(Feb. 3, 2023) – Today, the Joint Bob Bethell KanCare Oversight, chaired by Senator Beverly Gossage (R-Eudora), heard concerns from Shannan Flach, vice president of finance and reimbursement, Kansas Hospital Association, regarding prior authorizations. Flach highlighted how prior authorizations are no longer saving unnecessary costs but instead costing taxpayers money. She shared some specific examples about Medicaid-managed care organizations and how the prior authorization process creates delays in care and drives up staffing costs. She also emphasized how prior authorizations jeopardizes Kansas' ability to attract and retain clinical specialists. The MCOs' responded they weren't aware of any physicians waiting hours for prior authorization responses and suggested there was just a need to educate providers more on the topic. The committee members asked for response times and the percentage of initial denials. The chair suggested she is willing to sit down with MCOs and hospital stakeholders to facilitate a further discussion on this topic.

The committee also heard from:

• Lou Ann Kibbee, Southeast Kansas Independent Living, testified about worker needs, waiver lists and asked for parity in payments to workers.
• Audrey Schremmer, 3 Rivers, Inc., Center for Independent Living, testified regarding the patients they are seeing, as well as how Medicaid expansion could help their facility's direct-care service workers.
• Askia Adams, Private Citizen highlighted how the state can support direct-care professionals.
• Craig Knutson, Kansas Council on Development Disabilities, emphasized the work of the Special Intellectual or Developmental Disability Interim Committee.
• Liz Long, Kansas Council on Developmental Disabilities, requested a centralized licensing system with long-term state funding for such a system.
• Colin Olenick, Self-Advocate Coalition of Kansas, discussed the need for reformed evaluation processes.
• Matt Fletcher and Nick Wood, InterHab, spoke about the need for targeted case management rate enhancements and how caps could complicate programs.
• April Holman, Alliance for a Health Kansas, spoke about why KanCare expansion is needed and asked for a public hearing.
• Tanya Dorf Brunner, Oral Health Kansas, testified dentures need to be covered specifically for those living in long-term care settings.
• Scott Lopez, Alliance Rehab and Medical Equipment, emphasized the current reimbursement is unsustainable to continue providing services by his industry allowing Kansans access to necessary medical equipment.
• Carrie Grosdidier, Infant Toddler Services of Johnson County, gave examples of delays in equipment and access to medical procedures for children.
• Madison Elliott, National Alliance on Mental Illness, highlighted Kansas Health Institute report on Medicaid expansion and how it helps provide access to behavioral health services.
• Leslie Anderson, Kansas Association of Area Agencies on Aging and Disabilities, gave an overview of how programs save state funds.
• Linda MowBray, Kansas Health Care Association and Kansas Center for Assisted Living, shared a map showing that since 2020, 19 skilled nursing homes have closed and with one more scheduled to close in March.
• Rachel Monger, LeadingAge Kansas, distributed a situation report and walked through cost increases for staffing agencies. She requested increases to reimbursement rates, staffing agency reform and workforce innovation.
• Haely Ordoyne, Kansas Adult Care Executives, stressed they are united in requests for assistance from legislators.

Written testimony was submitted from:

• Rick Elskamp, private citizen
• Tony Johnson, Recover-Care Midwest

The committee heard from KanCare Ombudsman Kerrie Bacon and Medicaid Inspector General Steven Anderson.

Agencies appearing before the committee:

• The Kansas Department of Health and Environment provided updates on the following:
  • 1115 Waiver
  • New MCO contracts and request for proposals
  • Postpartum extension update
  • Health Care Access Improvement Program
  • Supporting and Training to Employ People Successfully (STEPS)
  • Analytics and performance metrics eligibility
  • KHDE clearinghouse update
  • Unwinding continuous eligibility
  • MCOs' financial review
• KDADS gave updates on the following:
  • Receiverships
  • Home and community-based services
  • HCBS waiver enrollment and waiver lists
  • HCBS waiver renewals and proposed amendments
  • HCBS Final Settings Rule
  • Regulations update
  • All-Inclusive Care for the Elderly Program
  • Behavioral health
  • Children's psychiatric hospital in Hays
  • Psychiatric residential treatment facilities
  • Long-term care
  • Nursing facility and adult care home COVID-19 issues
  • Staff recruitment and retention
  • State hospitals
  • Behavioral licensing/certification and workforce education
  • Performance metrics and analytics
  • Quarterly report on savings transferred to HCBS Savings Fund and fund balance
  • Community support waiver

The MCOs also provided updates to the committee.