Wednesday, January 21, 2015

I/DD service providers bring arguments to Supreme Court

U.S. Supreme Court considering if
Medicaid providers can sue over pay. 
The U.S. Supreme Court heard arguments this week in a case that could decide what recourse I/DD service providers and other agencies have if they believe Medicaid is paying them too little.

Federal law requires Medicaid to provide the same access to care as that given to people with private insurance. However, some say the program pays too little and can lead to difficulties in getting care for millions of people.

The issues before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. Based on their remarks so far, the court appears split...READ MORE.

Tuesday, January 20, 2015

InterHab review of Gov. Brownback's budget recommendations

InterHab Executive Director Tom Laing
 analyzes Gov. Brownback's budget plan 
The first review of the Governor’s budget recommendations is in, and the projections are not good, and also, not so bad.

The cautionary note is this – that in order for the relatively low-pain budget that has been proposed to actually come true it will require multiple difficult legislative actions to be successfully undertaken. Such difficult tasks include legislative adoption of a very controversial school funding plan, the passage of more than 100 million in new excise taxes (on liquor and tobacco), and very challenging KPERS funding recommendations which would negate some of the recent work done to strengthen the financial health of the retirement fund.  In other words, in order to get even the paltry budget outcomes which are recommended it will require dozens of other pieces of the puzzle to fall into place.

From a briefing InterHab staff received from KDADS last Friday, this is some of what we learned:

First, to summarize some the budget items which we reported Friday:

  1. The only recommended cut to community funding is in the area of CDDO administration in FY 2016, in the amount of $350 thousand in reduced SGF match, which means that the full loss of that cut, however, will be around $650 thousand (SGF and Federal dollars combined).
  2. New funding is proposed to serve additional persons from the IDD waiting list, totaling around $6.7 million, all funds.
  3. Also noted in the Governor’s statements is the note that dollars which were obligated this current year to “eliminate” the “under-served” list would remain in the base to serve those persons in the coming two year budget cycle. (This claim is intended to prompt applause, no doubt, but all it really says is that the Administration will not pull the plug on new services. From a current perspective, it is not likely they could get permission from CMS which essentially ordered the underserved list to be eliminated; from an historical perspective, this is not a newsworthy item, since no Administration has thrown persons with IDD out of services.) 

Some additional insight into the KDADS perspective:
  1. The cuts for CDDOs are proposed by KDADS because they, along with all other State departments, were directed to come up with proposed cuts. 
  2. When the decision was made to NOT cut services that left State Aid and CDDO administration as the only two remaining alternatives for IDD system cuts.  Why were CDDO cuts chosen and not State Aid? Because, as we understand it, legislative budget cutting ideas already include cutting state aid. 

Some additional items to follow: 
  1. Pay attention to the programmatic shifts between DCF to KDHE. Not sure what is afoot, but all Foster Care licensing is not going to DCF, and all Medicaid eligibility is shifting to KDHE. 
  2. School funding plans – in the face of stern court scrutiny – appear positioned to dodge the court rather than obey the court.  With the court saying that the schools are not being funded in compliance with the current law, the Administration is saying “OK, let’s change the law!”  
  3. And, finally, despite the belief by everyone (except the Administration and the Easter Bunny) that income tax cuts are at the root of the revenue crisis, there will be no meaningful rollback of income tax cuts. 

Thoughts from InterHab advocacy perspectives?
  1. No cuts have yet been made, and many legislators in both parties are reluctant to whack the heck out of any budget merely to protect tax cuts for the rich. So .. DO NOT fall into the trap of believing that cuts are inevitable. 
  2. NOW not later is the time to let your legislators know your perspectives on this matter. 
  3. TOMORROW for SURE we need your active voices involved with those of your InterHab Colleagues at our Issues Forum and Board Meeting. 

Thursday, January 15, 2015

Update on Medicaid in-home caregiver pay requirements

This week a federal district court judge blocked implementation of a regulation that would have required state Medicaid programs to pay in-home care workers minimum wage and overtime. The ruling upheld a provision in the Fair Labor Standards Act that allows some care workers to be paid less than minimum wage.

According to KHI News, KDADS Secretary Kari Bruffett alerted legislators earlier this year to the new rule's potential for increasing costs and reducing access to Medicaid-funded services that help people live in community-based settings rather than in nursing homes.

At the time, Bruffett said the regulatory change could affect more than 10,700 Kansans receiving in-home services. As many as 1,400 people, she said, could see reductions in sleep cycle support, a service that involves paying someone to stay with an individual who should not be left alone at night due to their disability or medical condition.

Click here for the entire KHI News article, which includes links to download the District Court ruling and an affidavit from Kari Bruffett.

Wednesday, January 14, 2015

KDADS files Medicaid waiver proposal

The state’s Medicaid waivers define which home
and community-based services are available for
frail elders, people with disabilities and
people with traumatic brain injuries. 
State officials have proposed several changes in the Medicaid waivers that define the state’s approach to helping frail elders and people with disabilities live in community-based settings rather than in nursing homes. 

The proposed changes, now posted on the Kansas Department for Aging and Disability Services website, were filed with the Centers for Medicare and Medicaid Services on Dec. 31. CMS is expected to respond to the proposal within 90 days. 

Tom Laing is executive director at Interhab, told KHI News that InterHab's members were pleased that KDADS softened language that could have caused some consumers to lose access to the case managers they use to navigate the system. 

“We are pretty cautiously optimistic about the effort the state is making,” Laing said. “They’ve indicated that they are requesting some additional technical advice from CMS. We’ve expressed our desire to be a part of that discussion, and we think they are interested in receiving that feedback from us.” 

KDADS, Laing said, did a “good job” in gathering and responding to providers’ concerns before filing its final proposal.

Read the entire KHI News article HERE. 

Thursday, January 8, 2015

Kansas Medicaid rates cut by close to 25%

Starting this month Kansas primary care physicians will be paid less for seeing Medicaid patients.

With the expiration of the Affordable Care Act the cut in payments to primary care providers in Kansas will be close to 25 percent. The change is expected to impact about 2,500 physicians in the state.

The reduction in payments rescind a two-year incentive package from the Affordable Care Act. The package expired on Dec. 31. To learn more, click here to read the in-depth article posted this week by KHI News.

Tuesday, January 6, 2015

Rep. Hineman pens editorial on state budget shortfalls

Don Hineman, R-Dighton
Photo credit: Hays Post
Kansas Representative Don Hineman commented in the Hays Post this week on the upcoming legislative session's challenge of dealing with very significant budget shortfalls.

Hineman stated that the state faces a $294 million budget deficit for the remainder of this fiscal year, followed by a shortfall of $436 million by the end of the next fiscal year. He noted that Gov. Brownback has proposed a solution to fill the budget hole but his proposal contains only $73.5 million in direct cuts and primarily addresses the issue with $206.5 million in one-time transfers.

Hineman believes Gov. Brownback's approach only magnifies the size of the shortfall and if this proposal is approved by the legislature then the projected deficit for 2016 will become $663 million.

Click Here to read the entire article.

Wednesday, December 31, 2014

Kentucky develops community healthcare resource for adults with I/DD

People with intellectual disabilities can have a very difficult time accessing good quality healthcare. It’s not uncommon for a parent or guardian to be turned away by a physician’s office due to their child’s challenging behaviors. 

The majority of doctors have been trained on how to treat and diagnose illnesses, but that training does not include taking care of adults with intellectual and developmental disabilities.

The New York Times recently profiled one woman’s struggles with finding appropriate care for her adult son with intellectual disability, autism, and cerebral palsy. Read the article and watch the video HERE.