Brain-injury therapy provider stunned by KanCare insurance company’s 28 percent rate cut

By Tim Carpenter, May 19, 2018

One of the for-profit insurance companies operating Kansas’ privatized Medicaid program unilaterally moved to impose a 28 percent reduction in payments to an Overland Park contractor providing rehabilitation services to more than 120 people with traumatic brain injuries.

Janet Williams, owner of Minds Matter, said the company ran on a 3 percent margin and was unlikely to survive the steep rate reduction contemplated by Amerigroup Kansas. She was skeptical Amerigroup Kansas could stand up a therapy delivery system equivalent to what Minds Matter created for patients in eastern Kansas.

“I think network adequacy, continuity of care and, most important, health and safety would be at a huge risk if there isn’t a trained and qualified provider standing by,” she said.

Amerigroup Kansas informed Williams in late April the elevated rate it paid for years to Minds Matter for delivery of home and community services to Williams’ clients, who generally live within 100 miles of Topeka or Overland Park, would be discontinued. Minds Matter currently treats 123 people with brain trauma enrolled with Amerigroup Kansas, but serves 40 percent of 425 Kansans in this portion of the Medicaid program.

On appeal, Amerigroup Kansas president and CEO Frank Clepper delayed implementation of the rate amendment until July 1 while pledging to negotiate a new market-based rate with Williams. Williams said Clepper described the rate paid to Minds Matter as an “outlier” that had to be brought down. Williams requested her existing rate be frozen until Oct. 1, pending future negotiations.

The issue wasn’t related to quality or accessibility of services, Williams said, but rather a desire by Amerigroup Kansas to lower its cost of caring for people with trauma-induced physical, behavioral or cognitive brain impairments and judged capable of improving through intensive rehabilitation.

Williams said she operated with a staff of 100 people who provided thousands of hours of therapy each month to Kansans who suffered brain injuries but sought to live more independently. She estimated the rate change by Amerigroup Kansas would leave people in 30 to 40 counties in jeopardy of treatment shortfalls. It might take six months for the large insurance company to line up personnel with expertise to care for brain injury patients, she said.

Minds Matter employees travel to the clients’ residence to provide services, while Amerigroup Kansas could choose to contract with hospitals or facilities that expect patients to be driven to those centers for therapy.

“It took us over five years to build up a trained and efficient workforce to provide this support,” Williams said.

The state privatized the $3 billion Medicaid program in 2013 under then-Gov. Sam Brownback, who promised services would be improved and expanded under contracts with three insurance companies — Amerigroup Kansas, Sunflower Health and United Healthcare. The KanCare program was controversial from the start, and the medical, financial and political friction revolving around the initiative continues under Gov. Jeff Colyer.

KanCare serves more than 400,000 people who are disabled, elderly or poor. Victims of traumatic brain injury who qualify for special services under KanCare — fewer than 500 people at any given time — are a niche within the Medicaid umbrella.

Malecki Dionisia, spokeswoman for Amerigroup Kansas, said good-faith negotiations would be conducted with Minds Matter to reach an agreement “consistent with other traumatic brain injury rehabilitation care providers in the Kansas Medicaid market.”

“Amerigroup periodically reviews provider agreements to ensure they are aligned with market conditions and structured to produce positive, quality health outcomes,” she said. “We fundamentally believe that individuals are best served when providers have incentives to produce high-quality health outcomes for their patients. We are hopeful that we can find common ground and continue our contract with Minds Matter.”

She said the company’s priority was to provide consumers access to reliable, affordable health care. Amerigroup Kansas has a statewide network of providers to treat people within Medicaid, she said.

Overall, Medicaid rates for traumatic brain injury services in Kansas were increased by 3 percent in 2017. The previous raise in the baseline reimbursement rate occurred a decade ago, Williams said.

Tim Keck, secretary of the Kansas Department for Aging and Disability Services, said the state’s responsibility was to set a base rate for services under Medicaid and monitor the three insurance companies to guarantee an adequate network of care providers. KDADS doesn’t participate in negotiations between KanCare insurance companies and direct-care providers, he said.

Keck said officials at KDADS had spoken multiple times with Minds Matter and Amerigroup Kansas about implications of the proposed rate reduction.

“It’s something that is a concern,” Keck said. “We want to make sure there is an adequate network. And Janet, I think, does a good job. We’re committed to walking through this with both groups.”

The situation has drawn the attention of state legislators and advocacy groups keen to hold the insurance companies and state agencies accountable for KanCare.

“Amerigroup will be before the KanCare oversight committee at our next meeting, and you better believe I have questions,” said Sen. Vicki Schmidt, a Topeka Republican who chairs the Senate’s health committee.

Schmidt said the program serving recipients of brain injuries was a point of emphasis during the 2018 legislative session. She sponsored a measure that removed the minimum age limit for participation in the program.

Sen. Laura Kelly, a Topeka Democrat, said the underlying profit motive of United, Sunflower and Amerigroup Kansas was cause for concern.

“This is what happens when you outsource your public health program to for-profit, out-of-state companies who are focused on the bottom line, not provision of services,” Kelly said.

Sean Gatewood, who represents KanCare Advocates Network, said to engage in a rate feud with a pivotal service provider, such as Minds Matter, risked weakening care available to people hurt in vehicle accidents, assaults or falling and eager to get better through rehabilitation. He said the move by Amerigroup Kansas illustrated why “private managed-care companies are really terrible at running services to people with disabilities.”

Brownback and Colyer have said privatization of Medicaid saved the state $1 billion and upgraded care for low-income and disabled Kansans. A recent report by the Legislature’s auditing division showed KanCare did boost use of primary care services.

Legislative auditors also found it impossible to analyze KanCare’s wider influence on patients because of incomplete data on health outcomes and cost trends. Neither Amerigroup Kansas, Sunflower nor United Healthcare are subject to the Kansas Open Records Act, allowing the companies to withhold “proprietary” information from state auditors.

http://www.cjonline.com/news/20180519/brain-injury-therapy-provider-stunned-by-kancare-insurance-companys-28-percent-rate-cut

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