KDHE Secretary Susan Mosier pushes back against a federal agency that criticized the state's KanCare system during a meeting Monday of the Kansas Senate's Public Health and Welfare Committee.

Topeka ? Kansas Department of Health and Environment Secretary Susan Mosier pushed back hard Monday against a federal agency that has criticized the state’s privatized Medicaid system known as KanCare, accusing it of using flawed analysis and offering its own opinions as facts in finding the program out of compliance with federal laws and regulations.

She also criticized the news media’s reporting on the issue, saying the state’s application to extend the program for another year has not been denied but merely “delayed.”

“It was reported that the waiver was denied,” Mosier told a Senate committee Monday. “When you actually read the letter, it says that it cannot grant the state’s request at this time and it cannot formally consider the state’s request for a one-year extension.”

Mosier appeared Monday before the House and Senate health committees to respond to the findings in a recent audit by the Centers for Medicare and Medicaid Services and its decision not to renew a waiver that has allowed Kansas to operate its Medicaid system as a privatized, managed care plan since 2013.

In a Jan. 13 letter, CMS said its on-site review of the KanCare system, conducted in mid-October, had verified complaints it had received over the last year from patients, health care providers and other stakeholders, and it said the state’s noncompliance with federal rules “places the health, welfare, and safety of KanCare beneficiaries at risk and requires immediate action.”

“I admit that on the surface, this letter looks alarming and concerning,” Mosier told the Senate committee. But she denied that the health and welfare of KanCare patients were being put at risk.

“As we went through the letter, item by item, one of the things that we saw, and one of the things that we knew was that there’s no evidence of decreased access and no evidence of harm to beneficiaries,” she said. “And so, although they talked about process and procedures, they did not look at outcomes related to our (long-term managed care) program.”

She said state officials had provided CMS with “over 2,500 documents, over 40,000 pages and over 3 gigs of data,” much of which she said was not considered when CMS made its findings.

“Also, there were statements of opinion rather than fact” in the report, Mosier said.

Mosier told committees that since KanCare was launched in 2013, patients in the system have recorded fewer inpatient hospital stays and fewer outpatient emergency room visits, while at the same time getting more preventive care through primary care visits.

Mosier also said that CMS officials had assured her agency in mid-December that Kansas’ waiver would eventually be extended.

Sens. Barbara Bollier, Vicki Schmidt and Laura Kelly ask pointed questions Monday of KDHE Secretary Susan Mosier during a Public Health and Welfare Committee hearing about the status of the state's KanCare program. Federal officials have denied the state's request to renew KanCare for another year unless it submits a plan to address several deficiencies.

But under questioning from Sen. Laura Kelly, D-Topeka, Mosier said CMS officials had not put that commitment in writing. “It’s customary for CMS to not put anything in writing until the very last conversation, so we’re having preliminary conversations and discussions,” Mosier said.

Other members of the panel questioned why Mosier had not notified the Legislature of CMS’s concerns, even though she knew about the on-site review and the agency’s concerns as far back as October.

“You’re telling me that these issues are there, and these are some really large issues, and yet I just met with you in my office and everything seemed to be going swimmingly,” said Sen. Barbara Bollier, R-Mission Hills. “And that’s a concern to me because these are some significant issues.”

Mosier said she actually had discussed CMS’s concerns with the Legislature’s joint KanCare oversight committee in November. But she also said that meeting occurred just two days after KDHE had received a preliminary report from CMS and so little information was included in the slide presentation she gave to committee members.

Minutes of that meeting and an online copy of the slide presentation show there was only a cursory mention that CMS had conducted an on-site visit, and there was little or no discussion about the specific findings.

Sen. Vicki Schmidt, R-Topeka, who chairs the committee, said she was concerned that many people have received coverage and care under the plan only after going through lengthy appeals of their denials, and she asked Mosier to provide more specific information about the number of times KanCare denials have been overturned on appeal.

She also said there have been concerns that many providers have either stopped accepting KanCare patients, or have reduced the number of patients they receive and the number of hours per week they spend with KanCare patients, since Gov. Sam Brownback ordered a 4 percent cut in reimbursement rates last year as part of a package of allotment cuts to balance this year’s budget.

Mike Randol, director of health care finance at KDHE, said only 13 providers, out of more than 20,000, had completely withdrawn from KanCare since those cuts went into effect, and he said there was no evidence yet that patients are using the system less now than they did before the cuts.

Schmidt said after the meeting that it would take time to absorb all the information Mosier presented on Monday, but that many lawmakers still have serious concerns about the program.

“I think all of us have heard from advocacy groups, and certainly from individual patients and beneficiaries about issues in KanCare, and it’s very important that they be looked into,” Schmidt said.

Kelly, however, said she was “disappointed but not surprised” that Mosier spent so much time attacking CMS for its report.

“It’s sort of been the way they’ve operated the entire time the KanCare issue has been around,” she said. “I hope that we don’t get distracted by that and we continue to get down to the problems.”

Mosier said the state would submit a corrective action plan by mid-February to address concerns raised in the CMS review and a new application to extend the program for another year would be submitted this spring.