TO: Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services & KanCare Oversight

FROM: Debbie Thuston, District 3 Co-Representative, Kansas Home Care & Association

KanCare Issues for Home Care and Hospice Providers

August 21, 2018

My name is Debbie Thuston, RN BA and I am the Neosho Memorial Regional Medical Center Home Health Agency Director. We provide home health services as well as hospice services to our rural community.

I would like to thank you for the opportunity to speak to you today on behalf of the Kansas Home Care & Hospice Association related to Medicaid Managed Care (KanCare), for the Home Care and Hospice providers of our association.

As you may already know, as a home health & hospice agency we provide skilled , therapy and aide services to individuals in their home environment. We help to assess, train, educate, and manage care to empower people to be able to manage their own at home. This service has proven to reduce hospitalization, unneeded trips to emergency rooms, and gives a person a sense of accomplishment to be a part of their own healthcare choices.

I would like to take this opportunity to give you a first-hand look on front line issues my agency is facing with the MCO’s on KanCare. These are just a few examples of issues we face that impact our patient care:

1) Young adult with mobility issues and is dependent on a motorized for daily activities. MCO refused to fix and/or repair his current motorized wheelchair. Therefore, client had to complete a new Mobility Evaluation, which was done in March 2018. Client did not receive his new motorized wheelchair until July 2018. This was a 4 month delay of services to this young person who depends every day on this durable medical equipment. 2) Denial for Medicaid: We are currently serving a person for home health services who does not have medical insurance through our agency. This person has a terminal prognosis and has applied for Medicaid twice and has been denied both times. This last time he was denied in July with the reason stating, he “did not live in Kansas.” Patient has been living in our county for quite some time receiving free medical care, not only from our agency, but through our and the surrounding community. I do not know how this individual cannot qualify for Medicaid. Our agency and hospital are trying diligently to help him appeal this denial. We are still awaiting the decision of the State for approval of services. 3) Communication between MCO’s and Providers: We find there is a large disconnect with the communication process between the MCO’s and providers. We are unable to speak with Medicaid case managers to update them on patient status, progress and plan of care, continuity of services, overlapping of services, etc. One important focus of home care is related to communication of care. This applies to all parties involved in the patient’s care. It should/would be important to update and address any concerns to the MCO case manager for the patient for the best transition of care. To this date, we are unable to incorporate this communication process into our transition of care. 4) Low reimbursement rate. Have a patient that needed daily wound care in his home. He was being seen by a wound care each week and home health SN visit 6 out of 7 days a week for wound care, assessment, and education. Patient did not have any other resources to fall back on to help him with his medical management. When you count up the SN visit and travel time, along with mileage and the administrative costs to provide care to this patient, we lost money on each visit. How can an agency survive providing “free” services all the time? 5) Authorizations for home care: Even though the MCO’s are all under KanCare Medicaid, each MCO has different rules and regulations to follow for authorizations and claim reimbursements. It is frustrating for staff to get timely responses for authorizations for patient care. For instance, with United Healthcare we requested authorization for continuation of services as follows: 7/9/18 – Faxed authorization for services 7/10/18- Received fax from MCO stating “request pending” 7/23/18 – Staff called MCO back. MCO informed us that request still pending. 8/1/18 - Staff called back and request still pending 8/6/18 – Staff called back – still pending, they were to “expedite” request 8/7/18 – Called back – no change 8/8/18 – Received fax from MCO – “no authorization required” This is just one example of the provider cost related to time, staff, and resources it takes to follow the different processes of MCO’s.

It has been proven that care in a patients home is the preferred and most cost effective way to care for a person, we should look at finding solutions to continue to provide high quality care in the home setting to provide what is best for Kansas citizens.

I would encourage the oversight committee to think about these issues and concerns that we are dealing with on a daily basis; to help us provide care to our community members; to find solutions to these important issues to strengthening our resources and make Kansas great!

I appreciate your time and attention to this highly important matter.

Respectfully submitted,

Debbie Thuston, BA RN, Director NMRMC Home Health Agency 1709 W. 7th Street Chanute, KS 66720 (620) 432-5436