By Dave Ranney, KHI News Service, January 26, 2012
TOPEKA — The House Committee of Aging and Long-term Care today endorsed a bill aimed at reducing potential for fraud and abuse in Medicaid-funded services for the disabled.
"The way the system is now, it appears that we we may be paying for more services than are needed," said Rep. Bob Bethell, R-Alden. "This bill, I think, addresses that."
House Bill 2424 would prevent a social service agency that assesses a disabled person’s needs from also serving as the person's case manager or providing the services they need to live in community settings rather than nursing homes.
Instead, each service – assessment, case management, in-home care – would have to be provided by a different entity.
Bethell said he’s been troubled by reports of agencies inflating their assessments in ways that generate higher payments for the others services they provide.
Last week, Kansas Department on Aging Secretary Shawn Sullivan said his agency already prohibits case-management agencies from also providing in-home services for the frail elderly.
Similar policies, he said, are not in place for agencies that serve the physically and developmentally disabled and autistic and emotionally disturbed children.
“It’s a little bit of a mishmash,” he said.
Sullivan said he supported the bill but noted that Gov. Sam Brownback’s Medicaid reform plan included a “conflict-free” process for assessing each individual’s needs and for helping them figure out which of three managed care companies would best be suited to meet those needs.
The governor's KanCare plan would extend managed care to all Medicaid clients starting Jan. 1, 2013. The administration currently is seeking bids from interested managed care companies. The deadline for submitting proposals is Feb. 22.
Sullivan said the pending "conflict-free" process would be guided by a new statewide entity called Aging and Disability Resource Connections (ADRC).
Sullivan said he expected to issue an RFP (request for proposal) for creating the ADRC in February. The new agency would coordinate care plans for people in all disability groups.
The managed care companies, in turn, would be expected to subcontract with agencies already providing case-management and attendant care services.
Committee members agreed to drop services for emotionally disturbed children provided by community mental health centers from the bill, noting that the centers' assessments are clinical rather than functional and already are subject to managed-care reviews. Also, in many communities the mental health centers are the only available provider.
The committee also voted to change the bill's proposed implementation date to July 1, 2013 from July 1, 2012.
“We did that because the governor’s managed care plan goes into effect on Jan. 1, 2013,” Bethell said, “and we wanted to reduce the chances of somebody having to switch case managers twice – once for (HB) 2424 and once the governor’s plan."
The bill now goes to the full House for consideration.
http://www.khi.org/news/2012/jan/26/committee-passes-confict-interest-bill/
The KHI News Service is an editorially-independent program of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment.