Kansas
Kansas court sides with Stormont Vail in Medicaid payment dispute
Stormont Vail Healthcare is in a legal battle with the state government, alleging the Medicaid program was wrong to refuse payment for the hospitalization of a pregnant patient with complications.
At issue is a disagreement between the Topeka hospital and the Kansas Department of Health and Environment over whether inpatient health care services were medically necessary for the Medicaid patient’s last two weeks of pregnancy.
The Kansas Court of Appeals did not resolve that dispute, but it did side with Stormont Vail in a May 8 decision. The unanimous three-judge panel reversed a decision by Shawnee County District Court Judge Thomas Luedke and vacated an order from KDHE’s State Appeals Committee. The matter now goes back to the appeals committee for reconsideration.
The appellate panel was comprised of Judges Jacy Hurst, Thomas Malone and Stephen Hill, which heard oral arguments on Aug. 5. Hurst wrote the court’s opinion.
The lawsuit stems from a 2018 case of a pregnant patient, who is not named in appellate court documents. She was 28 years old at the time and had an intellectual disability among other complications, including rapid weight loss caused by hyperemesis gravidarum.
The woman was originally admitted at Newman Regional Health in Emporia before she was transferred to Stormont Vail. Part of the hospitalization during her third trimester was covered.
But the final two weeks were not because Sunflower Health Plan, one of the managed care organizations in the state’s privatized Medicaid program known as KanCare, refused to reimburse for the patient’s continued hospitalization through the day the child was born via cesarean section.
“We are here because the Kansas Medicaid program has wrongfully refused to pay for some of an inpatient hospitalization while a Medicaid beneficiary was at Stormont Vail,” said Amanda Wilwert, an attorney for the hospital, during oral arguments. “Stormont believes the inpatient care was medically necessary as defined by the Kansas Medicaid regulations.”
Court records and oral arguments show the state expected Stormont Vail to look into having a home health agency care for the patient in Emporia instead of continued hospitalization — even though home health generally does not take care of pregnant patients and her doctors believed the expectant mother was not stable enough to discharge.
“The way it’s supposed to work,” said Darren Sharp, an attorney representing KDHE, “is the managed care organization, in this case Sunflower Health, on behalf of KDHE reviews the medical records, asks about the appropriate level of care and whether there’s any other interventions that would be more cost effective or appropriate depending on the level of or depending on the patient’s records and the patient’s status.”
Sharp argued medical records showed the patients was getting better because of total parenteral nutrition, or TPN.
“This is when a tube, a PICC, is inserted and your minerals and your electrolytes and all of your nutrition is then intravenously provided,” Sharp said.
He said the treatment “was eliminating her vomiting, her diarrhea, she had no fever, her glucose levels were stabilized.”
In their ruling, the judges indicated the KDHE appeals committee primarily cared about the cost saving of using home health versus hospitalization while disregarding the treating physician for insufficient reasons and ignoring evidence on potential benefits or harms to the patient.
But the judges declined to resolve the dispute. Rather, unless the decision is appealed to the Kansas Supreme Court, the matter goes back to the KDHE administrative process.
There, the agency’s appeals committee must reconsider the case consistent with the Court of Appeal’s ruling. The published decision sets new precedent interpreting state laws and regulations on the Medicaid program.
“While this court provides no opinion on whether the disputed inpatient healthcare services met the definition of medical necessity,” Hurst wrote, “the record shows that some of the (appeals committee’s) factual findings were not supported by the record as a whole and that the (appeals committee) inaccurately applied the law when it failed to consider (the patient’s) individual characteristics and assess the harms and benefits of the healthcare intervention.
“In making a medical necessity determination, the reviewing agency must make an individualized determination based on the record as a whole.”
Jason Alatidd is a Statehouse reporter for The Topeka Capital-Journal. He can be reached by email at jalatidd@usatodayco.com. Follow him on X @Jason_Alatidd.
Before Thomas Tuchel and his England players departed for the United States, there was talk about their World Cup training ground in Kansas City being too open. It was motivated, in part, by the Southampton spygate scandal. Would England’s rivals be able to steal a glance at them? Tuchel even said that the Football Association would look to erect protective fences.
The nine-pitch facility at Swope Soccer Village is certainly sprawling but here’s the thing. Nobody is getting on site without going past the armed police officers at the entrance. There was a throwaway line from a steward on Saturday as England trained on the complex’s showpiece pitch after flying in from Florida after their pre-tournament camp. “You guys see spying,” he said. “We see personal security.” The latter rather overrides the former. It was safe to say that they have it covered.
The buildup to England’s arrival was further coloured by the theft of some of their kit in transit from Florida, including boots and footballs. Again, it did not feel like much of issue. Everything was recovered; two arrests have been made. “My boots?” said the goalkeeper, Dean Henderson. “I’ve got them on my feet so it’s all good. We got them all back so it’s nice.”
There did not seem to be much to fret about as the players went through a light session that lasted about an hour – if training under blue skies and a blazing sun that pushed the mercury to 29C can be described as light. The second chapter of England’s summer adventure has started and if the focus is about to narrow and the intensity pick up, then the excitement has gone up a few notches, too.
The opening tie against Croatia in Dallas on Wednesday is edging closer and the good news is that England look to have what they need at Swope and, indeed, their hotel – the four-star, 54-room Inn at Meadowbrook, which is a 20-minute drive away.
England always wanted to stay in Kansas City because of its location in the centre of the US and how it would mitigate their travel distances to matches; the plan is to fly in and out for each assignment, the FA having been clear about the benefits of a fixed base, a home.
England were denied the first pick of Kansas City’s training bases and even the second because they were not drawn to play any of their group phase games here. Argentina and the Netherlands were and the former bagged the best facility – Sporting Kansas City’s performance centre. The latter went for the training ground of the women’s team, the KC Current, which is newer than Swope, perhaps a little slicker-looking. As an aside, a fourth nation – Algeria, who have matches in Kansas City – have ended up at the University of Kansas facility.
But Swope, which is home to Sporting KC’s second team and their academy sides, ticked the boxes for Tuchel and the FA. It was particularly reassuring to see the quality of the pitch they used on Saturday – in light of scare stories about that aspect of things. England will rely on a different grass surface which is around the back of the main building but the reality is that it is of the same standard. And the standard is high. Local media described all three grass pitches at Swope – the other six are astroturf – as among the best in the state. They are absolutely comparable to those that Argentina and the Netherlands will use.
The FA has put a new gym in at Swope and created a lounge for the players and they are happy, too, with the intimate Inn at Meadowbrook, which they have taken over exclusively. There are a number of permanent residents that live in condos close to the site and their access to areas like the principal restaurant will be restricted while England stay there. To say thank you, Tuchel’s players will have a meet and greet with them.
The training session at Swope was open to a number of local children, who were specially invited and thrilled to be there. Harry Kane felt a lot of love. “Harry, you’re better than Bellingham,” screamed one over-excited youngster. There were banks of media at one end of the pitch.
What stood out for England was the warmth of the welcome. The locals were out in force with flags and signs as they drove up to the hotel – a massive police escort having helped them there from the airport. As the players walked in, they heard music from the Kansas City Chief’s band and saw the NFL team’s cheerleaders. Even the mascot, KC Wolf, was there.
Kansas City was not supposed to be a host venue for matches but they got the invitation from Fifa after Chicago said no. They are overwhelmingly delighted to have been asked. It is a city of jazz music heritage, the birthplace of Charlie Parker. It is a city of fountains, with over 200 of them, some spectacular. There are 220 parks and 29 lakes. It is a city of barbecued meats, smoked ribs and burnt ends among the specialities. It is a city of charm and friendliness, which has a love affair with the heart symbol, partly because it is in the heart of the US. “We like to say that we greet people with a smile and a wink,” said one local.
Most urgently, perhaps, it is a city of sporting passion, headlined by the Chiefs, who have won three of the last seven Super Bowls. Also their baseball team, the Kansas City Royals. Football is big, too, thanks to Sporting KC and the Current, whose CPKC Stadium was the first in the world to be purpose-built exclusively for a professional women’s sports team.
The World Cup Fan Fest, which has been designed by the global architects’ firm Populous and holds 25,000, was rocking on Friday night as the US thrashed Paraguay in their opening World Cup tie. Fans enter it through a 65ft high heart. England intend to thrive off the positive vibes.
KANSAS CITY, Mo. — The National Weather Service has issued a tornado watch for the entire Kansas City metro on Saturday.
The FOX4 Weather team reports that isolated storm cells this afternoon and a small line in the evening could bring damaging winds, hail and possibly even tornadoes.
The Tornado Watch is in effect for Jackson, Cass, Clay, Platte and other Missouri counties, as well as Wyandotte, Miami, Franklin and other counties in Kansas. For a full look at where the alert is in effect and other warnings for the Kansas City area, click here.
A Flood Warning has also been issued in Cass, Henry and Johnson counties on the Missouri side of the state line.
Around 6:15 p.m., the National Weather Service issued a Severe Thunderstorm Warning for Nodaway, Holt, Atchison and Worth counties until 7 p.m.
With the FIFA Fan Festival continuing through the weekend, the KC2026 team is monitoring the weather situation as well. On Friday, it was announced that a delay, postponement or cancellation could happen if the weather proves too severe.
Already, The Chainsmokers concert at FIFA Fan Fest has been postponed due to the forecast.
Stay with the FOX4 Weather team for the latest weather alerts and updates.
KANSAS CITY, Mo. (KCTV) – Emergency crews treated nearly two dozen people after a carbon monoxide scare Friday morning. Four of those people were taken to hospitals.
The Kansas City Fire Department responded to a call about an unconscious person at a business located near NE Underground Drive near Missouri 210 Highway. The call came in around 8:30 a.m.
Emergency crews evacuated the business. They also began monitoring the air quality inside the area.
Crews later determined the issue was caused by high levels of carbon monoxide. Firefighters monitored the air quality for several hours after the call.
They cleared the scene shortly before 11 a.m. and people were allowed to go back to work inside the cave.
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