Kansas inspector general’s report identifies weakness in financial oversight of Medicaid – Kansas Reflector

TOPEKA — An audit by the Medicaid inspector normal in Kansas recognized oversight shortcomings within the state’s dwelling and neighborhood based mostly service packages that raised questions of potential overpayment to managed-care corporations and management weaknesses at an company within the administration of Gov. Laura Kelly.

Medicaid inspector normal Steven Anderson, who’s assigned to the workplace of the state legal professional normal, concluded Wednesday the Kansas Division of Well being and Atmosphere lacked “an efficient system for monitoring” beneficiaries in this system.

The evaluation lined providers delivered to Medicaid enrollees within the dwelling or neighborhood from January 2018 by way of April 2021. The report was submitted to Legal professional Common Derek Schmidt, Cupboard secretaries at KDHE and the Kansas Division for Growing older and Incapacity Companies, and the Legislature’s joint oversight committee for Medicaid.

The state’s Medicaid system, often called KanCare, serves greater than 440,000 folks. KanCare is a privatized system wherein the state contracts with three corporations to ship $3.9 billion in providers yearly.

Residence and neighborhood based mostly providers, or HCBS providers, are supplied to folks with autism, mind accidents, mental or developmental disabilities, bodily disabilities, extreme emotional disturbances and the frail aged. Companies would possibly embody help with day by day dwelling resembling consuming, bathing and dressing or might lengthen to assist with managing funds or getting ready meals.

Anderson’s report indicated KDHE lacked an efficient system of monitoring whether or not Medicaid beneficiaries ought to be within the dwelling and neighborhood based mostly service program. The lapse raised problems with doable overpayment to KanCare contractors that may very well be of curiosity to federal Medicaid regulators, he stated.

“KDHE doesn’t have an efficient system for monitoring the redetermination of Medicaid beneficiaries on the HCBS program,” Anderson stated within the report. “The quantity and kinds of findings recognized through the audit point out management weaknesses.”

As well as, Anderson’s report stated the three managed-care corporations, or MCOs, failed to meet administration tasks as a result of greater than 2,800 folks recognized as being enrolled in this system didn’t have any fee claims for at the very least 12 months through the 40-month audit interval. People should use HCBS providers at the very least as soon as a month to stay eligible.

The quantity of state funds to Kansas MCOs contracted to supply providers to those idle beneficiaries totaled greater than $193 million, the report stated.

“For the scope of this audit,” Anderson’s report stated, “MCOs are required by contract to observe Medicaid beneficiaries’ use of waiver providers and make the correct notifications if providers should not getting used. It seems, based mostly on the variety of Medicaid beneficiaries that aren’t utilizing waiver providers for prolonged intervals of time, this oversight operate shouldn’t be being met.”

In the meantime, the inspector normal’s report recognized 560 KanCare beneficiaries who had no Medicaid claims aside from the month-to-month cost for an emergency response notification system. If the state had merely paid a rental price for EMS service for these people the price would have been $55,000.

Nevertheless, funds to MCOs working KanCare statewide totaled $8 million to serve the 560 beneficiaries enrolled in Medicaid.

Schmidt and Kelly are each candidates for Kansas governor in 2022. Kelly is in search of re-election as a Democrat, whereas Schmidt is the presumptive Republican nominee.

Administration of Medicaid in Kansas turned extra politicized through the 2022 legislative session when GOP lawmakers moved to dam Kelly from working towards rebidding the $3.9 billion annual contract for KanCare.

A finances provision launched by Republican legislators would delay that course of till after the November election. If handed into legislation, it will be equal to a no-bid, one-year extension of contracts with Sunflower State Well being Plan, United Healthcare and Aetna Higher Well being of Kansas.

KanCare, the state’s privatized system of Medicaid, was launched in 2013 by Republican Gov. Sam Brownback. The target was to regulate the state’s expenditures on Medicaid and enhance providers obtainable to beneficiaries.