KHPA weighing changes to Medicaid program

TOPEKA — The Kansas Health Policy Authority is looking for ways to increase efficiencies, cut costs and find additional revenue within the state’s Medicaid program.

Agency officials say for several months they’ve been reviewing Medicaid policies affecting services, eligibility, program integrity and special populations.

The reviews — 14 in all — will be presented to a six-member Medicaid Transformation Committee comprised of health policy authority board members and staff.

The committee will develop recommendations for the agency’s full board, which, in turn, will forward them to the 2009 Legislature.

Possible changes being considered include:

Adjusting rates paid to doctors and hospitals.
Limiting home health visits and hospice stays.
Developing an online system for determining Medicaid eligibility.
Creating a managed care program for people with disabilities.
A provider tax on nursing homes that could generate up to $100 million a year in additional revenue.
Decreasing payments for durable medical equipment — oxygen, primarily — and transportation services.

“These things sound very appropriate for the health policy authority to study and review,” said Sen. Jim Barnett, R-Emporia, chairman of the Senate Public Health and Welfare Committee. “I’m confident they will be able to help us control costs, save money and increase efficiency.”

Barnett, a physician, said he sees inefficiencies within the Medicaid system “almost on a daily basis.”

Nursing home residents whose stays are Medicaid-funded, he said, “are required to have a physician evaluation every 60 days — it doesn’t matter if they’re stable or not, they still have to have those visits. So we have visits built into the system that aren’t medically necessary.

“Compare that to private pay patients — we see them as needed,” Barnett said. “So the system has inefficiency, overuse and extra cost built in.”

The transformation committee is scheduled to meet from 1 to 3 p.m. July 31 and from 9 to 11 a.m. Aug. 7 at the health policy authority office.

Earlier this month, committee members received a rough draft of the comprehensive program review. It noted:

Many states limit home-health services to 50 to 100 visits a year, roughly one to two visits a week. Kansas allows one to two visits a day.
The state’s Medicaid eligibility threshold for non-disabled adults is among the lowest in the nation.
The aged and disabled account for 26 percent of the state’s Medicaid population but 68 percent of its Medicaid spending.
The two costliest components of Medicaid hospital services are births and emergency room visits.
Kansas has one dentist for every 2,557 residents; the national average is one for 1,760 residents. The state’s reimbursement rates for dental care are roughly 60 percent of the regional average.
In the last five years, hospice-care spending has increased more than 139 percent, making it the fastest growing service within the Medicaid budget. Between fiscal years 2005 and 2007, the average length of stay in hospice care increased “significantly.”
In fiscal 2009 and in keeping with a federal mandate, Kansas expects to spend between $10 million and $12 million on emergency care for undocumented persons. Births are expected to account for 70 percent of those costs.

The transformation committee will present its recommendations to the full health policy authority board during the board’s Aug. 19 meeting.

“The impetus for the committee is a very strong desire on the agency’s part to be a data-driven policy center, and we believe our programs should be run as efficiently and as effectively as possible,” said Barb Langner, policy director at the health policy authority.

The committee members are health policy authority Executive Director Marcia Nielsen, Deputy Director Andy Allison, and board members Arneatha Martin, Joe Tilghman, Garen Cox, and Ray Davis.

Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.