Statewide Independent Living Council of Kansas (SILCK) and Kansas Association of Centers for Independent Living (KACIL)
Access to Home and Community Based Services Waivers by all people eligible. Addressing the long waiting lists for Home and Community Based Services (HCBS) should be a priority before any systems change occurs. Florida implemented their expanded Managed Care programs without addressing the waiting lists. At that time, advocates warned costs for very expensive nursing facility placements would increase by denying access to home care services. A new study shows these fears have been realized. The waiting lists have grown 30% over the last year and the for-profit Managed Care plan was not able to contain costs. In fact, that plan cost the state of Florida significantly more, 34%-54% more, than the traditional non-profit plans.1
In the month of January 2012, 10 individuals from the HCBS PD waiting list entered a nursing facility. Based on data from the Kansas Medical Assistance Report FY 2012, the average per person cost for nursing facility admissions was $3,067/month or a total of $30,670 for those 10 persons. If those same people had been offered HCBS PD services the cost to the state would have been an average of $1,562 per person or a total of $15,620 for those 10 individuals. This would have saved the state $15,050 for just one month; this would save $180,600 in one year. Fully funding HCBS waivers makes economic sense. The existing Waiting List for the PD Waiver could be fully funded (State funds) by just 5% ($33 M) of the Governor’s projected ending budget balance of approximately $700 M for FY2013.
There is a system available for Medicaid recipients to receive independent conflict resolution support. Centers for Independent Living are tasked with assisting people in advocating for their individual rights, including access to services and adequate service provision. We believe that any move to Managed Care, must be accompanied by an independent source to assist consumers with conflict resolution and ensure that Managed Care companies are truly meeting the outcome criteria for successful care management. This is especially important due to the fact that Kansas will be using out-of-state, for-profit Managed Care Organizations.
The transition to Managed Care does not occur until it can be assured that all supports for the system are in place. This includes the provider network, the billing framework, independent conflict resolution support, and the assessment and options counseling methods. The recent change to Home and Community Based Services waivers to the new Financial Management Services (FMS) system, including Kansas AuthentiCare (Electronic Visitor Verification System/ EVV), is a prime example of what can happen when systems changes are pushed through too quickly.
Implementing KS AuthentiCare has been a navigational nightmare. Due to the system not being ready, the implementation date has changed from 11/1/2011 to 1/9/12 then 1/16/12 then 2/1/12 then 2/16/12 and now the suggested complete implementation is stated as 3/16/12. With each change, procedures have also changed. This means, all consumers and direct service workers (DSWs) must be notified, at the expense of the providers. Many other issues have surfaced because of the push to implement Kansas AuthentiCare, before it was ready, including; unexpected costs to consumers, confidential consumer information being available to other FMS providers, and payment delays. There are also many un-reimbursed costs to providers that were compounded due to the many changes of implementation date and procedures. One CIL, in January alone, sent out an additional 6,300 pieces of mail, many of which were large informational packets. This same CIL had to cover the cost of an additional 8,735 telephone minutes, not only the cost of the phone bill, but the greater cost of providing staff time to handle the call volume, and the research needed to solve the problems created by the premature implementation of KS AuthentiCare. 2
It is imperative that we learn from both systems changes in our own state, as well as others, and move forward prudently to ensure the savings and health outcomes of Managed Care are realized. The state of Kentucky implemented a Managed Care system for Medicaid, and they are now discussing the issues that were unexpected and unplanned for. Some of these issues are lack of payments for medical services, difficulty in getting patient medications approved, and delays in authorizing services. Neville Wise, Kentucky’s Acting Medicaid Commissioner, told the Senate Health and Welfare Committee, “We didn’t expect the level of issues that we had.”3 Kentucky’s experience doesn’t even include Home and Community Based Services. Kansas should utilize the experiences of others to develop a better system.
Home and Community Based Services waivers must be the first line of service provision to those needing long term care. Kansas has a robust system of Home and Community Based Services waivers. It provides support to people to allow them to stay in their own homes, hire and manage their own workers, and allow for the optimum level of personal choice and responsibility. The CILs are the backbone of Independent Living, and must be fully funded. Access to them must not be impeded, and they must take precedence over other options that limit choice, such as PACE programs and Assisted Living Facilities. Over time, and especially with the implementation of FMS, the consumers’ lawful right to self direction has been eroded. When looking at new ways of coordinating long term care services, such as the proposed “Health Homes”, it is imperative that the consumer’s independence, choice, and expertise are woven into service delivery. The Independent Living Philosophy acknowledges that people with disabilities are the best experts of their needs and it would be a mistake to move towards a medical model that Kansans with disabilities have fought to escape.
Provider rates must be moved to sufficient levels before being “locked-in” by a Managed Care contract. In order to ensure access and choice for consumers across the state, provider rates for services like Financial Management Services (FMS), must be increased to sufficient levels to pay the costs of these services. Once approved rate of $140 per member, per month was arbitrarily reduced to $115. FMS providers, Centers for Independent Living in particular, are providing the much needed Information & Assistance service component of FMS at a level that truly supports individuals’ choices to remain in their home, and are doing so at a financial loss. Unable to sustain these massive losses, Kansas CILs are being forced to close or dramatically reduce staffing levels. This will cause increased unemployment rates in Kansas and consumers will be left without service providers. Since current provider rates are anticipated to be the “floor” rates for Managed Care, it is of the utmost importance to get these increases in place before the total implementation of KanCare.
Kansas has a well-established, cost-efficient Home and Community Based Services network. The philosophy of self-directed care is not only practiced here, it is codified into state law, and Kansas boasts a higher percentage of employment of people with disabilities than the national average. Each of these points came about due to the passion, hard work, and dedication of Centers for Independent Living, policymakers, and Kansans with disabilities.
The Statewide Independent Living Council of Kansas (SILCK) and the Kansas Association of Centers for Independent Living (KACIL) looks forward to working with the Administration, the Legislature, and our consumers to ensure that Medicaid Reform is successful. The success of Medicaid Reform should not only be measured in fiscal terms and health outcomes, but also in how thoroughly we honor choice, independence, and dignity of each Kansan who receives Medicaid services.