KanCare Web Chat with Secretary Sullivan

InterHab members are invited to attend a Web Chat with Kansas Department on Aging's Secretary Sullivan on Monday January 9, 2012 at 3:00pm.

If you would like to participate please contact jwells@interhab.org for the call-in details.

"Major insurance companies in the hunt for Kansas Medicaid contracts"

By Mike Shields
KHI News Service
December 5, 2011

"TOPEKA — Twelve companies have formally expressed interest in bidding on a Kansas contract to provide Medicaid managed care services, according to state procurement officials who have refused to identify the firms.

However, it is no secret that among the 12 are some industry giants in what has become one of the fastest-developing sectors of the health care industry.

Of the seven most prominent potential bidders identified by KHI News Services through interviews and various searches of public records, one is a Kansas-based mutual insurance company owned by its policyholders. The other six are for-profit, publicly traded companies headquartered in other states or subsidiaries of such companies.

Here’s a brief rundown on each of the seven:

• Sunflower State Health Plan Inc., a subsidiary of St. Louis-based Centene Corp. On Sept. 22, Sunflower filed application with the Kansas Insurance Department for certification as a Health Maintenance Organization. One of the state’s requirements of bidders is that they be a Kansas-approved HMO. Sunflower’s application was still in the review process as of last week, according to insurance department officials. Sunflower’s president, according to the filing documents, is Christopher D. Bowers, senior vice president of Centene’s health plan business unit. He previously ran a Centene subsidiary in Texas.

Centene has employed several Kansas lobbyists, including Matt Hickam, who until 2010 was a principal in Kensinger & Associates, the lobbying firm owned by David Kensinger, chief of staff for Gov. Sam Brownback.

Centene also has employed lobbyist Ashley McMillan, former executive director of the Kansas Republican Party and president of the advocacy group Kansans for No Income Tax.

Other lobbyists registered with the Kansas Secretary of State to represent Centene or its subsidiary, Cenpatico Behavioral Health, are Mike Hutfles and James Gardner.

Centene, after a series of rapid acquisitions in the last few years, now operates health plans in Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, Ohio, South Carolina, Texas and Wisconsin.

Centene shares are traded on the New York Stock Exchange. Centene reported a net loss of $43.6 million in 2006 but by last year had reported annual net earnings of $94.8 million and had become a Fortune 500 company, according to its 2010 annual report.

“We are seeing increased demand for these products and services as states continue to grapple with tight budgets. Specifically, there is a growing trend for states interested in issuing RFPs to move their highest-cost (Medicaid) beneficiaries, including Aged, Blind, or Disabled and LTC (long-term care) into managed care, to maximize cost savings,” wrote Centene Chief Executive Michael Neidorff in his 2010 message to shareholders.

Centene is among the companies that focus primarily on providing Medicaid managed care services.

• Wellcare of Kansas is a subsidiary of WellCare Health Plans Inc., which is based in Tampa, Fla. WellCare was launched in 1985 as a Medicaid provider for the state of Florida. It has grown since then and now has health plans in about a dozen states and offers Medicare plans. Recently, it had a number of high-profile problems with state and federal officials. The FBI raided the company’s headquarters in October 2007.

In March this year, the company’s former executive team, which was sacked as a result of the investigation, was indicted for conspiracy to commit Medicaid fraud. The company has paid the government more than $200 million in settlements since then but still faces whistleblower lawsuits from former employees who claim that WellCare profited between $400 million and $600 million from defrauding the Florida and federal governments.

WellCare stock is traded on the New York Stock Exchange. The company’s vice president of government and regulatory affairs is Bryan Baier, once a staffer for former Kansas House Minority Leader Tom Sawyer. WellCare of Kansas filed for Kansas HMO status with the state insurance department on Oct. 28. The application is still being reviewed, according to department officials. The chief executive of WellCare and its Kansas subsidiary is Alec Cunningham.

• Amerigroup Kansas, Inc. is a subsidiary of Amerigroup, which is headquartered in Virginia Beach, Va. Its president is Aileen McCormick, also president of Amerigroup Texas. The company filed application for certification as a Kansas HMO on Oct. 28. The company claims to cover one of every 42 Medicaid beneficiaries nationwide.

Founded in 1994, it has 5,000 employees nationwide and became a Fortune 500 company last year. Like Centene, Amerigroup is considered a “pure-play” Medicaid managed care company in that Medicaid is its primary business focus. Its shares are traded on the New York Stock Exchange.

Amerigroup is one of two managed care companies under contract to New Mexico to provide services for that state’s long-term care population. It has drawn complaints from the nursing home industry there. “I don’t want to get myself in trouble, but Amerigroup is the one I get the most complaints about now,” said Linda Sechovec, leader of a nursing home trade group in New Mexico. Sechovec said both managed care companies in the state have failed to make payments as promptly as the nursing homes would like, but dealing with Amerigroup has been more difficult.

She said her group’s board of directors was considering whether to oppose the company’s contract renewal. “We didn’t resolve that question at our last meeting, but it’s on the table,” she said. “Should we stage a protest against contractors that can’t get their house in order? That’s Amerigroup.”

Amerigroup is the nation’s second largest provider of Medicaid managed care services, covering about 2 million people.

• United Healthcare is a subsidiary of United HealthGroup, which is headquartered in Minnetonka, Minn. The parent company has more than 80,000 employees and operates in all 50 states. It is considered a “multiline” insurance company in that it offers plans covering people outside Medicaid. Jarrod Forbes is a registered Kansas lobbyist for United Healthcare. The company’s stock is traded on the New York Stock Exchange. The chief executive is Stephen Hemsley. It is the nation’s largest provider of Medicaid managed care services, covering about 3 million people.

• Coventry Health Care is a multiline insurance company that operates nationally. It announced in October its agreement to purchase Children’s Mercy Family Health Partners, which currently is the largest Medicaid managed care company in Kansas. Children’s Mercy is one of two companies under contract with the state to operate its HealthWave program, which provides health coverage for children in low-income families and pregnant women.

Coventry was incorporated in 1986 and since then has steadily acquired a number of regional companies. Its chief executive is Allen Wise. Its corporate headquarters is in Bethesda, Md. Its Kansas lobbyists include former House Speaker Doug Mays, Cheryl Dillard and Steve Robino. Coventry is the nation’s 10th largest provider of Medicaid managed care services, covering about 462,000 people.

• Aetna is the nation’s seventh largest company when it comes to Medicaid coverage, covering about 1.2 million people. It is headquartered in Hartford, Conn.

• Blue Cross Blue Shield of Kansas is the state’s largest provider of private health insurance. Providing Medicaid managed care services would be a major new emphasis for the company, which is owned by its policyholders. It has a well-established network of providers for private insurance, and those relationships might give it an edge in developing a network of Medicaid providers. It covers people in all Kansas counties except Wyandotte and Johnson.

“We are constantly evaluating the changing marketplace and exploring opportunities to grow our business so we may continue to serve Kansans as we have done for nearly 70 years,” said company spokesperson Mary Beth Chambers. “We recognize that Medicaid is likely to become a larger part of the Kansas health care marketplace in the future, which is why we are giving serious consideration to the state's Medicaid managed care RFP.”

This article from KHI News Service:
http://www.khi.org/news/2011/dec/05/major-insurance-companies-hunt-kansas-medicaid-con/

"Kansas Medicaid makeover part of a nationwide trend"

"Insurance companies making major moves into government programs"

Mike Shields

KHI News Service

December 5, 2011

"TOPEKA — Kansas isn’t the only state doing it.

When Gov. Sam Brownback announced his administration would seek bids from private companies to manage the care of virtually every person enrolled in the state’s Medicaid program, Kansas became part of what has been a rapidly accelerating trend since Medicaid managed care companies came on the national scene in the 1990s.

“Virginia, Florida, Texas, Illinois, New York, California … especially California and Texas and Florida. They certainly have a lot of people that are eligible for Medicaid,” said Michael McCue, a professor at Virginia Commonwealth University and co-author of a recent national study of Medicaid managed care operations.

Looking to cut budgets

“States are looking for ways to manage those populations and cut their budgets, and typically 20 to 30 percent of state budgets are going to Medicaid. With the recession, states are looking for ways to manage that cost,” he said.

In 2000, according to the federal Centers for Medicare and Medicaid Services, 18.8 million enrollees — or 55 percent of the nation’s Medicaid population — were covered by various managed care arrangements. By 2009, CMS reported that the number of enrollees receiving services covered by managed care plans had nearly doubled to 36 million, or 72 percent of the Medicaid population.

The agency also reported the nation now has 225 full-service Medicaid health plans that each have at least 5,000 members enrolled.

High stakes

But the business is increasingly dominated by a handful of major, for-profit insurance companies that are positioning themselves to manage the care of the 16 million more Americans expected to become eligible for Medicaid once the federal health reform law fully kicks in on Jan. 1, 2014.

“With enrollment in employer-sponsored health insurance steadily declining and more Americans falling into the Medicaid safety net, health insurance companies are going where the growth is — the Medicaid managed care market,” wrote Emily Berry in a recent article titled “Mining for Medicaid Gold” that appeared in American Medical News, a trade journal for doctors.

Most of the nation’s major managed care companies have shown interest in securing one of the three contracts that Brownback officials have said they intend to sign. The contracts are each expected to be in the range of $300 million to $400 million a year.

“Small state, big contract,” a representative of one of the major companies told KHI News Service, acknowledging his firm likely wouldn’t show interest in a contract here worth only $100 million.

The governor’s plan is a high-stakes affair for Kansans and for some of the insurance companies.

 “Health system reform, in combination with economic factors, is expected to speed consolidation of health insurers,” wrote Ron Sommer, an independent stock analyst who writes the blog Measured Approach.

Mergers and acquisitions

“The prospect for mergers and acquisitions throughout the industry is high due to pending reform initiatives and greater access to financing. In addition, there are tax incentives for privately held companies to sell now when capital gains taxes are relatively low. There is an incentive for health care insurers to be very large to realize economies of scale and efficiency. Instead of mega-mergers among the big companies, we expect to see the majors buy up the smaller regional providers,” Sommer wrote.

Evidence of that already is available in Kansas. In late October, a few days before the governor announced preliminary details of his Medicaid makeover plan, Coventry Health Care, a publicly traded national player, announced it had reached agreement to buy the nonprofit Children’s Mercy Family Health Partners. Children’s Mercy currently is the state’s largest Medicaid managed care company, providing services to about 155,000 women and children enrolled in the Kansas HealthWave program.

Coventry is one of the major national companies interested in securing a Kansas Medicaid contract.

Quick schedule for expansion

The governor’s plan would expand the state’s more limited use of Medicaid managed care for HealthWave beneficiaries to also include the elderly, disabled and mentally ill. Though more and more states are moving to managed care, Kansas, under the Brownback plan, still would be one of the very few to bring all those groups — generally the most expensive to treat — under the wing of managed care.

Also unusual is the relatively quick schedule the Brownback administration has set for itself and its goal of rolling out the new, expanded program statewide on Jan. 1, 2013. Other states that have included all those subpopulations in their managed care contracts have done so incrementally and at a slower pace. And even with that, there have been problems.

For example, New Mexico began its move to Medicaid managed care in 1997 but only recently phased it in for nursing home residents. Now, two managed care companies oversee nursing home care statewide, creating a host of problems for nursing homes, according to Linda Sechovec, executive director of the New Mexico Health Care Association, a long-term care trade group.

Sechovec said the state Medicaid program wasn’t paying the facilities enough to cover their costs before moving to managed care and that problem was made worse by the introduction of “third parties” that are slow to pay and impossible to negotiate with when it comes to setting payment rates.

Buying a "broke" system

“It’s just not a model that is well-served by pinching every penny to the point that service is inadequate,” she said. “In my state, providers haven’t had a rate increase since 2007. They have staff members who have gone without raises for three years or more, and we are pleading with our legislature and administration to address the chronic underfunding that existed not only before managed care but is now exacerbated.

“It was a broke system,” Sechovec said. “But the managed care companies came in and they bought it. They bought it and they didn’t fix it. That’s exactly where we’re at.”

Cindy Luxem, Sechovec’s counterpart at the Kansas Health Care Association, said she was well aware of the problems in New Mexico and other states where managed care has been extended to Medicaid’s long-term care populations. She said her group’s members are worried the same problems could emerge here.

“We're concerned about things like timely claims processing, the prompt-pay issue,” Luxem said. “Kansas had done a pretty good job historically of getting providers paid in a timely way, and I can't necessarily say that is the case in all the states I visit with, so that prompt-pay piece is really important for us.”

Brownback officials have said they expect the managed care companies to maintain advisory councils made of up providers and their representatives so that concerns — such as those about prompt payment — can be voiced and addressed. The administration’s contract proposal also would allow bonus payments to companies that meet various performance standards, including prompt payment of provider claims.

Introducing the profit motive

But the concerns of some in the state’s provider network are more deep-seated. They view with alarm the introduction of the profit motive to a segment of the social service system that deals with some of the state’s most seriously disabled.

Tom Laing, executive director of Interhab, an association that represents most of the community groups that provide services to the state’s developmentally disabled, said Kansas has a long-standing structure for providing those services that has worked well without including a profit-seeking insurance company in the driver’s seat.

“We provide many aspects of a managed-care model currently,” he said. “We have capitated rates where we assume the risk. We have annual review and assessment … and as a result we’ve been able to save the state millions and millions of dollars. Our costs per person served are slightly less than they were 15 years ago. We've already done the transition to managed care to the extent you can for our population.”

Laing said the Brownback administration signaled early that it intended to expand managed care.

“Going into this conversation, we understood this would be the administration’s goal,” he said. “They said it from the beginning. And we’ve said from the beginning that we don’t think it is a good fit for the developmentally disabled community, and we’ll continue to advise them and the Legislature accordingly. There is so much here that is experimental that somebody’s got to be looking at it.”"

Read full article: http://www.khi.org/news/2011/dec/05/kansas-medicaid-makeover-part-nationwide-trend/

"Healthcare Schemes Happening in Kansas"

For Immediate Release from the Kansas Department on Aging

Healthcare Schemes Happening in Kansas

Medicare beneficiaries will soon be reviewing their choices in Medicare Part D prescription drug plans. This has been a wonderful benefit for seniors to help in their medication needs. However, this has also opened the door for new and unprecedented fraud attempts.

In Kansas most recently, the Kansas Department on Aging Senior Medicare Patrol has received reports of Medicare recipients being offered “free diabetic supplies.” The caller then tells the person all the company needs is their Medicare number to receive these “free” diabetic supplies.  The scammer is then billing Medicare for diabetic supplies from several companies and then sometimes selling the Medicare number to others who are billing Medicare for other medical services.  

Protecting your personal information is the best line of defense in the fight against healthcare fraud and abuse. 

Here are some ways to take an active role in your healthcare benefits:

·         Protect your Medicare or Medicaid number as you would your credit card or bank information. Don't give out your personal information, such as your Medicare, Medicaid or Social Security number, bank account numbers or credit card numbers to anyone you do not completely trust.

·         Medicare and Medicaid do not sell or endorse any product. If someone calls you or visits your home and tells you that he or she represents Medicare or Medicaid, they are lying and cannot be trusted. Hang up the telephone or shut the door. “It’s shrewd to be rude.”

·         Medicare, Medicaid, Social Security, banks, etc. will not call you by phone to ask for your account number or personal information.  They already have your information.

·         Never accept “free” services from persons selling medical services. If anyone tries to offer you “free” services, be very suspicious. 

If you suspect Medicare, Medicaid fraud, errors, abuse or scams, contact the Kansas Department on Aging Senior Medicare Patrol hotline at 1-800-860-5260.

###

The Kansas Department on Aging’s mission is to foster an environment which; promotes security, dignity and independence, while providing the right care, at the right time, in a place called home.

"Census: 1 In 20 Kids Have A Disability"

Article from: www.disabilityscoop.com
By Michelle Diament
November 22, 2011

"About 5 percent of school-age children in the United States have a disability, according to a first-of-its-kind analysis from the U.S. Census Bureau.

The statistic comes from a brief released this month offering an in-depth look at kids ages 5 through 17 with disabilities who live in community settings.

While the Census has long collected data on this group through its annual American Community Survey, this year marks the first time that government officials analyzed the results, said Matthew Brault, a Census statistician and the author of the report.

Brault found about 2.8 million children living with cognitive, vision, hearing, ambulatory, self-care or independent difficulties in 2010, the most recent year data is available. That represents about 5 percent of the nation’s 53.9 million school-age children.

Those with special needs were most likely to have cognitive difficulties, which were reported by more than half of kids with disabilities in every geographical area of the country.

What’s more, the Census report found that children with disabilities were more likely than their typically developing peers to attend public schools rather than private. However, the number of students with special needs enrolled in public schools varied dramatically from 76.5 percent in some areas of the country to almost 100 percent in others."

"Sedgwick County senator wants revised SRS referral policy"

"Kelsey says current system leaves 'fox...guarding the hen house'"

By Dave Ranney
KHI News Service
Nov. 17, 2011

"TOPEKA — A Sedgwick County lawmaker wants the 2012 Legislature to undo a recent state welfare agency policy that he says is undermining the state’s mental health infrastructure and keeping some seriously disturbed children from getting the psychiatric treatments they need.

“We’ve put the fox in charge of guarding the hen house,” said Sen. Dick Kelsey, a Goddard Republican, testifying earlier this week before the Joint Legislative Budget Committee. “I’m really ticked about this.”

Others also say they are concerned about the policy change launched by the Kansas Department of Social and Rehabilitation Services in January, soon after Gov. Sam Brownback took office.

That new policy was formalized in a contract signed in September by SRS and Kansas Health Solutions, the managed care company that is the intermediary between the welfare agency and the state’s 27 community mental health centers.

The policy, state welfare officials say, was intended to decrease the use of inpatient psychiatric treatment facilities (PRTFs).

Gone and won't come back

Between 2009 and 2011, SRS spending on PRTF services went from $36.3 million to $46.8 million, an increase of almost 30 percent. There also..."

Click here to read the full article:
http://www.khi.org/news/2011/nov/17/sedgwick-county-senator-wants-revised-srs-referral/

Kansas First News: Medicaid reform proposal

News coverage from November 8, 2011