JOINT COMMITTEE Report of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight to the 2018 Kansas Legislature CHAIRPERSON: Senator Vicki Schmidt VICE-CHAIRPERSON: Representative Daniel Hawkins RANKING MINORITY MEMBER: Senator Laura Kelly OTHER MEMBERS: Senators Barbara Bollier, Bud Estes, Richard Hilderbrand (August and November meetings), and Jacob LaTurner (February and April); and Representatives Barbara Ballard, Susan Concannon, John Eplee, Jim Ward (February, August, and November), Chuck Weber, and John Wilson (April) CHARGE KSA 2017 Supp. 39-7,160 directs the Committee to oversee long-term care services, including home and community based services (HCBS). The Committee is to oversee the savings resulting from the transfer of individuals from state or private institutions to HCBS and to ensure that any proceeds resulting from the successful transfer be applied to the system for the provision of services for long-term care system. Further, the Committee is to oversee the Children’s Health Insurance Program, the Program for All-Inclusive Care for the Elderly, and the state Medicaid program, and monitor and study the implementation and operations of these programs including, but not limited to, access to and quality of services provided and any financial information and budgetary issues. January 2018 Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight ANNUAL REPORT Conclusions and Recommendations The Committee expresses the following concerns and adopts the following recommendations: ● KanCare 2.0 proceed as scheduled; ● The Kansas Department of Health and Environment (KDHE) include comprehensive dental benefits for adults in the KanCare 2.0 request for proposal; ● KanCare 2.0 include measures to reduce the waiting lists; ○ The Committee is concerned about the increase in Home and Community Based Services waiting lists; ● A comprehensive master plan addressing mental health be developed, including corrections; ● KDHE provide to the Senate Committee on Public Health and Welfare and the House Committee on Health and Human Services, by February 22, 2018, effective criteria and performance measures for the KanCare Clearinghouse and call center; ● The Kansas Department for Aging and Disability Services develop policies and practices for surveying long-term care facilities that will give surveyors latitude in interpreting deficiencies, provide adequate salaries and thorough training to enhance the work of surveyors, and monitor inspections and provide reports to the Committee regarding citations and fines; ● A letter from the Committee be sent to the Centers for Medicare and Medicaid Services requesting Kansas representation on a stakeholder group reviewing the nursing home survey process and a copy of the letter be sent to the Kansas congressional delegation. (Staff note: After further investigation, it was determined that such stakeholder group does not exist; therefore, no action will be initiated by the Committee regarding this recommendation at this time. The Chairperson has directed staff to advise Committee members of this development at the January 2018 meeting.); ● KDHE clarify the language regarding power of attorney (POA) documents to distinguish between POA for health care and POA for finances; and ● The Child Welfare System Task Force review and clarify Medicaid eligibility for children in foster care and consider streamlining eligibility to make the transition out of foster care more consistent and efficient. Proposed Legislation: None Kansas Legislative Research Department 1 2017 HCBS and KanCare Oversight BACKGROUND As required by statute, at the beginning of each regular session, the Committee is to submit a The Robert G. (Bob) Bethell Joint Committee written report to the President of the Senate, the on Home and Community Based Services (HCBS) Speaker of the House of Representatives, the and KanCare Oversight operates pursuant to KSA House Committee on Health and Human Services, 2017 Supp. 39-7,159, et seq. The previous and the Senate Committee on Public Health and Joint Committee on HCBS Oversight was created Welfare. The report is to include the number of by the 2008 Legislature in House Sub. for SB 365. individuals transferred from state or private In HB 2025, the 2013 Legislature renamed and institutions to HCBS, as certified by the Secretary expanded the scope of the Joint Committee on for Aging and Disability Services, and the current HCBS Oversight to add the oversight of balance in the HCBS Savings Fund. (See KanCare (the State’s Medicaid managed care Appendix A for the 2017 report.) The report also program). The Committee oversees long-term care is to include information on the KanCare services, including HCBS, which are to be Program, as follows: provided through a comprehensive and coordinated system throughout the state. The ● Quality of care and health outcomes of system, in part, is designed to emphasize a individuals receiving state Medicaid delivery concept of self-direction, individual services under KanCare, as compared to choice, services in home and community settings, outcomes from the provision of state and privacy. The Committee also oversees the Medicaid services prior to January 1, Children’s Health Insurance Program (CHIP), the 2013; Program for All-Inclusive Care for the Elderly (PACE), and the state Medicaid programs. ● Integration and coordination of health care procedures for individuals receiving state The Committee is comprised of 11 members: Medicaid services under KanCare; 6 from the House of Representatives and 5 from the Senate. Members are appointed for terms that Availability of information to the public coincide with their elected or appointed ● legislative terms. The Committee is statutorily about the provision of state Medicaid required to meet at least once in January and once services under KanCare, including access in April when the Legislature is in regular session to health services, expenditures for health and at least once for two consecutive days services, extent of consumer satisfaction during both the third and fourth calendar with health services provided, and quarters, at the call of the chairperson. However, grievance procedures, including the Committee is not to exceed six total meetings quantitative case data and summaries of in a calendar year, except additional meetings may case resolution by the KanCare be held at the call of the chairperson when urgent Ombudsman; circumstances exist to require such meetings. In its oversight role, the Committee is to oversee the ● Provisions for community outreach and savings resulting from the transfer of individuals efforts to promote public understanding of from state or private institutions to HCBS and to KanCare; ensure proceeds resulting from the successful transfer be applied to the system for the provision of services for long-term care and HCBS, as well ● Comparison of caseload information for as to review and study other components of the individuals receiving state Medicaid State’s long-term care system. Additionally, the services prior to January 1, 2013, to the Committee is to monitor and study the caseload information for individuals implementation and operations of the HCBS receiving state Medicaid services under programs, CHIP, PACE, and the state Medicaid KanCare after January 1, 2013; programs including, but not limited to, access to and quality of services provided and financial ● Comparison of the actual Medicaid costs information and budgetary issues. expended in providing state Medicaid Kansas Legislative Research Department 2 2017 HCBS and KanCare Oversight services under KanCare after January 1, KanCare Overview and Update 2013, to the actual costs expended under the provision of state Medicaid services The Secretary of Health and Environment prior to January 1, 2013, including the reported KDHE submitted a request for a one-year manner in which such cost expenditures extension of the current (1115) Medicaid waiver are calculated; (1115 Waiver). The Centers for Medicare and Medicaid Services (CMS) approved the request in ● Comparison of the estimated costs November 2017; therefore, the current KanCare expended in a managed care system of program will continue until December 31, 2018. providing state Medicaid services before January 1, 2013, to the actual costs KanCare Cost Comparison expended under KanCare after January 1, 2013; and At the February meeting, KDHE submitted testimony stating KanCare had produced more than $1.4 billion in savings to the State and a ● All written testimony provided to the portion of those savings were used to eliminate (as Committee regarding the impact of the of August 2016) the physical disability (PD) provision of state Medicaid services waiver and reduce the intellectual and under KanCare upon residents of adult developmental disability (I/DD) waiver waiting care homes. lists. Upon discussion with the Committee, the Secretary of Health and Environment indicated the All written testimony provided to the $1.4 billion could also be classified as “cost Committee is available at Legislative avoidance.” At the November meeting, the Interim Administrative Services. Medicaid Director provided information indicating that actual expenditures in 2017 (through In developing the Committee report, the September) were about $400,000 less than the Committee is also required to consider the external 2012 projection for KanCare expenditures and quality review reports and quality