House Social Services Budget Committee Meeting February 6, 2013 Overview of the Kansas Department for Aging And Disability Services Presented by: Shawn Sullivan, Secretary Kansas Department for Aging and Disability Services

Agency Overview Established on July 1, 2012 through Executive Reorganization Order 2,650 people employed by the Agency. Formerly known as the Kansas Department on Aging Goal of reorganization was to streamline state services and provide structure to allow affected agencies to operate more efficiently and effectively. Paved the way for reforming Medicaid system, now known as KanCare November 7, 2018

Mission & Vision Mission: The Kansas Department for Aging and Disability Services mission is to foster an environment that promotes security, dignity and independence, while providing the right care at the right time in a place called home. Vision: The Kansas Department for Aging and Disability Services envisions a community that empowers Kansas older adults and persons with disabilities to make choices about their lives. November 7, 2018

Budget FY 2013 budget: Approved budget totals $1.541 billion, including $642 million from State General Fund (SGF) FY 2014 budget: Proposed budget totals $1.499 billion, including $628 million from SGF. November 7, 2018

Agency Responsibilities Programs and services to assist older adults Behavioral health and disability services formerly housed in the KS Department of Social and Rehabilitation Services Oversight of the 5 State Hospitals Some licensure programs previously part of the Kansas Department of Health and Environment November 7, 2018

Organizational Structure November 7, 2018

Office of the Secretary Includes: -Chief Counsel -Communications Director -Human Resources -Legislative/Policy Director -Special Assistant to the Secretary Supervision of State Hospitals Administratively supports the KanCare Consumer Ombudsman November 7, 2018

Organizational Structure Department Commissions: Commission on Aging Community Services and Programs Commission Survey, Certification, and Credentialing Commission Financial and Information Services Commission November 7, 2018

Commission on Aging Administer a variety of community-based programs for the aging population through contracts and grants of state and federal funds Older Americans Act -Quality Assurance programs Congregate and home-delivered meals Caregiver programs In-home Services Senior Care Act Services Client Assessment, Referral and Evaluation (CARE) program Aging and Disability Resource Centers (ADRCs) November 7, 2018

Commission on Aging Oversee and implement grants: Senior Health Insurance Counseling for Kansas (SHICK) -Assist individuals with questions related to Medicare Senior Medicare Patrol (SMP) -Educates community about reporting Medicare/Medicaid fraud and how to identify scams Lifespan Respite Community Transition Opportunities -Works with nursing facilities to identify residents who desire to return to living in a community setting November 7, 2018

Commission on Aging Budget Proposal Shifting of $1.5 million to fund ADRC contract Sequestration possibility of 8% cut or $1.48 million dollars Will be able to cover between March 1 and Oct. 1 if sequestration happens to prevent cuts to programs Will be working with stakeholders for July bids for OAA changes November 7, 2018

Community Services and Programs Commission Provides care and services to 157,000 clients Responsible for: Behavioral health programs -mental health, substance abuse, addiction and prevention Home and Community Based Services PACE Managed Care division -Coordinates intra-agency KDADS activity around managed care. -Coordinates with all three KanCare Managed Care Organizations regarding KDADS-specific program areas November 7, 2018

Community Services and Programs Commission Budget Proposal for CSP Commission HCBS Waivers Behavioral Health Programs Problem Gambling and Addictions Fund Mental Health Initiative PACE November 7, 2018

Community Services and Programs Commission Budget Proposal for HCBS Waivers I/DD Waiver 7,825 served 3,176 on waiting list Caseload is flat. SGF is lower due to FMAP change. All funds budget is flat. PD Waiver 5,685 served 2,385 on waiting list FE Waiver 5,012 served KDADS proposed, and the Governor recommended, a reduction in funding for the HCBS/FE Waiver program of $7,490,205, including $3,250,000 from the State General Fund. This amount represents savings already gained through program efficiencies and WILL NOT affect the services provided. There is no wait list for FE waiver services, nor do we anticipate establishing one. November 7, 2018

Community Services and Programs Commission Budget Proposal for HCBS Waivers TBI waiver 454 served Caseload is flat. SGF is lower due to FMAP change. All funds budget is flat. Autism Waiver 45 persons served 283 on waiting list TA Waiver 391 served November 7, 2018

Problem Gambling and Addictions Fund Problem Gambling and Addictions Fund (PGAF) receives 2 percent of state gaming revenues. Less state gaming revenues than projected have led to decreased resources. Governor’s Budget keeps funding level for FY 13 but reduces funds in FY 14 for the Substance Use Disorder Grants, which are funded through PGAF. $946,336 is proposed reduction. KDADS is exploring options to backfill the revenue.

Governor’s Mental Health Initiative Funding $10 million dollar initiative $5 million of grants Community Mental Health Centers (CMHCs) receive will be re-focused to support at-risk consumers. Administration proposal will stabilize funding resources for CMHCs Proposal recognizes the loss of Children Initiatives Fund (CIF) dollars that will occur this year that impacts CMHCs. As a result, Administration proposes to preserve the $5 million CIF dollars with special revenue funds Proposal ensures no overall loss of resources to public mental health system in FY 2014

Regional Recovery Support Centers Creation of regional recovery support centers 5-7 community mental health centers will be chosen to serve as the regional recovery support center The regional system will allow CMHCs to have access to resources that they can not always afford to provide. $5 million will be used to enhance or develop programs for target at-risk populations.

Increased effectiveness for at-risk consumers More effective programs for at-risk consumers $5 million will continue to be allocated to the 27 Kansas Community Mental Health Centers to support at-risk consumers.  CMHCs must demonstrate outcomes for this targeted population Tax dollars must support effective programs

Mental Health Task Force Creation of a taskforce to comprehensively study Kansas’ mental health system New taskforce will comprehensively evaluate our current mental health system and make recommendations to transform the system. Taskforce will look at best practices to increase protective factors for person with or at risk of mental illness  Taskforce members will include persons who have experienced recovery as well as professionals from broad multi-disciplinary expertise.

Community Services and Programs Commission Budget Proposal for PACE Two programs through Via Christi Hope and Midland Cares Working towards PACE expansion as dual enrollment option to KanCare Budget Neutral November 7, 2018

Survey, Certification, and Credentialing Commission Key function is to protect public health through the licensure and inspection of adult care homes. Develop and enforce state regulations related to adult care homes Implement federal certification activities for Medicaid or Medicare-certified nursing homes Conduct Inspections -Annual Inspections -Unannounced Inspections resulting from consumer or provider complaints Credentialing of various licensed and certified health professions. -Adult care home administrators -Certified nurses aides -Dieticians -Other professions November 7, 2018

Financial & Information Services Commission Responsible for various administrative functions that support other KDADS commissions Accounting Budgeting Information Technology Technical Support to Agency staff and business partners. Fiscal and Program Evaluation Division is KDADS’ auditing, reporting, and data analysis group. Manages nursing facility reimbursement programs November 7, 2018

Financial & Information Services Commission Budget proposal for FISC and Administration Reduction in salaries and wages expenditures of $659,760 from all funding sources in FY 2013 and $1,551,131 in FY 2014 resulting from elimination of duplicative positions in reorganization, implementation of KanCare, and other restructuring within KDADS. Budget includes a reduction in rent expenditures totaling $250,000, of which $125,000 is from the State General Fund, due to reorganization. November 7, 2018

Nursing Facility Provider Assessment

Nursing Facility Provider Assessment Nursing facility Provider Assessment rate is scheduled to drop to 60 percent in FY14 and be eliminated in FY15. A reduction rate in the assessment rate would result in a decrease of $7.5 million in receipts to the Quality Care Fund in FY 14, which could result in corresponding payment cuts to nursing homes of $16.6 million. Allowing the Assessment to sunset would require and increase in SGF to maintain NF rates. Alternately, NF rates would be reduced by 2.2 percent.