2007 - 2008 Business Plan

STATE PLAN AMENDMENTS

Medicaid State Plan. Starting in the Spring of 2004, the Federal Centers for Medicare and Medicaid Services (CMS) notified SRS that substantial portions of the current Medicaid State Plan governing mental health/behavioral health/substance abuse services were out of compliance with their practice standards. Left unaddressed, these deficits would render the state vulnerable to negative funding decisions by CMS that would ultimately cripple our ability to provide these services to Kansans in the greatest need.

At the end of June 2006, our comprehensive package of proposals was submitted to CMS, including: extensive amendments to the Kansas Medicaid state plan; an application to amend our existing waiver for youth with Serious Emotional Disturbance (SED); and an application for a selective services contracting waiver for all public mental health/ substance abuse services.

We anticipate that these changes, once fully approved and implemented, will strengthen and enhance these critical public services, increase efficiency and coordination of related public resources, and expand the number of providers available to meet these service needs for Kansans. All critical services for Kansans needing mental health or substance abuse treatment have been retained, and some services have been added, including Peer Support and Professional Family Resource Care.

Mental Health Services. Mental Health Services will be provided utilizing a Prepaid Ambulatory Health Plan (PAHP). Publicly-funded mental health services will be accessed through the Community Mental Health Centers (CMHCs), who are responsible for a managed system of care – by direct CMHC service delivery, by association agreements with other practitioners, or by gate keeping/certification of need determinations for facility-based services.

Substance Abuse Services. Substance abuse services will be provided utilizing a statewide substance abuse contractor. The Kansas Substance Abuse Prepaid Inpatient Health Plan (PIHP) provides for the cooperative administration of Medicaid substance abuse services with the administration of SRS state and federal block grant funded substance abuse treatment programs.

Psychiatric Residential Treatment Facilities. CMS has determined that Level V and VI facilities are currently included in the wrong section of the state Medicaid plan. As part of the overhaul of all mental health services in Medicaid, the Level V and VI facilities are being included in the institutional reimbursement section of the state Medicaid plan and will be covered as Psychiatric Residential Treatment Facilities (PRTF). CMS has informally reported that it will not fund any services that occur outside the PRTF, such as doctor visits, acute care hospital stays, laboratory tests, etc. Based on what is known from CMS and Kansas Health Policy Authority (KHPA) at this point, the PRTF program will be implemented July 1, 2007. In the meantime, a few facilities have incurred additional staff operating costs to meet new higher CMS standards which originally were to go into effect January 1, 2007. SRS and the Juvenile Justice Authority (JJA) are making adjustments to these facilities’ reimbursement rates to prevent financial hardship caused by the delay.

Overall, our comprehensive package of responses to CMS have been very well received. CMS has fully approved our selective services contracting waiver application, which will govern all public mental health and substance abuse services in Kansas effective July 1, 2007, as well as the related state plan amendments and amendments to the SED waiver. We will continue to work closely with CMS, JJA and KHPA to finalize changes related to PRTF services, and with all interested stakeholders in preparing to implement systems changes by July 2007.

Preferred Futures. An array of service options is being considered for children and youth group homes and residential centers that will not qualify as Psychiatric Residential Treatment Facilities under the proposed Medicaid state plan amendment and waiver request. While the previous system of services has many positive aspects, it did not always support the agency’s mission, vision, and changes in funding structures. For these reasons, system modifications and enhancements will be necessary. The foremost objective in developing these service options is to deliver supports and services in the amount, scope, duration and intensity to best meet the needs of Kansas children in State custody in the least restrictive and appropriate setting. These changes will be implemented in conjunction with the Psychiatric Residential Treatment Facility changes.

FEDERAL AUDITS, REVIEWS, DEFERRALS, AND DISALLOWANCES

The federal government has continued heightened oversight and scrutiny of claims for federal funds. As a result, states around the country continue to face the risk of significant deferrals of federal funds, increased federal reviews and audits, challenges to state plans and cost allocation methodologies, and new intrepretations of existing laws and regulations. Below are a few of the deferrals and reviews currently facing SRS.

Child Welfare Medical Costs. The Centers for Medicare and Medicaid Services (CMS) has deferred behavior management services for children in state custody since July 2003. To date these deferrals have totaled $64 million. In addition to the deferrals, the Office of Inspector General (OIG) has reviewed all child welfare claims for the three years July 2000 to June 2003. OIG has not yet issued the draft report, but provided preliminary findings questioning all $83 million of Medicaid claimed and received during those years. SRS has completed significant follow-up of the preliminary findings with assistance from accounting and legal contractors and expects to work with CMS to resolve the concerns as soon as the draft report is issued.

SRS and KHPA continue to work with CMS to resolve these prior year deferrals and findings. The state plan amendments and waivers submitted to CMS in June 2006, were designed to address the deferral and audit issues and are expected to resolve all concerns going forward once approved and implemented.

CMS Federal Management Reviews (FMRs)
In addition to child welfare, CMS has completed several other reviews of the Medicaid program. The reports have not been issued yet, but CMS’s preliminary findings from these reviews question expenditures for targeted case management (TCM), certified match, and administrative cost reimbursement. CMS claims that SRS pays TCM rates in excess of what services actually cost to provide, that CDDOs are not public entities and therefore can not certify match for Medicaid services, and that administrative costs paid to providers were not calculated correctly.

SRS and KHPA have sent letters to CMS disputing many of their findings and pointing out that many findings are not supported by current regulations. In January 2007, CMS published proposed regulations in the Federal Register that address the findings previously made. We believe this supports our argument that CMS findings went beyond current regulations and prevent CMS from deferring past claims. However, the proposed regulations will require SRS review and change some programs to comply with the new rules. SRS and KHPA are currently reviewing all TCM rates claimed by the state to determine what changes to the program are needed. SRS is also looking at the certified match programs and working with our community partners to develop alternatives that comply with the new rules. Implementation of the state plan amendments and waivers will resolve the administrative claiming issues. After reviewing the alternatives and assessing the impact of the changes, particularly related to certified match, we will request a GBA if necessary.

A summary of each audit, review, and deferral is provided in the “Resources” section of the Business Plan. This document provides additional details of the audits and deferrals listed above and details of additional audits related to SRS programs.

CHILD AND ADULT PROTECTION REFORMS

Child Welfare Protection Reforms. SRS recently completed a review of the policies and procedures surrounding child protective services. Emanating from this review are policy revisions to enhance the receipt of intake reports, initial assessment decisions, and placing greater consideration on prior history when assessment decisions are formed. These policy revisions will place significant demands on staff time, but will help to insure that thorough and complete assessments are performed for every report of abuse/neglect. The Governor’s Budget Report added funding in both FY 2007 and FY 2008 for additional regional staff to implement these policies.

SRS supports the Governor’s proposal to add funding in the Governor’s Office budget to increase the number of Child Advocacy Centers (CACs) in the state. The CAC is an effective community partnership model for pursuing the truth in child abuse investigations. A multi-disciplinary team specially trained in forensic practices conducts interviews of alleged victims of child abuse, helping to ensure comprehensive interviews are conducted while reducing the child's trauma. SRS has allocated funding to specific CACs in the past and continues to do so. The availability of additional funding will assist in the expansion of these beneficial community partnerships.

An initiative to improve the training and qualifications for intake workers on how to effectively interview reporters of abuse is being implemented. The Butler Institute of Families, University of Denver Graduate School of Social Work, will complete the training of all child protective service intake workers by March 1, 2007, and will then expand the training to all social workers and their supervisors. In addition, a series of required training for all Child Protective Service social workers and their supervisors is underway.

Adult Protection Reforms. SRS has strived to improve adult protective service investigations. As more in-depth investigations have occurred and as coordination with the Office of the Attorney General has increased, the volume and complexity of investigations have increased. The number of adult protective service investigations rose 24 percent in FY 2006, greatly increasing the workload of staff. In addition, an increasing focus has been placed on investigations among aging and vulnerable adults in community settings. SRS has also observed an increase in fiduciary abuse and exploitation, the latter of which are more complex. The Governor’s Budget Report added funding in FY 2007 and FY 2008 to improve adult protective investigations. SRS is coordinating closely with the new abuse, neglect, and exploitation unit in the Attorney General’s Office, established under 2006 House Bill No. 2105. SRS is responsible for quickly transmitting information to the new unit on substantiated or confirmed findings, and on cases where there is a reasonable suspicion to believe abuse, neglect, or exploitation occurred.

The Governor issued Executive Order 06-05 which creates the Kansas Interagency Council on Abuse, Neglect, and Exploitation (ANE). The Council was formed to focus on issues of abuse, neglect, and exploitation of adults and tasked to review existing laws, state agency policies, identify gaps in the existing system, and make recommendations regarding better coordination between agencies and/or systems impacting adult protective services. Initial recommendations from the Council have been submitted to the Governor. The recommendations include the development of a single statewide registry of individuals who have been confirmed of abuse, neglect, and/or exploitation, expansion of the authority of the Long Term Care Ombudsman Office, prevention strategies, creation of a sub-cabinet team to better coordinate protective service functions, a death review board, and a public awareness campaign.

STATE MENTAL HEALTH HOSPITALS

State Hospital Surveys
Osawatomie State Hospital (OSH) and Rainbow Mental Health Facility (RMHF). In the Spring of 2006, CMS visited Osawatomie State Hospital and Rainbow Mental Health Facility to determine if they met Medicaid and Medicare requirements. CMS found both facilities lacking in “active treatment.” The facilities were notified that if uncorrected the deficiency in active treatment would result in loss of certification and federal funding. In response to these findings, new protocols were implemented which increased the participation of patients in various treatment components. Upon re-review, CMS found the protocols to be in substantial compliance. However, the facilities will need added resources in the form of personnel to maintain this more intense level of service delivery and remain in compliance with CMS. The Governor added funding for 7 additional FTE at RMHF and 20 additional FTE at OSH.

Larned State Hospital. In October and November of 2006, Kansas Department of Health and Environment conducted on-site inspections of Larned State Hospital. Those visits resulted in a statement of deficiencies report issued in December of 2006 which listed primarily physical environment issues. Larned has addressed, or is in the process of addressing, every issue cited in the report. Larned expects every issue to be corrected within six months.

Admissions and Census
State Mental Health Hospitals. SRS is addressing the increased admissions at the state mental health hospitals by increasing the intensity and effectiveness of hospital treatment, thereby reducing lengths of stay and stabilizing their census. The Hospitals have changed their service delivery to include crisis stabilization services for those who would benefit from a short-term, intensive hospital stay.

In cooperation with mental health system stakeholders, SRS has developed an agreed Protocol for Managing SMHH Census Increases. Key elements of the protocol are:

• Improved communication with community mental health staff to ensure discharge planning occurs upon the day of admission,
• More intense communication with community partners to quickly assist with upward census fluctuations;
• Extraordinary mutual planning and discharge effort when census crises loom;
• Hospitals working together to use admission diversion and transfer options;
• Seeking other treatment resources for people with intense or unique service needs;
• Special discharge planning to alternative services for persons who have experienced extended state mental health hospital stays; and
• Exploring and building alternative service options other than state psychiatric hospitals.

Supplemental Funding to Open One 30 Bed Unit at OSH. Recently the Joint Budget Committee requested that SRS provide an estimate of the cost to open one 30 bed unit at OSH within existing available plant physical space. SRS estimates the annual operating cost of such a unit to be about $3.2 million. In addition, $2.7 million will be needed to remodel and furnish existing space to meet necessary treatment standards. However, due to current remodeling, space needed to expand would not be available until early FY 2009.

Contractual Arrangements with Local Hospitals. SRS has begun discussions with other providers regarding the possibility of entering into contractual arrangements to provide acute care inpatient services. These discussions appear to be promising, especially for children and youth. Should these arrangements be possible and are funded, children and adolescent services provided by RMHF and LSH could be shifted to private providers and the units freed up to serve more adults thereby relieving census issues at all the state mental health hospitals.

Sexual Predator Treatment Program. Currently there are 150 individuals in the Sexual Predator Treatment Program at Larned State Hospital, and seven at the Transitional House Services (THS) program on the Osawatomie State Hospital grounds. The number of admissions per year remain at a steady pace - the average admissions for each month being 1-2 residents. However, the predicted number of transfers to the THS program at OSH, has slightly increased. Historically, transfers to the THS program averaged 1-2 residents a year. This year, the prediction is 2-4 residents. To address this growth, a wing in the Biddle building at OSH is currently being renovated to house an additional five THS residents. The renovation is set to be completed by February 2007.

DEFICIT REDUCTION ACT OF 2005

Stricter TANF Work Participation Requirements. The reauthorization of the Temporary Assistance to Needy Families (TANF) Program was included in the Deficit Reduction Act of 2005 (DRA). The bill establishes stricter work requirements for states by eliminating states’ flexibility in defining work activities and increasing the verification requirements of clients’ hours counted toward work participation. These changes will increase the difficulty of meeting the TANF work participation rates and will have a significant impact on the workload of SRS staff. The Governor’s Budget Report added funding in FY 2007 and FY 2008 to address the workload associated with the meeting the stricter work participation requirements. Failing to meet the TANF work participation rate will result in a TANF penalty followed by the requirement to replace the federal funds loss with state funds in the ensuing year. The amount of the penalty will be based on the degree of failure in meeting the work participation rate and the verification requirements.

Increased Demand for Child Care. Current caseload projections for both FY 2007 and 2008 reflect continued demand for child care. In recognition of the continuing caseload increase, the Governor’s Budget Report added $2.6 million in FY 2007 and $4.0 million in FY 2008. The DRA will increase the need for child care assistance to support the tighter work participation requirements and to support families who transition from TAF to the workforce.

New Citizenship Verification Requirements. The DRA mandates Medicaid applicants who declare to be a citizen or national of the United States to present satisfactory documentary evidence, such as a U.S. passport or U.S. birth certificate, and separate proof of identification to validate their citizenship or naturalization. These requirements apply primarily to non-disabled adults under age 65 and to children regardless of time on assistance. Medicare beneficiaries, persons receiving Supplemental Security Income (SSI) benefits through Social Security, and children receiving foster care or adoption support assistance are exempt from the new provisions. The law mandates that states provide assistance with obtaining these documents, if necessary. It also requires the state to establish an outreach plan to convey the requirement to current recipients and potential applicants. This change has impacted both SRS and the Kansas Health Policy Authority. Workloads of SRS and HealthWave Clearinghouse staff have increased and the new law has made it more difficult for citizens to access the Medicaid program.

New Child Support Enforcement (CSE) Provisions. The DRA contained several provisions which impact the Child Support Enforcement Program. The most critical change prohibits states from using federal child support enforcement incentive earnings as state matching funds, effective October 1, 2007. The GBR added $2.2 million from state funds to allow the CSE program to maintain current funding. See the SRS Legislative proposal for other CSE provisions.

Federal Administration Funding Limitations. The DRA reversed an earlier interpretation that allowed states to claim federal foster care administrative funds for foster care eligible children placed in unlicensed foster homes. The new law limits the administrative costs states can claim for children placed with relatives who are not licensed/approved by KDHE to only children that meet other restrictive criteria. The 2006 Legislature added state funds to replace the lost federal funds.

PREVENTION AND EMPLOYEE SUPPORTS ISSUES

Comprehensive Plan to Address Synar Compliance. An interagency collaborative effort has been ongoing since July 2005 to plan and implement effective strategies to reduce illegal sales of tobacco products to persons under the age of 18. The GBR added $400,000 in FY 2008 to continue this effort. Kansas has reached and continues to maintain compliance with federal Synar requirements regarding the sale of tobacco to minors. At 80.1% compliance, the state remains just above the required target of 80%. “It’s Everybody’s Business” encompasses a comprehensive approach to improving retailer compliance which includes enforcement, mobilization of community and state policies and practices, incentive-based compliance monitoring, retailer education, and a statewide media and marketing campaign.

Development of Parental Modeling Program. The 2006 Legislature provided $500,000 to test different family preservation models that will strengthen a family’s ability to care for, and safely parent their children, thus preventing children from coming into foster care. Many youth who come into foster care do so because of parent/child conflicts that result in uncontrolled behaviors. SRS has utilized the funding for three program models at various sites across the State.

The Health in Pregnancy Program promotes substance free pregnancies to women who are using or abusing substances during pregnancy. Any woman identified as pregnant and abusing illicit substances or alcohol, regardless of income, are eligible to receive services for 18 months. This program is being implemented in Douglas, Sedgwick, Ellis, and Barton Counties.

The Family Assessment and Referral Program, being implemented in Barton county, pairs a clinician and juvenile intake/assessment worker to perform a clinical assessment of the child and the family situation to create a wrap around plan within the first 72 hours of the disruption in the home. This assertive outreach will result in children and their families entering into needed services at the time of the disruption and prior to the legal issues having progressed to the point that the child is placed in state custody. One advantage of the program will be to allow the judge to direct the family into the recommended services at the initial court hearing, based on the wrap around plan.

The Savannah Family Institute’s “Parenting with Love and Limits” Program is designed to teach parents and their teenagers the core skills they need to determine rules, stop behavior problems and prevent their further occurrence. This program is being implemented in Shawnee and Reno counties.

Strategic Prevention Framework State Incentive Grant to Enhance Substance Abuse Prevention Efforts in Kansas. Kansas has received $10 million over the next five years to help communities prevent substance abuse. The $2.1 million per year will help coordinate efforts involving state and community agencies, address gaps in service and improve results. Because the risk for substance abuse mirrors the risks for other behavioral issues, this grant provides the opportunity to address substance abuse prevention in connection to other social influences. More than 85% of the grant will go to local communities for prevention efforts and it will be coordinated by SRS.

The State of Kansas and local communities will use the grant to focus on:

• Prevention of the onset and reduction of the progression of substance abuse, including childhood and underage drinking;
• Reduction of substance abuse-related problems in communities; and
• Building prevention capacity and infrastructure at the state and community levels.

Kansas received the grant from the Federal Office of Substance Abuse and Mental Health Services Administration. The grant began on October 1, 2006.

Cross Agency Collaboration. SRS will actively participate in the State’s efforts to brand Kansas as “an employer of choice.” This effort includes utilizing common images, phrases and other marketing efforts intended to market state employment. These tools are developed in cooperation with the work of the Department of Commerce to unitize the image of the State. Through the Diversity Summits and subsequent Diversity Fairs, SRS partners with other state agencies to develop methods and strategies to increase the diversity of the state workforce, and to create mechanisms to receive inputs from targeted diverse communities.

SRS also will actively support and participate in the Statewide Training Action Team (STAT), an interagency initiative to ensure the state workforce acquires the skills and competencies needed to effectively serve the citizens of Kansas. SRS will assist STAT with collecting and analyzing relevant data; share learning resources, knowledge and expertise; and maintain a web presence where the Kansas state government training community can access and share learning resources, coordinate activities and collaborate in the efficient and effective development of the entire workforce of all agencies regardless of size.

Employee Recruitment. SRS continues to focus on difficult to recruit jobs such as social workers, RNs/LPNs, pharmacists and clinical counselors. The agency will invest time this fiscal year to explore strategies to address these recruitment challenges. Some potential ideas the agency will explore include: loan forgiveness resources and seeking avenues to raise the KPERS limit for retirees. Depending on strategies determined to best attract these types of employees, the agency can expect a fiscal impact.

Cultural Competency. The State demographics reflect Kansas is more diverse now than it has ever been, and this diversity will continue to grow. SRS has begun a process to explore how serving the public effectively can provide services to this increasing diverse population in a manner consistent with its needs. To further enable employees and funded providers and contractors to provide effective services to an ever changing population, SRS will engage in a process to thoroughly examine the degree of cultural competence from an organizational view, and make recommendations to move the agency to become culturally proficient.

HEALTH CARE POLICY ISSUES

Autism Waiver. The Secretary of SRS held focus group meetings across the state for the purpose of hearing from stakeholders and parents of children with autism or autism spectrum disorders to discuss the need for services in the community. As a result of these meetings, SRS sees the best way to meet the needs is through a home and community-based services waiver that would be developed to specifically serve children with autism or autism spectrum disorders. This waiver would provide early intervention services, respite care, in-home supports and possibly specialized child care. A waiver of this type would assure that children are receiving the necessary and appropriate services that would decrease the need for extensive services as the child grows older. The GBR includes $1.49 million to fund this waiver with a target implementation date of January 2008.

Psychiatric Residential Treatment Facility (PRTF) Waiver Grant Awarded. The PRTF Waiver application was a grant applied for in October 2006. SRS has recently been awarded this grant which will fund community-based services for youth to divert them from a PRTF. The award totals $17.4 million for a five year period.

Home and Community-Based Services Mental Retardation/Developmental Disabilities (HCBS MR/DD) Waiver. On July 1, 2006, SRS distributed approximately $8.7 million to Community Developmental Disability Organizations (CDDOs) to grant access to new persons requesting Home and Community-Based Services funding as well as persons currently receiving HCBS funding but have been identified to be in need of additional DD services. At that time, there were 2,207 people on the statewide waiting list for these services. SRS, along with the CDDOs, were able to use the funds to meet the new and additional needs of 399 persons across the State. The current waiting list is approximately 1,373 persons. The GBR has added an additional $9.9 million for FY 2008 to serve 280 additional persons on the waiting list.

Developmental Disability Conflict of Interest. The 2005 Legislature recommended SRS bring together a group of stakeholders to address issues regarding conflict of interest in the developmental disabilities (DD) service system when a Community Developmental Disability Organization (CDDO) is also a Community Service Provider (CSP). In response to this recommendation a review tool was developed to monitor CDDOs in their compliance with the Developmental Disability Reform Act and carrying out the tasks as outlined in their contract with SRS. The review tool relates directly to the goals of the strategic plan in the areas of quality improvement, consumer choice, access to employment, and persons receiving the appropriate services and supports for which they are eligible. SRS completed two pilot projects to test the CDDO Review Process, one in Shawnee County and the second in Brown County. After the pilots were completed, the DD Strategic Oversight Committee reviewed the results and approved the process for implementation.

Home and Community-Based Services/Physically Disabled (HCBS/PD) Waiver. The Physically Disabled (PD) waiver currently serves 6,097 consumers, adding a net average of 65 consumers per month. A waiting list is employed as the rate of offer exceeds the budgeted average cost per month. Currently there is no waiting list. In an effort to maintain no waiting list for the PD waiver in FY 2007, SRS estimates the need to add 600 persons to PD waiver services from FY 2006 through FY 2007. The FY 2008 GBR adds $9.9 million in all funds which will cover the annualized cost of serving the 600 persons added in FY 2007 plus an additional 185 persons added through September 2007.

The Money Follows the Person Proviso. The Money Follows the Person (MFP) program has been utilized for those elderly and physically disabled consumers having resided in a nursing facility for 90 days or more that request to return to community settings. MFP eligibility criteria includes waiting list placement, physical eligibility for HCBS/PD or the Frail Elderly waiver services, and an initiation of waiver services within 60 days. If there is no waiting list, consumers are unable to utilize the MFP program. Key community partners, the Kansas Department on Aging, and SRS have reviewed current policy and have revised it to remove the stipulation of waiting list placement. This policy change will improve the timeliness of program access.

Adult Dental Funded through HCBS Waivers. SRS in partnership with key stakeholders and an array of other state agencies and organizations has submitted amendments to the HCBS waivers to add Adult Oral Health (dental) services. The oral health services are available to all adults that receive HCBS community services by a Medicaid participating dentists statewide. The coverage is broad in scope to cover most oral health needs. Dental Services have not begun due to delays in CMS approval. SRS is in discussions with rural health clinics to begin serving consumers immediately in anticipation of CMS approval. Necessary computer changes for implementation of this service have already begun although a firm effective start date has not been yet established.

Targeted Case Management (TCM). In partnership with CMS, multiple State agencies are collaborating with the Kansas Health Policy Authority to develop a State Plan Amendment aimed at streamlining the delivery of Targeted Case Management across systems. KHPA, along with SRS and other State agencies, are working with a Contractor to create a survey instrument which will help service providers identify Medicaid billable activities. It is anticipated that the survey results will demonstrate the importance of TCM in facilitating access of individuals to services directly related to improvement of quality of life while maintaining overall fiscal accountability.

Addiction and Prevention Services (AAPS) Capacity. Demand for alcohol and drug treatment in Kansas continues to outstrip program capacity as AAPS funded providers provided $1.3 million in unreimbursed treatment services to AAPS eligible individuals in FY 2006. While funding for individuals involved with corrections has increased with legislative approval in recent years, capacity, especially for residential services, has not grown at the same rate. This shortfall has left some priority populations, (women, adolescents, medically high risk and SRS consumers) waiting or not receiving the services they need. To begin addressing this issue the GBR includes $2.4 million for rate increases for AAPS grants in FY 2008.

Anti-Stigma of Mental Health. During 2007, SRS, in collaboration with consumers, families, providers, schools, advocates, and other stakeholders throughout Kansas, is implementing a mental illness anti-stigma campaign. The purpose of the campaign is to erase discrimination associated with experiencing a mental illness and enhance strategies for suicide prevention. Experience shows us that sharing factual knowledge regarding mental illnesses and serious emotional disturbance, as well as understanding the services available to support individuals and their families experiencing these disorders, can help reduce stigmatizing behaviors.

Eliminating stigma and discrimination allows people with a mental illness to live, work, learn, and contribute to the community in which they live and is essential to a mentally healthy Kansas.

AAPS Problem Gambling. AAPS currently contracts with vendors to provide services for problem gambling awareness and treatment capacity development. Those services include: training for Problem Gambling Certification for counselors; prevention focused activities and professional awareness training; funding of a 24 hour help line to provide crisis intervention; and free initial assessment and consultation to callers and their families experiencing problem gambling. Based on national data, it is estimated that approximately 0.9 percent or 17,234 Kansas adults experience pathological gambling problems. In addition, individuals experiencing problem gambling issues have a 10 times higher risk for suicide. Public funding to support treatment for problem gamblers is necessary as often by the time a person seeks treatment for their problem gambling, their resources to pay for treatment has been depleted.

New AAPS Standards. The Standards for Licensure/Certification of Alcohol and/or Other Drug Abuse Treatment Programs had not undergone any major revisions for approximately 30 years and, as a result, did not reflect current practice. AAPS staff, with substantial input from treatment providers, developed a new set of licensing standards that have been adopted by the Secretary of SRS and became effective January 5, 2007. The implementation phase of the new standards will occur in 2007 and will include training of staff and providers. AAPS plans to conduct site visits utilizing the new licensing standards beginning January 1, 2008.

Real Choice Systems Transformation Grant. Kansas is one of eight states awarded a 2006 Real Choice Systems Transformation Grant from the Centers for Medicare and Medicaid Services. The total amount awarded to the Kansas Department of Social and Rehabilitation Services is $2.2 million for the five year project.

This project seeks to promote community-based living for Kansans of all ages with long-term support needs by continuing or building upon achievements from previous New Freedom grants awarded to Kansas. The primary purpose of the project is to encourage community-based living options by enhancing consumer control and direction through a coordinated service delivery system. This is an infrastructure grant with the following goals:

• Increased choice and control: enhancement of self-directed service delivery system.
• Transformation of information technology to support systems change.
• Creation of a system that more effectively manages the funding for long-term supports that promote community-based living options.

INTEGRATED SERVICE DELIVERY ISSUES

Grandparents as Caregivers Program. Senate Bill No. 62 created the state-funded Grandparents as Caregivers Program, effective January 1, 2007. A grandparent or other qualifying relative will be eligible to participate in the program if he or she is at least 50 years old; has physical and legal custody of a grandchild; has an annual income of less than 130 percent of the federal poverty level; the children are not in state custody; and the parent or parents of the child do not reside with them. Subject to appropriations, program participants will receive $200 per grandchild per month not to exceed a total of $600 per month. The Governor’s Budget Report added $2.0 million in FY 2008 to fund the program for the full year.

Presumptive Disability Determination. Prior to September 2006, applicants for General Assistance (GA) had to meet income and resource tests, and obtain a physician’s opinion indicating the client’s disability. This opinion was guided by social security disability criteria. If financially eligible and found severely impaired by the physician, the General Assistance client received GA cash assistance and MediKan, a more restricted form of medical coverage relative to Medicaid, until being formally approved eligible for federal disability. Once approved for federal disability benefits, the General Assistance case was closed and the client became eligible for Medicaid. Effective September 2006, the income and resource tests remained unchanged; however, to minimize the delay in obtaining federal disability benefits, the Kansas Health Policy Authority replaced the physician’s opinion with a presumptive assessment for federal disability. General Assistance applicants who meet the financial eligibility requirements and who are presumed eligible for federal disability now receive GA cash assistance and Medicaid, until they are actually approved eligible for federal disability benefits. General Assistance applicants who meet the financial eligibility requirements and who are not presumed eligible for federal disability, but who possess a severe impairment, will continue to receive GA cash assistance and MediKan.

CSE Customer Service Center. The Child Support Enforcement Program will implement a statewide customer service center in a rural locale through a contract with a private vendor. The service center will combine a staff of trained customer service representatives, available during daytime hours, with an interactive voice response system to respond at all times. Initially handling only child support questions, the service center may be configured to allow expansion to other SRS lines of business and to other communications media, such as e-mail. The goals of the customer service center are to improve the timeliness of responses and customer satisfaction, to allow caseworkers’ time to be effectively focused on increasing support collections and fee fund revenues, and to support economic development in rural Kansas. The process was designed to encourage participation by rural communities and many considered partnering with potential vendors. The contract is expected to be awarded in Spring 2007, and the implementation will be phased in beginning Summer 2007.

Other Child Support Enforcement Changes. The Child Support Enforcement Program is in the process of implementing the various provisions granted during the 2006 Legislative session and the provisions of the Deficit Reduction Act. These include: administrative restriction of debtors’ driving privileges, denial of recreational licenses issued by the Department of Wildlife and Parks to support debtors certified by CSE, changes to federal tax offset and passport denial processes, federal matching with insurance data, and mandatory reviews and adjustments of support orders for TANF cases.

Child Support Payment Center Contract. The new contract for the Kansas (Child Support) Payment Center will begin in May or June 2007. The emphasis on electronic transfer of payments to bank accounts or stored value cards, will reduce costs while improving customer services. Payments will be prompt and reliable, and for some, check cashing fees will be eliminated. Additional improvement factors include requiring the latest version of check processing equipment which will image documents thus reducing manual input as well as updated automated accounting and distribution systems.

Kansas Early Head Start. Kansas Early Head Start (KEHS) provides early education and home visitation services to families working toward self sufficiency. Children, ages birth through age four, receive child screening and assessments to measure overall health, developmental milestones and school readiness. Pregnant women are assessed to measure prenatal health for successful birth outcomes. These services support the Governor’s vision that all children have safe, healthy, nurturing learning environments from birth to school age and promote school readiness. The $1.8 million expansion approved for FY 2007 increased the number of children served by 192, from 825 to 1,017. For FY 2008, the Governor’s Budget Report included $2.2 million to serve an additional 287 children, raising the total children served to 1,304.

Increasing Emphasis on Quality Control in Public Assistance Programs. The Improper Payments Information Act of 2002 was signed into law November 2002. Although the new law passed with little notice, the legislation has recently been the driving force behind federal agency proposals to reinstate quality control reviews and establish payment error rates for Medicaid, SCHIP, TANF, Child Care, and Foster Care. The Food Stamp program is already compliant due to its ongoing quality control process. Medicaid, SCHIP, and Child Care programs are currently involved in developing quality control review processes. Kansas has been involved in a pilot to develop a quality control review process to determine payment accuracy of the Child Care Program. From this pilot review, Kansas will be assessed an error rate for the Child Care Program for federal fiscal years 2008-2009. The Administration for Children and Families has also begun discussions with states regarding how to determine payment accuracy in the TANF program. Once federal regulations are finalized, state quality control reviewers will be required to review a statistically valid random statewide sample of cases each month. Based on the outcome of these reviews, states will be required to submit corrective action plans when error rates exceed certain levels and may be required to pay a penalty when error rates exceed established levels.

Rehabilitation Services Public Meetings. Rehabilitation Services is conducting several community meetings across the state to discuss vocational rehabilitation issues and to solicit suggestions for improvement. In addition to the public, SRS staff have been invited to participate in these sessions. Several consistent themes have arisen to date which include : the importance of consumers having one on one time with rehabilitation counselors; the flexibility of rehabilitation services in designing employment plans that match well with consumers’ interests and talents; the need for improvement in communications between counselors and consumers; the life changing impact of full integrated employment; the need to develop business focused marketing strategies related to opening doors for Kansans with disabilities; and, the failure of education and rehabilitation services to effectively address the transition needs of youth with disabilities preparing to exit high school. Once these 18 community meetings are completed, Rehabilitation Services will compile the feedback and identify key themes brought forward by consumers, providers and advocates. Those themes (both positive and negative) will be reported back to attendees and other interested stakeholders. Those common themes will also be used as the foundation for development of a long term plan for the future direction of Rehabilitation Services.

Streamlining Partnerships. SRS, the Child Welfare Community Based Service Providers (CWCBS), and the Judicial System collaborated on the planning and implementation of Streamlining Partnerships. The purpose of this initiative is to reduce the amount of duplication within child welfare practice, specifically between SRS and the CWCBS providers. Effective January 1, 2007, SRS staff will no longer attend case planning conferences or court hearings, unless the judge requests someone from SRS in the courtroom. Elimination of duplicate case management functions will allow SRS staff the opportunity to conduct more thorough and timely child protective service investigations and assessments, initiate prevention activities, and provide quality oversight of CWCBS providers.

Monthly Caseworker Visits Program Grant. Kansas received child welfare federal funding in connection with the Children and Families Improvement Act for the monthly caseworkers visits program. The first year of funding is to improve monthly visits to children in foster care, and the second year funds substance abuse prevention.

Food Stamp Bonus. The official Food Stamp error rates for 2005 were released by USDA on June 23, 2006. The Kansas payment error rate of 4.37 during FFY 2005 was 10th best in the nation. As a result of this exemplary performance, Kansas received a Food Stamp bonus payment of $1.6 million. These funds will be used to enhance training and outreach resources, enhance the on-line and paper application processes, and target quality assurance.

ADMINISTRATION ISSUES

Human Services Management System. SRS is currently developing plans for the implementation of a Human Services Management (HSM) system that provides a common computing infrastructure across the agency. HSM will be a business and technology blueprint for outcome-based, client-centered, integrated delivery of services across needs-based and contribution-based programs. HSM will provide SRS with a comprehensive view of a client across these programs in order to integrate service delivery and achieve positive outcomes. This will be accomplished by implementing an integrated infrastructure approach. This approach will allow multiple programs to be supported, using consistent and standard-based technology and management practices.

The scope and magnitude of this project will require an incremental phased approach to ensure a successful implementation. In 2006, SRS contracted with Forrester Research to conduct a Feasibility Study for the implementation of HSM. The result of the Feasibility Study by Forrester recommended an implementation strategy of acquiring Commercial Off the Shelf (COTS) solutions and the modernization of the current systems at SRS with an estimated cost of $98 million dollars.

Also suggested in the Feasibility Study, SRS is currently developing a Request for Proposal termed the Human Services Management Roadmap that will further define the High level project requirements including the exact number project phases, a more detailed budget estimate, and a high-level timeline for the entire project. SRS anticipates that funds expended in the first phase of the project will be used to contract for professional services to develop a standardize business reference model that will define the standardized business processes and customer service channels that services will be delivered to our customers. The scope of this first phase of the project will also probably include the implementation of a Customer Relationship Management package with the functionality for determining eligibility across multiple programs.

The HSM project will provide SRS a comprehensive view of a client across multiple programs resulting in enhanced services to the citizens of Kansas. SRS staff will have the information and tools they need to provide improved customer services. The implementation of HSM supports the Governor’s desire to make government work smarter and more efficiently with more accountable to the people of Kansas.

Page last updated: February 6, 2007