TOPEKA — Members of the Kansas Legislature today had their first opportunity to question administration officials about several health policy changes made since the Legislature adjourned this spring.
They also heard about some of the things planned for in the near future by Gov. Sam Brownback. For one, they were told that there was no plan to close Kansas Neurological Institute in Topeka next year.
"We're going to keep it open," said Rob Siedlecki, secretary of the Kansas Department of Social and Rehabilitation Services.
"I'm more than ecstatic to hear that," said Sen. Vicki Schmidt, the Topeka Republican who chairs the Legislature's Joint Committee on Health Policy Oversight. "That's worth the price of admission today."
Schmidt and other Topeka-area legislators from both parties have pushed hard to keep the state hospital for the developmentally disabled open. It is one of the city's major employers and some family members have said KNI residents, all of whom are severely disabled, would have trouble moving to new homes after many years living in the institution.
A closure commission formed during the administration of Gov. Kathleen Sebelius, a Democrat, concluded that KNI should be closed so that residents could live in more home-like settings and the state could save money. And the Brownback administration, which is Republican, earlier this year seemed willing to follow through on the recommendation.
KNI is one of two state hospitals for the developmentally disabled. The other is in Parsons.
Also at Monday's meeting:
Lt. Jeff Colyer gave a brief overview of the administration's thinking as it prepares to unveil its plan for reforming the state's Medicaid program. Officials have said the plan will be released next monthafter several months of talking with various interest groups and members of the public.
Colyer avoided describing details of the plan, saying many elements of it are still being worked on.
More managed care
But he made several comments to suggest the plan will include some sort of managed care contract that would focus on individual case management for some of the Medicaid program's most expensive patients.
"Roughly, about 20 percent of the patients consume 80 percent of the resources," Colyer said.
Kansas has managed care contractors administering the state's health insurance plans for children. When the Brownback administration plan is released, most expect it will expand the managed care approach to at least also include the disabled or those with multiple chronic illnesses.
Colyer mostly spoke in generalities. But he said the current Medicaid model was no more rational than the Soviet military economics he had studied and written about in the 1980s.
He said the "fee-for-service" approach to reimbursing Medicaid providers wasn't working and that a new system should reward doctors and patients for producing better health outcomes.
That means encouraging more personal responsibility and letting doctors or other providers share in the savings they realize from keeping patients healthier, he said.
Innovator grant defended
Colyer also defended the governor's decision last month to reject a $31.5 million federal "innovator" grant that would have helped pay for the state's development of a health insurance exchange as required under the Affordable Care Act. The decision came just ahead of the Kansas Republican Party adopting a plank saying that Kansas officials should not take part in implementing the health reform law.
Colyer said the decision was based on three main factors:
- The grant would have required the state to launch an exchange "roughly a year" earlier than other states while it was still uncertain that the U.S. Supreme Court would let the controversial health reform law stay on the books.
"We have a policy," he said. "We are not going to implement an exchange until the Supreme Court rules."
- The administration didn't want to act without the Legislature's input on the matter.
- Recently proposed exchange regulations issued by the federal government were complex and raised many questions in the minds of administration officials.
Also, he said, "Obamacare was not popular in the state of Kansas last time I checked."
Colyer caught flak from several committee members, including Sen. Pete Brungardt, a Salina Republican.
"It seemed to me like a rather huge opportunity to turn down," he said.
Brungardt also said that even if the administration doesn't like the federal law that didn't mean it shouldn't comply with it.
"States don't get to belong to the United States on a selective basis," he said.
Kansas Insurance Commissioner Sandy Praeger testified after Colyer and gently refuted each of the claims, which she described as "misunderstandings."
- The state would not have been required to launch an exchange earlier than any other state. All states face the same Jan. 1, 2014, date for having an operational exchange.
- The working groups she had formed to plan for an exchange had planned - and still plan - to bring their recommendations to the Legislature for consideration. An exchange could not be implemented without the Legislature's approval.
- The proposed regulations are still subject to modification pending public comments and if Kansas doesn't launch its own exchange, the federal government will run one for the state that likely will have regulations more onerous to Kansas insurance companies and agents than one designed specifically for Kansas by Kansans.
Community Transformation Grant
Also before the commitee was Dr. Robert Moser, secretary of the Kansas Department of Health and Environment.
He gave a brief overview of what has happened since the former Kansas Health Policy Authority was merged into KDHE as its new Division of Health Care Finance as the result of one of the governor's executive orders earlier this year.
And responding to lawmakers' questions, he also defended his decision to not apply for a federal Community Transformation Grant that potentially could have meant millions of dollars in federal aid to beef up disease prevention programs. The grants also were part of the Affordable Care Act.
Moser said the agency had prepared a grant application because of widespread interest among local public health officials. But the application wasn't turned in after he discovered the federal government would require the hiring of three additional staff members at KDHE to manage it.
He said the governor is very interested in combating obesity, however, and the agency is considering applying for a second-round prevention grant, assuming there are dollars available.
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