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