Monday, October 7, 2013

Health care providers raise concerns about KanCare

By SCOTT ROTHSCHILD, The Lawrence Journal-World

TOPEKA, KAN. — A long line of health care providers today appeared before a legislative committee to complain about problems under KanCare, the privately run managed-care program that provides medical services to nearly 400,000 Kansans.

Hospitals across the state have complained about delays in payments and unwarranted claim denials from the three private insurance companies that run the program. And prior authorization requirements for treatments have in some cases created significant delays in patient care, health officials have said.

But state officials and representatives of the companies said many of the concerns are being addressed and that some problems were inevitable in the transition to KanCare, which is administered by three private insurance companies: Amerigroup Kansas Inc., Sunflower State Health Plan and United Healthcare Community Plan of Kansas.

"Claims are being overpaid, underpaid and in some areas, not being paid at all," Tom Bell, president and chief executive officer of the Kansas Hospital Association, told members of the House-Senate oversight committee on KanCare, which held its first meeting.

Lawrence Memorial Hospital, however, has reported not running into similar problems with KanCare.

Cindy Luxem, chief executive officer of the Kansas Health Care Association, said nursing homes were having serious problems with KanCare.

"There has been a huge administrative price to pay with the new systems. These are dollars and resources not being used for patient care, not going into the quality of care for our residents," Luxem said.

But several health care groups said while there have been serious concerns, they acknowledged that the Kansas Department of Health and Environment was working hard to address them.

Kari Bruffett, director of the Division of Health Care Finance at KDHE, said the agency and the managed care organizations were making progress on resolving problems.

Jean Rumbaugh, chief executive officer of Sunflower State Health Plan, said the company was taking steps to ensure improved care.

"We are committed to resolving any issues in a timely manner, and I want to make sure that you know how to reach me," Rumbaugh said.

Doug Funk, owner of Funk Pharmacy in Concordia and immediate past president of the Kansas Pharmacists Association, said many pharmacists are still waiting for payment for medical equipment, such as wheelchairs and walkers, that was dispensed in January.

"Pharmacists and their staffs have spent countless hours trying to get reimbursed for this equipment when the procedures for reimbursements that the MCOs were using were, from our point of view, never correctly put into place," he said.

But Funk added that his colleagues in other states that transitioned to managed care programs had experienced greater problems than pharmacists in Kansas have with KanCare.

Kathy Lobb, of Lawrence, who works with the Self Advocate Coalition of Kansas, and who has a disability and receives services under KanCare, said savings from the program need to go to reducing the waiting list for services for people with intellectual and developmental disabilities.

Kansas has directed $9 million over the next two years to help take 250 people off the waiting list.

"It is important, however, that we don't stop there," Lobb said. "The waiting list is growing faster than the amount of people who are being taken off of it," she said.

Mitzi Fatrich, executive director of Kansas Advocates for Better Care, said her organization has received a steadily increasing number of calls from older adults and adults with disabilities about reductions in services.

"The consistency of stated problems and the increasing volume of calls validates that the problems are not uncommon, nor isolated," Fatrich said.

For example, she said a woman with serious heart disease who is a full time caregiver for her 90-year-old mother and her son, who has serious mental illness, was unable to get the MCO to call back for 72 hours when her son was in a crisis and needed immediate help.

Rocky Nichols, executive director of the Disability Rights Center of Kansas, said the Legislature needed to make the KanCare Ombudsman's office more independent and make sure it's used as an advocate for consumers. Currently, the ombudsman is housed under the Kansas Department for Aging and Disability Services.