Archive for Monday, October 7, 2013

Health care providers raise concerns about KanCare

October 7, 2013

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— 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.

Comments

RustWatcher 1 year, 9 months ago

What do you expect from the State of Kansas? Brownback has loaded up the state with "non-care" and is now stiffing the providers. Should have opted in to Medicare Sam. Still paying Elsbeth Schaefer (the "Lying Judge" who was forced to resign) to win cases for the state of Kansas that it doesn't want to lose? Same crap Sam...same Crap...You have loaded the State with liars and cheats.

nick_s 1 year, 9 months ago

In response to everyone bashing the ACA's technical problems from the start, look at this strictly Republican/Brownback program that is still having troubles. It has been "working" since way before Oct. 1. There will not be one single one of you ACA bashers on this thread complaining about this debacle though, will there?

"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."

So its essentially ok when its just our friends in Brownbacks pocket running a public/private partnership? They will fully admit that there are bound to be "inevitable problems" when its their for own for-profit business. In the health care industry none the less. They should fully understand all the potential issues that could be experienced in such a complex industry, & when servicing the entire population. Not just one measly state. When it comes to the ACA however.... How convenient.

Thinking_Out_Loud 1 year, 9 months ago

nick_s makes a good point. There is a double-standard when problems in KanCare are "inevitable" but similar problems in ACA are seen as evidence of complete unworkability.

FarleyM 1 year, 9 months ago

Apple had glitches with their system. These glitches with KanCare will be worked out. Give it time.

RustWatcher 1 year, 9 months ago

Apple had glitches... excuses excuses excuses. There would be as lame an excuse for "holding up payments" as one could profer.

RustWatcher 1 year, 9 months ago

Kansas wants a block grant from Medicaid now. So, can't pay the bills till the Fed's pony up. Funny how red states take in more fed money than they provide, yet want to feign that they mistrust the feds. Sam that's phony, and very much like Texas...a usurious state of Federal money.

Larry_Local 1 year, 9 months ago

FarleyM - that makes perfect sense. KanCare glitches are EXACTLY like Apple's glitches... only we are talking about the welfare of PEOPLE being affected, not whether or not someone can play Angry Birds... wow...

Armstrong 1 year, 9 months ago

Odd, I don't see any of these prolific posters airing the same concerns about Owebamacare.

deec 1 year, 9 months ago

One has been live 7 days, the other 9+ months.

One is preventing people from signing up for medical coverage. The other is keeping people from using their existing medical coverage while also stiffing providers who have already supplied medical coverage.

jafs 1 year, 9 months ago

This is pretty obviously deliberate. The insurance companies have the money from the state, and the longer they hold on to it, the more money they can make by investing it, rather than spending it.

Where are the efficiencies that result in better care for less money that were promised?

Instead we have worse care and providers not being reimbursed, or not being reimbursed in a timely manner.

nick_s 1 year, 9 months ago

Like I said, not one ACA basher on here...

RustWatcher 1 year, 9 months ago

This isn't about the ACA, it's about incompetent Kansas Republican politicians coming between Kansans and their health care providers. The KS hospitals didn't want KanCare, the wanted the Medicaid expansion. Problem is, most bashers of the ACA are ignorant about the law. These folks are getting their opinions from republican wing-nuts and Koch brother propoganda.

nick_s 1 year, 9 months ago

While I agree, the parallels are very similar. New insurance/medical program having difficulties, huge outcry against one program, while not against the other. That's the point I was trying to make. The same Tea Party/Repubs are admonishing the ACA in its infancy, but keeping conveniently quiet on this one, which has had alot more time to work out the problems. Not only are they keeping rather quiet, they are willing to admit that there would be "inevitable problems" w/their own program, but not allowing for the same transition period w/ACA.

Liberty275 1 year, 9 months ago

Instead of complaining, don't accept medicaid as payment.

jafs 1 year, 9 months ago

Right.

So then the dd folks that my wife works with will get fewer services, since Medicaid provides funding for them.

Great outcome - why do many of your suggestions just increase suffering?

akt2 1 year, 9 months ago

Only private practice physicians have that choice. The polite way to say it is "We are not contracted with your insurance."

RustWatcher 1 year, 9 months ago

"Only private practice physicians have that choice."

The hospitals want the Medicaid expansion. The ones who are "private practice" are sometimes the ones that don't have affiliation with a hospital because they are quacks.

akt2 1 year, 9 months ago

Or highly trained specialists that don't have to sell out. They are the ones that the other doctors refer their patients to when they aren't sure what to do. They usually have hospital privileges with at least one hospital, sometimes more. But they aren't owned by a hospital.

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