Changes…. Managed Care!

Hopefully all of you have been keeping track of all the proposed changes to Medicaid programs that are going on at the state level.  The first big change is that developmental disability funding will no longer be overseen by SRS.  We will go under the Department of Aging whose name will be changed to Department of Aging and Human Services.  This is to take place in July 2012. 

A much bigger change is Medicaid changing to KanCare.  Instead of the state managing Medicaid, it is proposed that Medicaid will be managed by at least three different companies called Managed Care Organizations (MCO).  Currently DD services will be included.    We are asking that you write your Governor and representatives and ask that we be carved out.  DD waiver services cannot be managed like medical services and we feel that lumping us in could put the quality of services at risk.  The contracts are to be awarded sometime in January 2012 and implemented January 2013.

One key area for concern is case management.  Case management is not a waiver service, it will change DRAMATICALLY.  How will depend on the MCO!  It is important to share what you want now while everything is in development. 

 Important Talking Points:

·       My case manager works for me and my son/daughter.  Why should I give that up and have to deal with an individual whose primary goal is “resource allocation” (code for budget cuts)? 

·       Managed Care companies have little or no experience with the types of long term support services that comprise the developmental disability programs.  Why should they be allowed to gain this experience in Kansas?

·       Only four states have considered putting disability services under Managed Care and none have fully implemented it.  The savings they have achieved were from closing institutions.  The few remaining institutions Kansas has are not included in the Request for Proposal (RFP).  Why should our sons and daughters be subjected to a “Kansas Experiment”?

·       Due to the passage of the DD Reform Act and the creation of the CDDOs 15 years ago, Kansas is light years ahead of the four Managed Care states.

·       Why the rush to turn this over to a for-profit, out of state company? Obviously the insurance companies will be paid for this service and will have a vested interest in saving money to make money!  Why would this be better for my son or daughter?

·       The Kansas community-based DD service system is already a managed care system in several respects, including a capitated payment structure, an annual assessment process to ensure eligibility , referral to less-costly service options, management of the system through locally-designated gatekeeping entities, system-wide utilization reviews, and a quality assurance and data management system. DD Services and Case Management should not be part of managed care. The current system is an effective managed care system that operates on only 2.4% of the DD budget versus over 5% for a managed care company.

·       The comprehensive redesign of targeted case management with no appreciation of how differently TCM is performed in the various service networks. 

·       Individuals may not have a choice of who their Case Manager will be. This will remove someone who knows the person, their family, their medical history, psychiatric history, etc. intimately.

·        In any managed care model being developed, the reform of health care practices and health care administration holds the greatest opportunity for significant financial savings, not changing case management services.

·       Kansas currently has a system that is not broke and will provide the same services as a new managed care company at less cost. I recommend that DD Services and Case Management are carved out from any future managed care organizations. 

 Contact Information

Go to http://www.capwiz.com/interhab/issues/alert/?alertid=58260531&type=SW , click on Take Action Now!  This will allow you add a personal note and send it to the appropriate people. 

Or

Contact

Office of the Governor                                          Office of the Lieutenant Governor

Capitol Building                                                                Capitol Building, 2^nd Floor

300 SW 10^th Ave, Ste. 241S                                                      300 SW 10^th Ave

Topeka, KS 66612-1590                                                           Topeka, KS 66612

1-877-579-6757                                                                  1-800-748-4408

Email:  [email protected]                                                 Email:  [email protected]

You can locate your Kansas Legislators by going to www.kslegislature.com.