KanCare Member Education Meeting – Sept 5 2018


Hi, this is Jeff Anderson Secretary of KDHE we just finished another one of our KanCare member education meetings where we’re answering questions for those who want more information about the KanCare program. We have more meetings coming up in October also You can go to kancare.ks.gov for more information whether your provider or a member in our can care program. Thank you I’m Carrie McMahon from the community engagement Institute at Wichita State University And I’ve got several of my colleagues from Wichita State here as well to help out with our process today They are waving their hand and saying hi So if at any time Can I give you some assistance don’t hesitate just have one of them and they’ll be happy to help in any way they can The community engagement Institute as a University Center that’s partnered with KDHE to help with stakeholder engagement So we’re really here to help make it an easy process for YouTube with feedback and ask questions for KDHE tonight So today we’re here so that the state can Provide you some information aboutKanCare open enrollment that’s coming up and also about the change in MCS that’s happening so that They can share it with you a little bit of information. And so they’re really going to be pretty short And then we will have plenty of time to ask questions about what’s happening And hopefully get answers to those questions We dress that and keep in mind that some of these questions we might not have any answered work for you today We are going to take down all of the questions that are asked and the state’s gonna work on putting those together Into a frequently asked questions document so be on the lookout for that And there will be other opportunities for you to ask questions later on the self Those answers will be coming down the road if there is something that we don’t have information for you on tonight As far as what to expect today but like I said We’ll have a really quick presentation from KDHE and then we’ll use as much divert that our main time as we need to For you to ask your questions And help get those answers for you We’ve got up to 2 hours So if we go through all your questions will end early But we need to move you’ll stay with us both that will time for you after the presentations you do have like Isaidr the state staff here and they’re willing to hang out and Continue to get out to talk with you one-on-one to answer your questions as well With that I’ll have things over to Becky Ross the Medicaid initiatives Coordinator at KDHE Thanks, Carrie I wanted to thank you all for coming out tonight Time to meet with us As Carrie said we’re here to present some information and then answer your questions I would like to introduce our state staff we have several folks here At this table, we’ve got some state staff folks from KDADS – Brad Ridley and Melissa Warfield We have Russell Nitler eligibility expert and Claire Vallejo who is an MCO manager Over here. We have Jennifer Crawshaw who is a provider and customer relations person and in the back we have Secretary Anderson the secretary of KDHE and then at this table, we also have Marc Woodring who is our director of policy and operations so as Carrie said if we don’t get to all your questions or you have a particular personal question Particular instance. Come see us after We finish and we’ll try to get you an answer or get some information to take back to get you an answer So we just have a real quick presentation just A reminder KanCare provides services to over 400,000 people so it’s a big program And we cover a variety of folks. So pregnant women children seniors and people with disabilities All services are provided through managed care organizations To make sure that those services work well for you and that everything is well coordinated We try through the program to emphasize wellness and avoiding health problems before they happen you Should all be familiar with you can’t guarantee us that we have Our first contracts when we began the program were with the Mara group sunflower state health plan and United Healthcare of the Midwest We’re required by the federal government to procure contracts regularly so they don’t let us continue to have contracts with the same managed care organizations without Doing a new procurement periodically so we did that and the tail end of 2017 we issued a request for proposals and really received bids on that and we had a number of staff working on both that request for proposal and on reviewing the proposals that came in and Making recommendations as to which MCS to contract with So beginning in January 1 of 2019. We will be contracting with Aetna better call sunflower and United So you can see Amerigroup is no longer in India that will be contracted with after 18 So what’s covered and can’t care you’re still going to get all the services they can get now we require the NCOs now or in the future to cover everything that we Tell them to cover and that is in our Medicaid state plan. So all the services that are currently covered will continue And that includes your doctor’s visits hospital visits treat them for mental illness and substance use disorders drugs or folks who needed nursing facilities transportation and other services that get it now you Can still choose your canned care health plan and we’ll talk a little bit about that in a minute You can choose your doctor. You can change your daughter If your job if you have a doctor that you need that isn’t available In your hometown and you have to travel to go see that doctor the health plan must provide you Transportation and that’s what we call our on emergency medical transportation Some other protections that you haven’t kan care Include that you have a member advocate that will help you file a complaint if you have a complaint with an MCO Each MCO also has to have a group of members to advise them they have a member Advisory Council and you can find out more about that by talking with your your MCO or looking in your member handbook You will be asked how you like urine Co we do surveys SEOs have to do a survey over here and Survey a sample members and report that to us There will still be no co-pays or irregular can’t care services The basic dental care that was provided In kan care through the MCO s the adult cleanings will continue And of course children also get some other dental services There’ll be some improved service coordination later on in 2019 To help people with serious health problems and complex commotion We’re still requiring the MCO s to bring what we call extra services or value-added services At no cost to the state. So those dental cleanings that they provide for adults The state doesn’t pay for the NCOs. Bring those services pay for them themselves There’s there’s others of those services and hopefully you’re familiar with some of the ones that are occurring today They’ll be some new ones coming in 2019 There’ll be the same providers same services So your services will stay the same your Medicaid ID number will say stay the same you’ll still have the right to appeal to file a grievance to Have a safe fair hearing if you have a dispute with your MCO and you have the right to choose your MCO every year So if you’re an American member today what that means is You will no longer have a merit group in 2019 because we’re not contracting with Aetna will be the third MCL. What we will do is temporarily assigned you to Aetna And later this month you should get a packet of information That will tell you that it will also give you information about how you can change if you don’t want to be with that And how you can choose one of the other two MCS? If you want to stay with that nut, you don’t have to do anything but if you want to change you can call or fill out a form and That will be part of your packet So if you’re an American member now, you should continue to get services through the end of this year from America They’re not they can’t change how they provide services they’re contracted with us and obligated to provide those services through the end of the year In October or later this month you should get that packet with the letter that they tell you that you’re going to be assigned to ed and starting in January and Again, if you don’t want to switch and you’re okay with trying F done You don’t have to do anything But if you want to switch doping information of the packet that will tell you how to do that You can choose Any of the plans and you’ve the three plans that are available. So Aetna sunflower ignited Now what will change for everyone is that? Everyone will eventually get an enrollment packet? So even if they’re not with the mirror good been here with you nine inter sunflower You’ll get an enrollment packet and the letter will say you’re currently with United or you’re currently with sunflower But you have the option to choose a different plan if you want to you don’t have to okay You can continue to be with either sunflower United and again You’ll have a letter there telling you that there will be a phone number you can call or divorce or that you can turn in whichever you’re more comfortable with if you want to just pick up the phone and say I Know I want to switch. That’s fine. If you want to stay with the plan that you’re already with You don’t have to do a thing You will have until April 3rd To make your choice, so if you want to you can switch several times in that time period and It’ll be coming out in October To talk with you again about it We’ll bring one of those enrollment packets and show you what it looks like and talk to you through all the information in it But of course one of the things you want to look at is are your doctors and your medical providers with the particular plan? That you want to that you want to select What are the value added benefits that that plan is bringing? What are the extra services that they’re bringing and aren’t any of those going to be useful to you? there will be a phone number and a form in your packet and you can use either one to make your choice and again you’ll have until April 3rd of 2019 So some of the new extra services that will be available right now the NCOs offer that basic preventive dental care They also offer standard or extra minutes on self They provide ways for you to earn points that you can spend on health items They provide help to quit smoking Some of the new extras that will be coming in 2019 Include extra help people remove from the nursing home back to their community Some extra help for children in foster care and their families For some HCBS members, there’ll be some extra transportation services available social events or to help them get get to work and one planet even offering free internet access as a reward for healthy activities So when you get that that enrollment packet there will be a table in it that has a side-by-side comparison of the value-added services of those extra services So you’ll see what a bizarre what central Arizona at 29 is our entry to make a comparison Because that’s one of the things you should you should use to make the decision as to what plan you’re going to be with So we’ll talk more about those October meet meetings here after we get done with the questions But I’ll turn it back over to Carrie so we can get started on the questions Information about what’s changing and what isn’t so thank you for sharing that information. Thank you We’re go ahead get ready to open things up to hear from you and again We really want to focus on hearing your questions about the information that we’re sharing this unique About the change in its knows about open enrollment getting ready to start so we’ve got Vince Etta and link with microphones and They’re gonna come bring a microphone to you If you have a question So, please do wait to ask your question until we have a microphone so we can make we can make sure me and everybody else Can hear you? You do want to make sure we can hear you and get you the the right answer for your question and As you can see there are a lot of people so it will take a little bit of patience for them to make their way around the room And we do ask that you ask your questions one at a time and we just want to make sure we have time we can Let everybody who wants to ask a question ask a question if we come to you and need to come back. That’s perfectly fine we just want to make sure we have time to talk to as many people as we can and Like I said before we’ve got plenty of time to talk and hear from you So with that we’ll go Again Thank you very much my son is an American member he has a a Medicare Advantage plan, so his MCO picks up the co-pays and my question is he has a number of services physicians doctors clinics that are in the network for American Will he still have those same doctors clinics and organizations available in? And For the most part That’s one thing to look at When you get that open enrollment packet and call the number and say His daughters of in your network And you can do the same thing with subtler and United today You could call them up and just ask are these doctors in your networks? You don’t necessarily have to give never to ask that question But but we are expecting those MCS to have Robust provider networks. They have to by federal regulation and so we’ll be Monitoring that to make sure that you have adequate networks but that is one thing you’ll be to look at when When you determine whether or not your son’s gonna be with that narrative to one of the others is are all his providers in their network So this is something that I can find out by calling each of the NGOs, or I guess I can go to the physicians and say you have that and The primary concern courses is primary care physician who he’s had for 12 years. Yeah So yeah, that’s another big ways. Just just ask the providers You can also go online each Indian sianis has their provider information online You can plug in the provider name Or other information and it’ll search and let you know about if that’s a particular providers in their network. Thank you. I Didn’t forget to give one quick reminder before we get the next question. I apologize I did wanna mention at the back of the room. We do also have a representative from the the King care Ombudsman’s office so again If you have that question or challenge carries leaving your hand back there if you have a question or challenge that’s unique to you that you need assistance with or maybe that’s Not quite related to our topic today feel free to talk to Kerry or any of the other state staff after our after we wrap up here that way you can get That bottom one attention and talk a little bit more in depth about your situation. So Okay Could you tell me if Edna as new MCO? What their track record has been as a managed care provider for long-term care services for HCBS clients in the United States? They are in the Medicaid program in 23 states I’m using the neither medical model that has a long-term care residential they service provider MCO Well, that’s one of the things that we look to have in in their proposal and they don’t experience with that in other states So they’re used to providing their services for that population Hi, I’ve got the dental coverage It says the Descent included, but I’ve had difficulty finding a provider that actually accepts it Any suggestions Well, I don’t think is any secret to people who live in Kansas – that no first of all very shortage of dentists Period we also have a shortage of dentists who take Medicaid We know exactly whose hairs will continue trying to build that Network I will say that one of the things that United is doing is they’re actually moving away from The two coins and the next four years are basically giving I believe it’s a five hundred dollar Benefits or anything so it could be for cleanings fillings, whatever That may be more useful to folks and it may actually attract more but you know Yes Was whether that dental benefit that been kind of talking about what started in 2019 And I think just for ease we’re going to start at the front of the room and work our way back for questions so I didn’t get to the back and I promise they’re coming back there and questions Once you enroll You have to re-enroll every year if you don’t change anything Are you talking about choosing a plan an NCO or in talking about image? We do have you do have to – there’s a review process and So you should receive a packet of information you know telling you that your reviews coming up and Return the information from that packet If you have a specific question about that see this gentleman in the blue shirt On behalf of my mother she has Amerigroup I just wanna understand a little bit more about the enrollment Would it be correct to say that, you know about the new Prius? I’m not so common January 1st there was no, and they if that passed who’s my mother she be discontinued that which doesn’t have to be any further or Do we have to do something? No You don’t have to do a thing I would advise you to take a look at the information in that Enrollment packet because though the information about sunflowers United as well You know make sure that her doctors are going to be in the network If there’s value-added services that meet her needs, you know, we’re definitely didn’t you’re good to go but any time from getting that ignored packet to April 3rd you can make More of an answer to the question we happen to ask Organa stolen Topeka and She sent this to doctor as a dentist doctor Fassbinder excellent Excellent doctor because my son in their mouth and now he was Questioned he had to see my son for Ways better trip to Kansas City to you, but you know, it’s cleaned his teeth He’s talked about feelings and he gives him on their Little basically most of their the patients that I’ve seen with, you know having some kind of need So it’s not that fast buddies came the city Of question of working Know that should that should stay the same your bring him. Yeah, that’s not going to change Hi you gotta mention issues with a provider community with dentists and the fact that BMC knows that provide an adequate network Similar issues with behavior analysts or children with autism that there simply aren’t enough providers that are Contract with the NCOs providers services the number of kids that need the service Can you comment on what actions the states taking to address that? So, I’m glad leave Liam with Department breaking disability services so we know there’s an issue with autism providers About a year or so ago. There was some changes that open that service up to those services up to two more kids Make this project so we are working closely with the MCO s to Look at the network look at where there’s gaps in the network We’re trying to come up with new ways to monitor what we consider network adequacy And some of that will be changing and also on January 1 there’s new federal requirements that require us to better monitor HCBS network adequacy So we’ll have several efforts moving forward to address the autism Network issue as well as when we have any to do services Yes, I have a question for nursing home care and Ana durable power of attorney for my brother and He had this is an eligibility question for that and he had Community Care Came here That’s it you know, so they said that would slide over to Nursing care. Well, that was almost six months ago. I just wanted to know And know even nothing is we haven’t heard anything. I wanted to know What is the rationale for such a before for the two types of eligibility and how can you have one together and Secondly, how long should a person wait or think it should take for that to happen? Okay, so your eligibility for HCBS that Community Care that he had before he went into the nursing home Is this sort of same standard for? nursing home eligibility, so if he was getting HCBS eligibility his eligibility Into the nursing home should be rather smooth. There’s a core that the nursing home would need to fill out called 21264 and then once the can care clearinghouse gets that form. They’ll change the code So you might want to See me afterwards. I’ll get your name and phone number and check to see if it’s just not done or something happened Well, all that has happened and I guess that we just want me in the chin They check up every two or three days and they’ve been told that what happens is if something little thing happens He gets kicked to the bottom and then there’s 45 more days on the list that it takes for them to deal with it and I just don’t think that’s very efficient Longer compassionate. Yeah, I would invite you to stop by afterwards So question about the targeted peace management’s what changes are happy to look for that with the FDP waiver and we’re hearing about Community service coordinators that are going to be from the NGOs So what exactly is going on there? Well, nothing will be going on until mid 2019 Service formation will continue there it is and targeted case management will certainly continue as it is starting in July We hope to Phase II and community service coordination for certain populations through the beginning of 2020 the ideally population will be the last population based in and Before we implement any of that. We’ll be putting together a group of stakeholders to talk about how that should look And the MCO and State will be involved in Training and oversight of the community service coordinators and what they need to be able to do But we’re hoping that that will be a more robust service than targeted case management Which is a fairly old service and the federal government, really? limits what targeted case managers can do and get paid for through Medicaid So we’re hoping there’s community service coordination We can broaden that so that they can do more things and get paid for Who’s going to be a part of the state race? Family members providers And we’ll be pulling that group together probably later this year early next year Thank you for taking my question the question is I had very group and I have services kept a lot too December and in January do I need to go in? The insurance company come in and see if that’s what I need to do or guess the questions, what’s the last Scheduling you can do for America Our group is contracted through December 31st of 2018 and semi-finished on this Procedure and that you have through the end of this year will be covered as long as this service For things in January, I will be talking to your provider and ask in contact Hi friends questions for you, um You know what might just asked about for the behavior specialist My son is 23 and needed behavior specialist has autism and America nothin and I had a pocket for help. So luckily I was able to do that. So we have to look at kids Because So And then the other side of that is when you’re talking about new Care coordinators will we even be contacted by our care coordinators? Because that is a Revolving door with Amerigroup iPad since it started in my remember I don’t even know who it is right now They never contacted. So one of the changes that you talked about a little bit ago community service coordination That’s one of the issues that you just talked about We’ve been hearing for years of what we’re trying to do is get community individuals involved in that care coordination and share that responsibility With the MCO so that we can have local folks similar to what exists In targeted case management, but have those local folks that can work more closely with folks And so people know who their community service coordinators. So who’s accountable for that? Not just America you all are countable rare, correct? Okay. All right. Just wanna make sure somebody is accountable Yeah, we keep getting Shifted it shifted and shove it and it’s extremely frustrating And we are accountable and that’s one of the reasons we’re making that change so that we can position Yes, my name is Kirsten tonight and I have a son severely autistic who has to another Fassbinder, I guess my Observation is that I’m hearing about these agencies that have available services, but that does not Equate with the accessibility of them. I think the elephant in the room, is that the reimbursement For our medical psychiatric dental community is abysmal Dr. Pathfinder will be retiring. He does one of the hue interstate as for those that are severely disabled and as a parent and as the stapler and as a citizen and I expect better cater For our loved ones. So when we talk about these agencies, we really need the boots on the ground The waiting lists for services even dermatology after a reaction of that medication reaction in Heights Having to go to an emergency room that are having a three-month waiting list to see a dermatologist Office that doesn’t work for our cultivation, which is the neurotypical population so I we’ve got to find some way to really make that connection because having Very chunky even pretty talking about though the $500 The initial service that United will be off is your mother would be 19. Yes. Yes, very Well, I don’t know that they’ll be directly the Knowledgeable of it. We hope there will be but your mother and you will have that information to share with the nursing facility Thank you But are actually Training on accident. Yes, that would be part of the whole process that the Indians and the state will develop Training before the community service coordinators, but they’ll also be education for the members Well, we don’t know yet, okay, that’s the part And I should just say this is the chainage the can care in the legislature basically Told us we could make programmatic changes to can here Prior to July 1st of 2019. So that’s why it’s not happening now and we’ll be working with folks to Bring down online mid-year in 2019 Year so have the case-mate Right. And as I said, the IgE population will be the last population and we move into that the IVD population folks with intellectual and developmental Disabilities will be the last population that we face This is much about the foot care That’s supposedly awkward What’s on my mind is trying to figure out what watch they cover a lot of times. That will say Medical necessity like if they have diabetes or something like that My sister has fungus speech. We just really different O’Neill’s and its really very very hard. Not just Trim them, so she needs to go to the dieters every 61 days Is that covered not covered are there restrictions? I don’t know of that particular thing is covered. My recommendation is make a call customer service at the NCO and ask Your microphone If you clarified the TCM, are you gonna totally phase out case managers? And I guess I’m confused by what you’re saying about The service itself So their role would be expanded if they choose to continue in there Is the fact she talked about This now his primary job for his said he lets it go and it’s not taking Dara There’s a good chance that he’ll lose His title it could be even lower The other thing is the normal person is having our time to even So Here Is The question that I have to is who are the community service coordinators going to work for so right now we have Yeah, our care coordinators who work for San Jose. We have our T CMS that Actually work for us and so They fight for us and hello it work for us and and do all that for us. So we’re if you’re kind of getting my drift here, is there conflict of if I have a care coordinator that needs to work for us that’s employed by America Aetna or sunflower and the Looking at the budgets Mine what services became cut we can’t cut things like that. So That is a very scary moment Process who’s actually working for us and who’s actually working for our loved one And then the other part is that is what’s happening with How much money we have Is determined by the legislature they allocate money to engage me, which then allows us to pay the dues he owes second targeted case managers now contract with DMC OS And then bill VM cos for that service the same would hold true for community service providers They believe they would be working in an agency in the community that contracts with the NCOs to be paid And as far as the CEOs just still be around they can be community service providers I Have a two-part question and this is kind of general And I asked it because kind of a loaded question but it’s political year and many times as taxpayers who find Answers What is is there an overall? Long-term plan for your department for what? It covers in the state and secondly it is there a group who is the group in the state that evaluates the Efficiency and thoroughness of what we have now Against what we had before when we privatized all this those are going to questions well He’s been a state department for many many years Kansas was within the Medicaid program Since shortly after Medicaid came along in 1965. So Medicaid is here to stay The form that it takes, you know, whether it will continue to be all managed care you know, I’m not I’m not a Fortune-teller. I can’t see in the future We’re signing contracts with peers to notice that our five-year contract their current contracts with two one year extensions So at this point the state is saying we’re in managed care will continue with managed care of these three plans And as far as oversight, we have the federal government If you’re interested in reports that we submit to the federal government, they’re all online We have quarterly and annual reports that look at a variety of things From the number of grievances and appeals and there are five trials and what I determine, you know for what purpose There’s quality information out there. There’s a load of information on the Cantor website in those quarterly and annual reports We also are audited annually by the legislative this audit we have a single state on it that occurs for kdg and a lot of other parts of state government So there’s a lot of oversight you Know I can’t speak to what’s gonna happen in this I can only tell you that What we’re seeing going forward is can Harris manage? Committee who looks at what you do most of us work organizations where we have a change And whether they’re better than what we had before we usually have County control where we could go to County now we go to take care office they can’t really help us we get referred to the state and Particularly for the county. So my Johnson County that are far from to be Penn and far from lots of medicine You know the doctors there at the disadvantage Having those people on the ground that new system I’m just asking To say whether what we have now is significantly better than what we used to have Okay, and I think you’re talking about the former SRS offices and DCF offices And and now we have the clearing house. And so your question is who’s looking at that everybody’s working with that legislature governor? federal government We answer to all those people You know, we’re an executive branch agency so our secretary answers to the governor As a state in the Medicaid program. We answer to the federal government and the legislature Overlooks everything we do they’re the ones who fund us. We actually have a can’t care Oversight Committee. It’s a joint legislative committee That meets throughout the year Not just when the Legislature’s in session and we have to constantly report to them so I can tell you that everybody’s looking I can also tell you that we’re doing everything we can to make changes to try to improve the system in terms of Eligibility and how quickly we can get eligibility done Would you please clarify the community people Community service coordinators will work for a community agency That contracts with EMC knows Just like other providers contract with NGOs now we are ultimately responsible for what they do and what the NCA is do because we Are you I can’t get your furniture, okay? You should not have co-pays if they’re covered Prescriptions Well, you know every insurance doesn’t cover some things and If it’s an over-the-counter insurance or over-the-counter of two things Does your doctor write restriction for us? Isn’t it? Okay come see me afterwards so I can get that information We can take a look at Okay, so sorry, when are the NCOs going to be directing community I’m not sure write me by directing community the state will define the service the state will define what community service coordination enters and If community service coordinators are providing that service They can bill the MCO to get paid for now the NCOs would every provider Can on any of their providers they go to doctors offices. They’ve got a hospital’s they say, let’s see Sure you provided Services Yes, so at this point he doesn’t have a target case manager Because that population doesn’t have targeted case management Well, I’ll just say business may be appropriate for later again, one of the crime needs Whether you use a self-directed or an agency is finding people It’s almost impossible labor is particularly difficult, and I’m just wondering if there was this community service coordinator or somebody else who could get involved and developed resources to find DCA’s Well, that’s a that’s a bigger issue personal care attendants are Difficult on it’s hard work. It’s not very well and Not just and only if ever Johnson County just Try to do something about it. Well community service coordinator role would not be to you know build networks that that’s not their functions that they could certainly help search or Building on his question the previous question. What is the state doing to help entice? workers coming into the system to help Well, you know that United the CEO of United has pulled together a group to start talking about how we can do that particularly in terms of trying to build a career path you know for nursing a lot of people start out as a CNA is a Wagner’s a assistant or a certified medical assistant and in my little angel So Kevin sparks you as a CEO in United has pulled together a few folks to start having that discussion. How can we do that in Kansas? What’s a good way to do that? 10 years ago that was the process because that’s what we came to us with our son who’s now 18 Down the nurses are going straight from Opiates Wolff straight into the RN they’re not stopping. They’re not going to be going into the homecare Father continuing get in there REM they’re just going straight Open and they’re going through graduation to Facilities because they’re painting the venue and they’re hiring Dinner and they’re getting the benefits of the facilities. So they’re saying telling the state and all all of us thanks, but We don’t take care of us This is where we get a better deal. We’re obvious they can’t compete Well, it’s time it’s tough to compete without money and You know as I mentioned the legislature besides what we can spend that benefit And we have to cover it’s an entire programs for 400,000 people with they give us So there are things we have covered their rates that are low you know it starts with loitering near legislation your legislature to say, you know There’s a there’s a lot of money in Medicaid and there’s not a lot of money to spread across I mean people talk about our program being a four billion dollar program it is but it serves four hundred thousand people Problem it’s not a problem. You know it started before It is done with your writer it Smelly camp your problem, you know, Jenna came across the nation medicate traditional things lower than other health insurances Target case management resource coordinators Coordinators will be Services No I Have a question a ton of the times here this was creepy and providers and six-week members Is that going to be an all-day event? No, no, they are just like these need a selfie through nearly two hours. So Provider meetings will be me afternoon a member and family So from 6:00 p.m. A No, no you do not Who are the providers? Providers are all the folks who actually provide the Medicaid Services doctors hospitals HCBS providers pharmacist All the folks who are doing the actual services that get paid by the NCOs to do those services Does that include any agencies? Yes Because there’s a lot of things that We excellent people do to like you say the money crunch and they were trying to do the service But they haven’t run all over the state of Kansas You know But you know if you just sit down to a timesheet or one of the days you don’t take care of one person That’s pretty that’s quite a bit. So You know, so you go to this provider that’s not only supposed to be answering my needs and The paper we’re keeping on top of everything, but you’ve got one You know doing two or three jobs it, you know, I understand we’re short-staffed so also that earning about This has to do with my sister has Medicare She has D Hospital insurance plan, and she herself came here Medicaid Unfortunately Karen, hey, the others don’t want to pay either so It seems like Or between a rock with her place. It’s like what’s the point Atta gated? But Medicare can I paint something that the others are Well, it should just be our hand that Medicaid doesn’t pay It’s evil but just a government employee I’m just curious as to why just because Medicare has been Is your mother and at nursery yes. Yes, okay with Russell but there For nursing facilities, they’re dedicated staff. There’s not offices in every county, but there’s dedicated staff at the clearinghouse Nursing facility On Into where There are So I guess my observation is we’ve lost 11e on the Moment where we can an agency wants to decrease costs that our population is increasing And they will list a number worse right, so it just doesn’t there’s a disconnect but I Think about how they can help The other thing to think about is Does everyone Can there be other services that would help that are paid or that maybe aren’t as Resource intensive You know Apartments or other settings that that may be, you know, obviously some folks need more staff time than others but look at as well I would also encourage them to think about health foundations oftentimes Health Foundation’s won’t grant money for sustained activities But they will help or planning or bringing something up if you can, you know find your funding to support it. So There’s there’s Foundation Kansas City. They reach foundation But we have six or seven health foundations in Kansas, you know as as family She might want Amanda ever work with usury He’ll approach them to those foundations and see what they can do to help as well to sort of get things started and as I said, you know once one some things I’ve been running in it and we Which has been ongoing for over a year That will handle it every time we talk to someone and then just read them Now that’s that’s one of the issues with declared house. There are case managers for cases If you if you have information if you’ve got his his number and the date you complied or renewed You see Russell afterwards. He can check on for you to see what’s happening They don’t tell us enough information. They just tell us it’s in the works that we can find out anything more go there That’s right against the folks that you talk to you where the customer service folks the people who are working The applications are in the applications. They’re not on the phone. So they can’t answer those questions and the customer service people Status Kinda benefit who determines our criterion the MCO The federal government or Kansas how to benefit any qualify for an event You have a statement benefit. Let’s say a mental illness residential This again skill it to set the criteria for you to qualify for that or is that something you do the follow that? It’s actually a combination so for every healthcare code That is it different with each MCO very similar meaning that you might qualify under London MCO for the benefit Maybe not in the other or do they follow all the same right here? okay, so it starts with federal government deciding water carries for and Typically with that they’ll say you can provide it. You know, what type of provider? you know and Criteria like that. So then if we cover that service We need to find it in policy region and that is Sheriff Jim Speros All these guys have to cover that service now in some cases, they apply what’s called medical necessity and That means they look at every individual and medical necessity is individualized So, you know if I break my leg and Russell breaks his leg we might not get the exact same treatment because there might be something slightly different about my leg breath break than his and They would apply the best you know clinical guidelines for that broken leg all of the NCOs use guidelines that are either women or Injured wall And those are set or physical health care and for many of the behavioral healthcare codes not all of them So they can they can take what we say has to be covered and then they can apply medical necessity and use those clinical guidelines on an individualized basis to say You qualify that you don’t or this particular choice, then who gets the appeal? The individual you know If you appeal it gets well first first the appeal if your if your remember the appeal goes to the MCL But you also have to know And the statement witness state so there’s no arbitrator or it never gets rolled up No, no So it goes to the museum they can review it But you can also it’s not called an appeal to the state You can file for a state fair hearing and that comes to us and we have an Office of Administrative Hearings. It’s an independent entity with administrative law judges who review and hear those My question is about the change to community service coordinators from TCMS is this expected to be a cost neutral to each or is this expected to cost more or will it cost less than the previous model and Another question I have is regarding the I DD waiver. Is there any effort? Currently or is there any change for those? That will shorten the waitlist or the IDT waiver, which is currently at eight to ten years Okay, I’ll take the first question a lot Brad take the second line The first question is we don’t know if it’s going to cost someone cost less or be the same It’s going to depend on the work that we do with stakeholders how we define the service what we decide to pay Etc. So we’re not you know, we’re not saying one way or the other is going to save money or costs money We think it’s the right thing to do based on all the feedback Years about care coordination And on the IEP weightless Pen goes back to Becky’s comment earlier Funding eliminates a waitlist so right now we have a Cap of how many individuals we can serve behind II which is just about nine thousand with the existing funding that we have So to serve more than nine thousand individuals, we would have to have additional funding from the legislature our agency last year we put a budget every question to eliminate those an AED in the PD waitlist Which the cost of that was going to be about two hundred million dollars So we are Linking this year is where you prepare a budget to Submit a five-year plan that would break it if we eliminate those waitlist within five meters So that’s something we’re working on currently of what a five-year plan would look like if we can get funding over five years So that was specifically related to those renewals better I Have a daughter Tamara HTTP Bernie and Erica came here with and hairless first developed part of the reason for that our understanding was that would reduce the cost of Normal, I’d like to know The cost of Medicaid in those five years So I can speak a little bit to that. I know we do have we presented to the legislature. Basically what the cost is very Little that was cost savings. Most of it was what we call cost avoidance basically preventing the cost time from Continuing to rise so we do have some some some data that we can provide probably as part of the Q&A that we’ll have afterwards that we can include as part of that to show what what that those possible to look like freakin fair if you would have Stayed in fee for service. And what was the cost look like today? Okay, so We mentioned we’re having meetings in October. So look for the invitations to those meetings come to your loved ones or you all Shortly, there’s there are being mailed out now I think there are sheets on or half sheets on your table with more details about The exact locations of these meetings and the times but they’ll be similar to this 6:00 to 8:00 When we’re going to have more Because we want to make sure we’re reaching everybody when we talk about those enrollment packages So make sure you’ve come to one of those meetings that’s where we’re going to go over there value-added services the 3mc others including Aetna will be able to Speak to you at those meetings so you can meet Representatives from each of the plans you can ask the questions We’ll go over the enrollment packet. I’ll talk more about those value-added benefits and you can actually see a chart that will compare the three plans on the particular issue If you have questions you can call Can go to our website and get our wealth of information including those reports that I talked about And we want to thank you all for coming tonight Choker and remember if you have these specific individualized questions, you can meet up with a person

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