Friday, August 24, 2012
CMS Public Comment Period - Round 2 Begins!
The public comment period for the Kansas 1115 waiver re-submission is officially open and will last until September 21. Approval by the federal Center for Medicaid Services (CMS) of the 1115 waiver will enable Kansas officials to fully implement KanCare.
The link to the CMS Public Comment Forum for the Kansas 1115 Waiver re-submission is:
https://cmsideas.uservoice.com/forums/173237-section-1115-demonstration-kansas-kancare#/settings
Please note that the CMS public comment forum is much like a “talk back” section for online media, which includes a social media component, i.e. you can ‘vote’ for or concur with others’ posted comments. You can concur a maximum of ten times. Please note that your comments are limited to 5,000 words. It is important to be concise in sharing your concerns with CMS.
All persons with developmental disabilities; family members of persons with DD; and professionals in the DD field are encouraged to provide feedback directly to CMS via this public comment forum. You may recall having participated in this online forum before. The state retracted it's original waiver submission to CMS due to an oversight to consult all tribal health organizations (as is required by the State of Kansas' tribal consultation policy).
The re-submission of the Kansas 1115 waiver request process now requires a second round of public comment opportunities. While CMS has assured advocates that comments submitted during the previous public comment period were saved, it is very important that concerned Kansans once again express their thoughts directly to CMS.
Thursday, August 16, 2012
KDADS Announces Additional Forums on KanCare
The Kansas Department of Aging and Disability Services (KDADS) will host additional informational sessions for persons receiving Medicaid services; family members of persons receiving services; and providers of Medicaid services.
From KDADS: "The purpose of these sessions are to provide updates and information about the implementation of the KanCare comprehensive managed care program effective January 1, 2013, and to respond to any questions you have."
It's important to note that long-term support services for Kansans with developmental disabilities are not scheduled to be wrapped into KanCare until 1 year after the program is initiated. However, persons with DD and their families will still be auto-enrolled into the program from the beginning, due to the fact that medical services will be included in the KanCare managed care program. For these reasons, recipients of service and providers of service alike are encouraged to continue attending any of these forum opportunities to learn more about the program, ask questions and express concerns!
As with the previous round of meetings, state officials are offering separate meetings for providers of service and recipients of service - all participants are asked to RSVP!
Please take a look at the attached document for details.
Monday, August 13, 2012
Update from KHI: ADRCs & Case Management
See below for an article by Dave Ranney that provides insight into progress on Aging and Disability Resource Center roles and responsibilities:
KHI News Service
August 13, 2012
Changes underway for determining in-home Medicaid services:
New assessment system expected to start in January along with KanCare
"State officials are changing the way they determine which in-home Medicaid services are provided to the frail elderly and people who are physically disabled.
The new system will rely on a single agency or organization with a presence in each of the state’s 105 counties to assess what services a person will receive. Currently, there are more than 30 organizations involved with the process. Some assess only the elderly. Others focus solely on the physically disabled.
State officials said their aim is to create a “one-stop shop,” so that services will be determined in the same place regardless of a person’s condition.
'Mishmash'
“The system we have now is a real mishmash,” said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. “We’ll be going to one that takes more of a no-wrong-door, single-entry approach and implements a conflict-free provision of services.”
About 12,000 Kansans currently rely on the services provided by the system, at an annual cost to taxpayers of about $200 million.
A solicitation to potential contractors interested in managing the new system was put out in February. Bids were due April 3.
Sullivan said he hoped to have the contract awarded sometime next month so that a single, statewide Aging and Disability Resource Center (ADRC) will be up and running by Jan. 1, which also is the scheduled start of KanCare, Gov. Sam Brownback’s plan for letting managed care companies administer the state’s $2.9 billion Medicaid program. KanCare remains contingent upon federal approvals.
The resource center, according to Sullivan, would be in charge of measuring the needs of an elderly, physically disabled or brain-injured person. It also would do preliminary screening for Medicaid eligibility and help the person choose the managed care company best suited to meet the person’s needs.
Today, the assessments are handled by 11 area agencies on aging, 10 centers for independent living and about a dozen home health agencies that specialize in caring for the brain-injured.
“When you have this many systems in place, it can be confusing as to who to turn to for assistance,” Sullivan said. “With the ADRC, we’ll be going to one database, one information source and one hotline for people to call.”
Federal initiative
The change, he said, was driven by a federal initiative aimed at increasing efforts to help Medicaid beneficiaries live in community settings rather than nursing homes and a concern among state officials that not enough was being done to prevent the centers for independent living from inflating their assessments in ways that generated more work — and therefore more revenue — for their case management and home-health programs.
Currently, the centers are allowed to assess a physically disabled person’s needs, serve as the case manager and provide the services.
“When we did our KanCare public forums last year, we had a lot of (Medicaid) providers say we should look at separating the services — that it might be OK for someone to do the assessment and the case management, but it wasn’t OK to have someone doing case management and direct care,” Sullivan said. “Part of the ADRC is in response to that.”
The concern about potential conficts of interest has centered on the centers for independent living.
The area aging agencies assess the needs of the frail elderly and often serve as case managers, but unlike the centers for independent living, none of them provide in-home care. Instead, the frail elderly receive services from individuals hired by the seniors or employed by home health agencies.
“Objectivity has always been one of our core values,” said Julie Govert Walter, who runs the 18-county North Central-Flint Hills Area Agency on Aging in Manhattan. “We’re not getting paid to provide a service in somebody’s home, so there’s no incentive to say they need a whole bunch of services they may not really need.”
In Kansas, Medicaid provides home and community-based services for about 5,400 frail elders, 6,100 people with physical disabilities and 400 people with brain injuries. The new system will not apply to people with developmental disabilities who receive in-home Medicaid services. Their needs will continue to be assessed by one of the state’s 28 Community Developmental Disability Organizations.
Case management
Sullivan said that after Jan. 1, the ADRC assessments would be forwarded to the managed care companies, which then would take on the case management responsibilities.
The companies, he said, would have the option of subcontracting with other case management organizations. For example, the companies could subcontract with a center for independent living for case management or direct-care services.
Some details still are being worked out.
“We’re in the process — over the next couple weeks — of finalizing the details for the managed care plans,” Sullivan said. “That’s not been decided yet.”
But it’s clear, he said, that a subcontractor won’t be allowed"...(read more)
Another related article from KHI on ADRCs:
Kansas looks to Wisconsin for ADRC model
System there has helped reduce waiting lists for services, officials say
KHI News Service
August 13, 2012
Changes underway for determining in-home Medicaid services:
New assessment system expected to start in January along with KanCare
"State officials are changing the way they determine which in-home Medicaid services are provided to the frail elderly and people who are physically disabled.
The new system will rely on a single agency or organization with a presence in each of the state’s 105 counties to assess what services a person will receive. Currently, there are more than 30 organizations involved with the process. Some assess only the elderly. Others focus solely on the physically disabled.
State officials said their aim is to create a “one-stop shop,” so that services will be determined in the same place regardless of a person’s condition.
'Mishmash'
“The system we have now is a real mishmash,” said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services. “We’ll be going to one that takes more of a no-wrong-door, single-entry approach and implements a conflict-free provision of services.”
About 12,000 Kansans currently rely on the services provided by the system, at an annual cost to taxpayers of about $200 million.
A solicitation to potential contractors interested in managing the new system was put out in February. Bids were due April 3.
Sullivan said he hoped to have the contract awarded sometime next month so that a single, statewide Aging and Disability Resource Center (ADRC) will be up and running by Jan. 1, which also is the scheduled start of KanCare, Gov. Sam Brownback’s plan for letting managed care companies administer the state’s $2.9 billion Medicaid program. KanCare remains contingent upon federal approvals.
The resource center, according to Sullivan, would be in charge of measuring the needs of an elderly, physically disabled or brain-injured person. It also would do preliminary screening for Medicaid eligibility and help the person choose the managed care company best suited to meet the person’s needs.
Today, the assessments are handled by 11 area agencies on aging, 10 centers for independent living and about a dozen home health agencies that specialize in caring for the brain-injured.
“When you have this many systems in place, it can be confusing as to who to turn to for assistance,” Sullivan said. “With the ADRC, we’ll be going to one database, one information source and one hotline for people to call.”
Federal initiative
The change, he said, was driven by a federal initiative aimed at increasing efforts to help Medicaid beneficiaries live in community settings rather than nursing homes and a concern among state officials that not enough was being done to prevent the centers for independent living from inflating their assessments in ways that generated more work — and therefore more revenue — for their case management and home-health programs.
Currently, the centers are allowed to assess a physically disabled person’s needs, serve as the case manager and provide the services.
“When we did our KanCare public forums last year, we had a lot of (Medicaid) providers say we should look at separating the services — that it might be OK for someone to do the assessment and the case management, but it wasn’t OK to have someone doing case management and direct care,” Sullivan said. “Part of the ADRC is in response to that.”
The concern about potential conficts of interest has centered on the centers for independent living.
The area aging agencies assess the needs of the frail elderly and often serve as case managers, but unlike the centers for independent living, none of them provide in-home care. Instead, the frail elderly receive services from individuals hired by the seniors or employed by home health agencies.
“Objectivity has always been one of our core values,” said Julie Govert Walter, who runs the 18-county North Central-Flint Hills Area Agency on Aging in Manhattan. “We’re not getting paid to provide a service in somebody’s home, so there’s no incentive to say they need a whole bunch of services they may not really need.”
In Kansas, Medicaid provides home and community-based services for about 5,400 frail elders, 6,100 people with physical disabilities and 400 people with brain injuries. The new system will not apply to people with developmental disabilities who receive in-home Medicaid services. Their needs will continue to be assessed by one of the state’s 28 Community Developmental Disability Organizations.
Case management
Sullivan said that after Jan. 1, the ADRC assessments would be forwarded to the managed care companies, which then would take on the case management responsibilities.
The companies, he said, would have the option of subcontracting with other case management organizations. For example, the companies could subcontract with a center for independent living for case management or direct-care services.
Some details still are being worked out.
“We’re in the process — over the next couple weeks — of finalizing the details for the managed care plans,” Sullivan said. “That’s not been decided yet.”
But it’s clear, he said, that a subcontractor won’t be allowed"...(read more)
Another related article from KHI on ADRCs:
Kansas looks to Wisconsin for ADRC model
System there has helped reduce waiting lists for services, officials say
Monday, August 6, 2012
A look at the Kansas political landscape...
The New York Times published an article yesterday examining the changing political landscape in Kansas and showcasing the viewpoints between conservatives and republicans:
The New York Times
By John Eligon
Published August 5, 2012
"TOPEKA, Kan. — In eight years in the Kansas Legislature, State Senator Dick Kelsey said, he never voted for a tax increase and frequently supported spending cuts. As an evangelical pastor, a staunch opponent of abortion and an acknowledged leader in the fight to elect conservative lawmakers, he has been endorsed by Kansans for Life and the National Rifle Association.
Yard signs for state candidates at a Republican forum in Topeka. Conservatives say some party members are too moderate.
But after publicly criticizing elements of Gov. Sam Brownback’s tax plan this year, Mr. Kelsey found himself among a cluster of conservative Republican state senators that a more conservative coalition here is working to defeat in Tuesday’s primary elections.
Kansas politics have been tilting more to the right for at least the last two decades. And now that shift is prompting a bitter clash within the state’s Republican Party. Conservatives are feverishly working to win the Senate and drive out the last remnants of what they see as moderate Republicanism in a state with a deep-rooted history of centrist Republicans in the mold of Bob Dole, Dwight D. Eisenhower and Nancy Kassebaum.
The divisive primary campaign reflects the ambivalence gripping Republicans across the country, yet the situation here is more complicated than the typical conservative-versus-establishment disputes.
What sets the battle in Kansas apart is the distance between the factions. Conservative and moderate Republicans essentially operate as separate parties, and so far, no one — including Mr. Brownback — has stepped forward to try to bridge that gap in the popular tradition of moderation. Instead, each side claims to represent the soul of the party.
“We don’t even know what it means to be a Republican in the state of Kansas,” said Casey W. Moore, a conservative Senate candidate from the Topeka area.
Nationally, conservatives have been defining the party in their image. Last week, they scored a big victory in Texas when a Tea Party favorite defeated Gov. Rick Perry’s favored candidate in the primary for an open United States Senate seat. That outcome followed conservative victories this year over established Republicans in Senate primary races in Indiana and Nebraska.
Kansas conservatives are optimistic that they can do the same on the state level and upend long-held assumptions that the people of their state prefer moderate lawmakers.
Two years ago, conservative Republicans here captured a majority in the Kansas House of Representatives — around 70 of 125 seats — for the first time in about four decades"...(read more)
The New York Times
By John Eligon
Published August 5, 2012
"TOPEKA, Kan. — In eight years in the Kansas Legislature, State Senator Dick Kelsey said, he never voted for a tax increase and frequently supported spending cuts. As an evangelical pastor, a staunch opponent of abortion and an acknowledged leader in the fight to elect conservative lawmakers, he has been endorsed by Kansans for Life and the National Rifle Association.
Yard signs for state candidates at a Republican forum in Topeka. Conservatives say some party members are too moderate.
But after publicly criticizing elements of Gov. Sam Brownback’s tax plan this year, Mr. Kelsey found himself among a cluster of conservative Republican state senators that a more conservative coalition here is working to defeat in Tuesday’s primary elections.
Kansas politics have been tilting more to the right for at least the last two decades. And now that shift is prompting a bitter clash within the state’s Republican Party. Conservatives are feverishly working to win the Senate and drive out the last remnants of what they see as moderate Republicanism in a state with a deep-rooted history of centrist Republicans in the mold of Bob Dole, Dwight D. Eisenhower and Nancy Kassebaum.
The divisive primary campaign reflects the ambivalence gripping Republicans across the country, yet the situation here is more complicated than the typical conservative-versus-establishment disputes.
What sets the battle in Kansas apart is the distance between the factions. Conservative and moderate Republicans essentially operate as separate parties, and so far, no one — including Mr. Brownback — has stepped forward to try to bridge that gap in the popular tradition of moderation. Instead, each side claims to represent the soul of the party.
“We don’t even know what it means to be a Republican in the state of Kansas,” said Casey W. Moore, a conservative Senate candidate from the Topeka area.
Nationally, conservatives have been defining the party in their image. Last week, they scored a big victory in Texas when a Tea Party favorite defeated Gov. Rick Perry’s favored candidate in the primary for an open United States Senate seat. That outcome followed conservative victories this year over established Republicans in Senate primary races in Indiana and Nebraska.
Kansas conservatives are optimistic that they can do the same on the state level and upend long-held assumptions that the people of their state prefer moderate lawmakers.
Two years ago, conservative Republicans here captured a majority in the Kansas House of Representatives — around 70 of 125 seats — for the first time in about four decades"...(read more)
Friday, August 3, 2012
Wichita Eagle Editorial: Waiting lists loom
DRC's "End the Wait" Campaign inspired a great editorial from Rhonda Holman of the Wichita Eagle Editorial Board:
Published Friday, August 3, 2012:
"As the Brownback administration takes pride in fiscal-year-ending reserves, another number looms large and shamefully – the more than 7,000 Kansans with physical or developmental disabilities who are awaiting home- and community-based services.
With such services, individuals can live independently or in homelike residential settings. Without them, they may be forced to move into nursing homes – not only sacrificing quality of life but costing taxpayers far more.
Neither Gov. Sam Brownback nor the Legislature has demonstrated much urgency to better fund disability services and whittle down these lists, although the budget surplus would have made that possible.
The Brownback administration has argued that it inherited the waiting lists from former Gov. Kathleen Sebelius, now U.S. secretary of health and human services, and “that merely increasing funding for such services will not solve the problem,” as Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, wrote in a May commentary.
Officials also point to reforms coming with the reinvention of Medicaid as KanCare in January 2013, and with the addition to KanCare of the management of long-term care services for the developmentally disabled a year later.
But state leaders soon may be unable to set their own timetable for addressing the lists.
That’s because the U.S. Justice Department has been conducting an investigation into whether the waiting list for individuals with physical disabilities violates the Americans With Disabilities Act and court decisions including the U.S. Supreme Court’s 1999 Olmstead case, which ruled that a disabled person has a right to live in the “least restrictive environment.”
That investigation could lead to a lawsuit, and eventually a costly remedy being forced on Kansas. Georgia has had to spend $100 million on disability services since 2009 as part of a settlement agreement with the federal government.
“Wisdom would tell you we should handle this waiting-list issue on our own terms, proactively,” Tim Wood, manager of the Topeka-based Disability Rights Center of Kansas’ “End the Wait” campaign, told The Eagle editorial board.
Wood and other advocates plan to ramp up their campaign in time for the 2013 legislative session, looking to a long-neglected legislative blueprint for guidance on how to not only reduce waiting lists but expand and strengthen the home- and community-based services system. Another meeting is planned in Sedgwick County for Aug. 14 or 16 (for more information, call 785-273-9661).
The campaign aims to reduce the waiting list for services for the developmentally disabled, which includes more than 3,200 people without services and another nearly 1,700 awaiting additional services.
The wait averages 30 months but can stretch on for years.
Looking the other way won’t make these lists disappear, nor do anything to help the people languishing on them."
Published Friday, August 3, 2012:
"As the Brownback administration takes pride in fiscal-year-ending reserves, another number looms large and shamefully – the more than 7,000 Kansans with physical or developmental disabilities who are awaiting home- and community-based services.
With such services, individuals can live independently or in homelike residential settings. Without them, they may be forced to move into nursing homes – not only sacrificing quality of life but costing taxpayers far more.
Neither Gov. Sam Brownback nor the Legislature has demonstrated much urgency to better fund disability services and whittle down these lists, although the budget surplus would have made that possible.
The Brownback administration has argued that it inherited the waiting lists from former Gov. Kathleen Sebelius, now U.S. secretary of health and human services, and “that merely increasing funding for such services will not solve the problem,” as Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, wrote in a May commentary.
Officials also point to reforms coming with the reinvention of Medicaid as KanCare in January 2013, and with the addition to KanCare of the management of long-term care services for the developmentally disabled a year later.
But state leaders soon may be unable to set their own timetable for addressing the lists.
That’s because the U.S. Justice Department has been conducting an investigation into whether the waiting list for individuals with physical disabilities violates the Americans With Disabilities Act and court decisions including the U.S. Supreme Court’s 1999 Olmstead case, which ruled that a disabled person has a right to live in the “least restrictive environment.”
That investigation could lead to a lawsuit, and eventually a costly remedy being forced on Kansas. Georgia has had to spend $100 million on disability services since 2009 as part of a settlement agreement with the federal government.
“Wisdom would tell you we should handle this waiting-list issue on our own terms, proactively,” Tim Wood, manager of the Topeka-based Disability Rights Center of Kansas’ “End the Wait” campaign, told The Eagle editorial board.
Wood and other advocates plan to ramp up their campaign in time for the 2013 legislative session, looking to a long-neglected legislative blueprint for guidance on how to not only reduce waiting lists but expand and strengthen the home- and community-based services system. Another meeting is planned in Sedgwick County for Aug. 14 or 16 (for more information, call 785-273-9661).
The campaign aims to reduce the waiting list for services for the developmentally disabled, which includes more than 3,200 people without services and another nearly 1,700 awaiting additional services.
The wait averages 30 months but can stretch on for years.
Looking the other way won’t make these lists disappear, nor do anything to help the people languishing on them."
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