls from irate or confused constituents once the new system was launched.
http://www.khi.org/news/2012/jan/12/brownback-officials-challenged-medicaid-plan/