What a conference we are having! It is like the who’s who’s in disability policy!
The big surprise of the day was a visit by Secretary Saddler! She addressed the group and
spent the morning with us. We appreciate her support of The Arc!
Today at The Arc’s Leadership Conference we will hear from Lilia Teninty who will share her
perspectives on managed care and the 1115 waiver. One of the states I have been following
on managed care and the 1115 waiver is Kansas because it will be the first state to utilize for-
profit managed care organizations for IDD Long Term Care. This is similar to what Illinois is
implementing and has on the table for Phase III. Initially the Center’s for Medicare & Medicaid
rejected Kansas’s proposal a few weeks ago. I was surprised that CMS has now approved the
Kansas proposal with many important safeguards which you can see below, with includes
eliminating the waiting list.
See the summary of this from Maureen Fitzgerald with our national office.
Kansas received approval from CMS to move 1915(c) waiver services for individuals with I/DD
into KanCare, the state’s managed care program, beginning February 1, 2014. Kansas will be
the first state to provide LTSS for people with I/DD through private health insurance companies.
Attached are the letter of approval and the special terms and conditions (STCs) for the new
program. The documents also are available at http://www.khi.org/news/2014/jan/30/feds-
Among the STCs that may be of interest, are the following:
Continuity of Care – STC 35 (b) iv. People can keep their service providers even if they are
out of the MCO’s network for 180 days or until a new service plan is developed and agreed upon;
people receiving residential services can keep their providers even those out of network for one
year at full FFS rates.
Changes to Ombudsman Program – STC 42. Strengthens the role of the ombudsman,
requires trained personnel, and requires robust system of data collection and reporting,
including 6-month reports to CMS.
Quality Measurement – STC 46. Within 12 months, Kansas must submit an amendment to its
1915(c) waiver to incorporate quality measures that reflect services delivered through managed
care. Measures should focus on outcomes, quality of life, effective processes, and community
Eliminate waiting list – STC 47. A portion of any savings realized through KanCare must go to
providing more 1915(c) waiver services to those on waiting lists.
Conflict of Interest – STC 48. Kansas must establish conflict free service planning guidelines
for contracted entities to ensure that consumers have choice in services and providers, a method
for requesting changes to service plans, HCBS and settings alternatives from which to choose,
and grievance and appeal rights.
HCB setting and community integration – STC 51. Incorporates new HCB setting
requirements (42 CFR 441.530).
ID/DD in Managed Care – STC 54. People may keep their targeted case managers; MCOs must
contract with at least 2 providers of each covered LTSS for each county and make at least 3 offers
to all providers at or above the state-set FFS rate. Kansas must review MCO service planning
process within first 180 days and conduct training for MCOs in DD service system in 2014 and 2015.
Any proposed reduction, suspension, or termination of services by an MCO must be approved by
the state and the process used shall be publicly available. Within 6 months, all waiver recipients
receiving some but not all waiver services (the approximately 1,700 underserved) shall have
their unmet needs assessed and met.
State oversight – STC 58, 60, 62, 63, and 64. The state must conduct ride-alongs with MCOs
during the first 180 days to observe needs assessment and service plan development. Kansas
must hold calls at least 2 times a week with MCOs during first 30 days and weekly for the next 60
days. During the first 30 days, Kansas must review all call center data daily and at least weekly
for the next 150 days. State must review complaint, grievance, appeal notices, and appeal logs
for each MCO weekly for the first 90 days and then at least bi-weekly for the next 90 days.
State must approve all referrals to public nursing facility or ICF/IDD.
CMS oversight – STC 62. The state must submit weekly reports to CMS about issues
encountered during calls with MCOs and plans for addressing them.
1825 K Street NW, Suite 1200, Washington, D.C. 20006
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423