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Minutes for SB332 - Committee on Public Health and Welfare
Short Title
Removing medicaid services for intellectual and developmental disabilities from managed care delivery.
Minutes Content for Fri, Feb 9, 2018
Chairperson Schmidt on behalf of Senator Bollier withdrew a bill that Senator Bollier introduced on Feb 5, 2018. There were no objections.
Chairperson Schmidt asked for a motion to approve Committee minutes for meetings held on Jan 9, 10, 11, 16, 17, 18, 22, 23, 24, and 25, 2018. Senator Hilderbrand made the motion, with a second from Senator Kelly. All voted aye, motion passed. Minutes approved.
Chairperson Schmidt opened the hearing on SB332.
Scott Abbott, Staff Revisor, gave an overview of the bill. There were no questions from the committee.
Chad Von Ahren presented testimony in support of SB332 stating that the bill gives the state the opportunity to return to being a national leader for providing supports to people with I/DD to participate in communities across Kansas. SB332 includes a mechanism to fund services into the future, helping to expand capacity and experience in the system. This bill also removes the Long-Term Services and Supports, which have never adequately fit in this medical model of reimbursement, as well as creates a mechanism for a collaborative approach to develop a strategy to address the growing waiting list issue. (Attachment 1)
Ron Fugate testified in support of SB332 as a parent whose son who is intellectually and developmentally disabled. He stated that it is time to remove long-term care services and supports for special needs kids from KanCare and return them to local county oversight and administration. (Attachment 2)
Gayle Richardson, as the parent of a son with developmental disabilities, presented a video which contained testimonies by parents and guardians regarding their experiences with KanCare's non-medical, long-term care supports and services. She testified in support of SB332. While she has no opposition to the State of Kansas using private vendors to provide services if they have the ability to administer such services better and more economically than state government. However, she believes KanCare is the wrong system for administering long-term care for the children as it is a medical model and the children are not primarily sick. They need a delivery system that can help them with their behavioral events and daily needs. She also stated that KanCare adds another layer of bureaucracy onto the delivery of services and is not saving the state any money. (Attachment 3)
Aldona Carney testified in support of SB332 as the mother of a son with severe autism. She believes that long-term supports for people with disabilities do not fit in a medical model of insurance approvals, denials and appeals. (Attachment 4)
Colin McKenney testified as a proponent of SB332 stating that I/DD Services do not belong in KanCare and the Act is just words on paper without appropriate resources. Having endured nine years with only funding cuts and no rate increases has negatively affected the lives of Kansans, both those with developmental disabilities and also their caregivers, family members, employers, etc. (Attachment 5)
Brenda Jackson gave supportive testimony for SB332 as both a mother of a son on the KanCare I/DD waiver, as well as a designer of health care programs for persons with disabilities for states throughout the country including programs for persons with intellectual and developmental disabilities. She testified that a medical model does not service I/DD populations well. However a person-centered planning model looks at personal goals and needs of the individual and supports the person to the best of their ability. (Attachment 6)
Jerry Henry testified as a proponent for SB332. He is asking for passage of SB332 to address a potential conflict of interest in the Community Developmental Disability Organizations (CDDOs) having roles in both case management and service plan development. (Attachment 7)
Tim Cunningham testified in support of SB332 stating that it will accomplish several goals. It will return the system to a local management and delivery model which reduces the bureaucracy and inefficiencies of manged care. It also prioritizes persons with intellectual and development disabilities by focusing on independence, employment, and integration, and not on reducing services in order to gain profit. It will also return to a case management system that is truly person centered and establish a fair system for reimbursement that progresses towards the elimination of the waiting list. Lastly, the new system would gather data in a consistent manner to allow for the measurement of consumer outcomes for long-term supports and services. (Attachment 8)
Doug Wisby offered proponent testimony for SB332. He stated that the addition of a "care coordinator" by KanCare has added an additional layer of bureaucracy that didn't exist before. He advocates for the removal of long-term support and services. (Attachment 9)
Shelby Fry testified in support of SB332. As one who assists individuals in seeking, obtaining and maintaining employment she stresses the need for a system that is flexible and understanding of the extreme uniqueness that is employment services. The current medical model of service does not account for the ever present, relatively unchanging needs of services of those with an intellectual or developmental disability. (Attachment 10)
Aurie Wornkey, a proponent of SB332, shared several examples of individuals in their service system that are not served well by the current medical model. She said that their service system, before KanCare, focused on person-centered, helpful processes, and good partnerships that all had a common goal that could deliver what was needed to the consumer. (Attachment 11)
Rocky Nichols testified in support of SB332 with the provision that an amendment he is proposing is adopted. The amendment concerns aspects of the Development Disabilities Reform Act (DDRA). (Attachment 12)
Questions were posed by committee members.
Written proponent testimony was provided by:
Ed Eilert, Johnson County Board of County Commissioners (Attachment 13)
Steve Gieber, Kansas Council on Developmental Disabilities (Attachment 14)
Robbin Allen, Parent (Attachment 15)
Tim Wood, Interhab (Attachment 16)
Tammy Hammond, Rosewood Services Inc. (Attachment 17)
Jerry Michaud, Developmental Services of Northwest Kansas Inc. (Attachment 18)
Ed and Marla Flentje, Parents (Attachment 19)
Kirk Davis, Lakemary Center (Attachment 20)
Dr. Betse Gage and Dr. William M. Chase, Parents (Attachment 21)
Kathleen Brennon, Guardian (Attachment 22)
Katie Cosgrove, Individual (Attachment 23)
Linda Lock, Brown County Developmental Services, Inc. (Attachment 24)
Phil & Marilyn Kubler, Parents (Attachment 25)
Susan Jarsulic. Parent (Attachment 26)
Shari & Shannon Sauer, Parents (Attachment 27)
Mike Oxford, Topeka Independent Living Resource Center (Attachment 28)
Dr. Scott Williamson, Parent (Attachment 29)
Brad Ridley testified as an opponent to SB332. Topics he addressed in his testimony were a) waiting lists - stating that the state has been able to prevent higher waiting lists by adding 500 additional spots for I/DD individuals with the saving from KanCare; b) claims payment - by stating that the State tracked claim denials for the first several years of KanCare and found most denials were related to duplicate claim submission; c) movement toward managed long-term services and supports - by including reports that provides an overview of the many benefits states, including Kansas, have experienced by having Long-Term Services and Supports included in managed care. ; d) improving member experience, quality of life and health outcomes - by stating a high level of overall satisfaction with service provision in the current system of KanCare; e) conflict of interest - by removing HCBS from Managed Care will increase the state's and IDD systems already difficult task of mitigating conflict of interest to comply with CMS requirements and f) state fiscal impact. (Attachment 30)
Stephanie Rasmussen offered testimony in opposition to SB332 stating that although some challenges remain, removing I/DD services from KanCare would reverse positive progress and it would remove many of the specialty services offered. (Attachment 31)
Frank Clepper testified as an opponent to SB332 as he is concerned that the bill will reduce access and available services and will once again segregate I/DD members from a full and beneficial integrated care model. (Attachment 32)
Jamie Price presented opponent testimony to SB332. She stated there are many new models around the country that are tailored to the specific state and said the best one for Kansas has not been determined. (Attachment 33)
Opponent written only testimony was provided from:
Dr. James Bulot, Navigant Consulting (Attachment 34) (Attachment 35) (Attachment 36)
Kathy Stiffler, Easterseals Capper Foundation (Attachment 37)
Mark Hinde, Southwest Developmental Services, Inc (Attachment 38)
Sheila Goscha, The Alliance for Kansans with Developmental Disabilities (Attachment 39)
Kevin Sparks, UnitedHealthCare Community Plan of Kansas (Attachment 40)
Questions were taken from committee members.
Janis DeBoer testified with a neutral position on SB332. She stated that Seniors are not mentioned in the carve-out bill and they are satisfied with being excluded. But they would like to see a comprehensive, collaborative, visionary way to restore and enhance the integration of health care for seniors and other populations on the waivers. (Attachment 41)
Written neutral testimony was provided by:
Barb Conant and Sean Gatewood, KanCare Advocates Network (Attachment 42)
Mitzi McFatrich, Kansas Advocates for Better Care (Attachment 43)
Chairperson Schmidt closed the Hearing on SB332 and adjourned the meeting at 11:45 a.m. The next scheduled meeting is February 12, 2018 at 9:30 a.m.
