By Dave Ranney
KHI News Service
TOPEKA, March 21
State welfare officials say they need an additional $10 million to launch a managed care company that is set to administer community mental health programs on July 1.
“We”ve put in for a Governor”s Budget Amendment,” said Department of Social and Rehabilitation Services Secretary Don Jordan, testifying Tuesday before the House Health and Human Services Committee.
“It”s being worked on now,” Jordan said. “I expect you”ll have it before the veto session.”
Budget Director Duane Goossen cautioned against assuming the governor’s office would approve a $10 million budget amendment.
“It’s our understanding that the feds can be satisfied with a lot less than ($10 million) and that the mental health providers want a lot more than that,” he said. “We have to see.”
Other managed care initiatives affecting the state”s foster care, juvenile justice and substance abuse programs are likely to cost even more, resulting in additional governor”s budget amendments this session, but a total amount has yet to be announced.
The initiatives are driven by several federal audits that have called for changes in how the state uses Medicaid to pay for mental-health and child-welfare services.
Jordan said he expects the managed care initiatives to resolve most
if not all
the issues raised in the audits, setting the stage for the release of some portion of more than $64 million in deferred payments to Kansas by the Centers for Medicare and Medicaid Services since July 2003.
“By June 30, we should be back in good standing with the feds and the money should be flowing,” Jordan said.
CMS has been withholding $5.5 million per quarter since July 2003, SRS officials said.
For several weeks, directors of local social service programs have been pressing legislators for details on how managed care will affect their services and their budgets. Jordan, testifying to the committee, spoke to several of their concerns:
Kansas Health Solutions, the managed care firm created to administer admissions and payments to the state”s community mental health centers, is a new, nonprofit company started by
but separate from
the Association of Community Mental Health Centers of Kansas. The $10 million contract proposed between the company and SRS was not subject to the bid-letting processes. It still remains subject to federal approval.
“I know that sounds like the fox guarding the chickens,” Jordan said of the new company. “But this contract is subject to a lot of federal requirements, and we at SRS are going to watching it very closely.”
Jordan said SRS chose to work with Kansas Health Solutions rather than bringing in a for-profit company that might “destroy an infrastructure” that”s been 40 years in the making.
Any profits derived from increased efficiencies will be used to pay for additional services.
“This really isn”t about saving money,” Jordan said. “It”s about increased efficiencies. Any money that”s saved will go right back into services.”
Kansas Health Solutions will be required to meet an “access standard” designed to make sure people
children, especially
receive services when they need them. For some clients the standard the company must meet may be two hours; for others, two days or as many as 10 days.
If the standard isn”t met, Kansas Health Solutions will be expected to find ways to generate additional openings.
The standards have not yet been defined. But Jordan said he won”t put up with reports of foster children having to wait weeks to see a counselor.
“I expect the standard will be set high,” he said.
Under managed care, more Medicaid-funded services should be available to more people because Kansas Health Solutions will be contracting with any provider who”s licensed by the Behavioral Sciences Regulatory Board and who”s willing to accept Medicaid patients.
Currently, Medicaid-funded services are reserved for community mental health centers which may or may not choose to contract with other providers.
Kansas Health Solutions will be governed by a 15-member board. Eight of the 15 members will be directors of community mental health centers; the remaining seven will include a person who”s experienced mental illness, a mentally ill person”s family member, and five at-large positions.
The at-large positions are likely to include a private provider and at least one of the state”s foster care contractors. Board members will be appointed by the company.
“There will be consumer input,” Jordan said.
Foster children”s stays in group homes
now called Psychiatric Residential Treatment Facilities
will be limited to those considered “medically necessary,” Jordan said.
Children whose
stays are not considered “medically necessary” and who are now in these homes will not be forced to move July 1. Instead, contractors will have several weeks to find alternative placements.
“We don”t want people falling through cracks,” Jordan said.
Surveys have shown that about 25 percent of the children now in group homes will not meet the new funding criteria. SRS has 746 beds available through its group home contractors and they are usually full.
Several providers have questioned whether Kansas Health Solution will be up and running by July 1.
In an interview with KHI News Service, Association of Community Mental Health Centers of Kansas Executive Director Mike Hammond said Kansas Health Solutions has hired a project manager. It”s also hired an executive “search firm to help recruit a CEO with managed-care experience,” he said.
Hammond is serving as Kansas Health Solutions” interim CEO.
“We”re putting our infrastructure together now,” he said, noting the company”s provider network has to be in place by May 15.
“We”re on an aggressive timeline,” he said. “We”re working feverishly to put all the pieces together.”
It”s unclear how many private mental health counselors will join the network.
“We”re going to have to see what the provider agreements are,” said Sky Westerlund, executive director at the Kansas Chapter of the National Association of Social Workers. “Truth be told, there are some people who want to take Medicaid and they”ll do whatever it takes to get there, but, overall, I don”t think we”re going to see an opening of the floodgates. There”s too much we don”t know.”
In an effort to answer providers” questions, SRS has posted several documents on a Web site it shares with Wichita State University:
www.medicaidtraining.org
. The site includes a form for asking questions.
Plans call for eventually posting the questions and answers on the site.
Hammond and SRS Deputy Secretary of Health Policy Ray Dalton will answer questions at a Kansas Mental Health Coalition-hosted forum
at 11 a.m. on March 28 at the Topeka and Shawnee County Public Library, Room 202.
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.