TOPEKA —ÌýSen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even as major legislation moves through both houses of Congress that would have similar goals as the pilot program.

The pilot program is called Access Received Closer to Home, or ARCH. It’s offered at five sites — Pratt, Kansas; Caribou, Maine; Farmville, Virginia; Flagstaff, Arizona, and Billings and Anaconda, Montana. The program allows veterans to get healthÌýservices from community providers if they live at least one hour from a VA health facility.

Five senators to the VA secretary, asking why the program is ending. The letter reads, in part: “For reasons we do not understand, the Veterans Health Administration (VHA) is choosing — at VHA’s own initiative — to end this successful program despite the more than 90 percent satisfaction rate communicated by veterans. … All along, the VHA gave us the impression that they were waiting on analysis about the success of ARCH to inform their decision about extending the program — this is a misleading storyline at best. We are deeply disappointed by this breach of trust because those who suffer from this recklessness are veterans.”

In addition to Moran, the letter to Acting VA Secretary Sloan Gibson is signed by fellow Sens. Jon Tester, D-Mont., Angus King, I-Maine, Susan Collins, R-Maine, and John McCain, R-Ariz.

While VA officials have told members of Congress that no decision has been made on whether to let ARCH expire,ÌýMoran said veterans and VA employees in Kansas have told him that the national program director for ARCH directed the five pilot sites several months ago to begin contacting veterans who participate in ARCH to let them know the program would be ending. Moran suspects the VA is motivated by financial concerns.

“If they pay for services outside the VA, it’s less money that they’ve had to use within the VA, and of course the focus ought to be on the quality of service and the timely access to care that this kind of program can provide,” Moran said.

Moran said bipartisan legislation based on the ARCH program is moving through Congress, a response to the VA waiting times scandal. That legislation offers some veterans the opportunity to seek care outside of the VA system. It would cover some of the same services vets have been receiving under ARCH, but Moran and the other senators are concerned that ARCH vets could see a lapse in care if the VA doesn’t extend the pilot program. He’s calling on Gibson to halt plans to dismantle the program.

“I believe the VHA intentionally misled my colleagues and I who have sought answers from the VA for months regarding the potential extension of the program,” Moran said in a news release.

At a House Ìý in Washington, Wednesday, Philip Matkovsky, an assistant deputy under secretary for the VA, said that “technically speaking, we have the authorities to cover” continuing the ARCH program.ÌýÌýHe pointed out that ARCH was a contract with a one-year term and two optional years. The second of those optional years expires Sept. 30. “Typically,Ìýunless a contracting officer can determine a compelling reason to extend that, and I’m not a contracting officer, we let contracts expire,” Matkovsky said.

A spokesman for the VA said that the department has Moran’s letter and will provide an official response.

This <a target="_blank" href="/news/future-uncertain-for-va-rural-health-pilot-program/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includes ,ÌýKaiser Health News andÌý .

Kansas insurance officials – trying to develop a recommendation for “essential health benefits” that individual and small group health insurance policies will be required to offer under the 2010 federal health law – are running into a problem: the calendar.

Health care policy consultant Beverly Gossage testifies at Kansas essential health benefits hearing September 5th, in Topeka. (Photo by Bryan Thompson/Kansas Public Radio)

The state must settle on its plans for those benefits by Sept. 30, says Insurance Commissioner Sandy Praeger, or the federal government will dictate the coverage requirements. But Republican Gov. Sam Brownback, an ardent opponent of the health law, wants to wait until after the presidential election in November.

“We want the governor’s office to understand that if we don’t make that election by the end of September, then we will have lost the opportunity to determine what that essential health benefit package will look like,” said Praeger, also a Republican.

Brownback’s spokeswoman Sherriene Jones-Sontag says the administration will not make any decisions regarding the health law’s implementation until the presidential election is settled. Republican candidate Mitt Romney has vowed to overturn the law, which was passed by a Democratic Congress and signed by President Barack Obama.

But state insurance officials note that if the federal government sets the health benefits for Kansas, the state could end up with a richer—and more expensive—benefits package than the governor might prefer.

The health law defines 10 broad categories of coverage for these insurance plans that will be sold on the state exchanges, or marketplaces, starting in 2014, but the federal government has allowed each state to determine much of the specific coverage that will be mandated in each state. Among the items and services that are included in the federal requirements are such things as maternity and newborn coverage, behavioral health care and prescription drugs.

Congress specified the children’s coverage because it is cost effective, said Suzanne Wikle, of the advocacy group Kansas Action for Children, who testified last week at a public hearing on the benefits. It “shows the law’s intent—that children should receive benefits beyond those that are laid out in the other nine categories,” she said. “Rather than being limited to oral and vision care, pediatric services should include all of the medically-necessary care that is not covered by any of the other nine categories.”

Some would like to see pediatric services extended even further.Ìý Pam Shaw, a pediatrician and professor at the University of Kansas Medical Center and the mother ofÌý a child with autism, told the insurance officials at the meeting, “And I can tell you that having autism coverage as part of the state employee health plan is essential now.ÌýAs we see the rates of autism, one in 88 children having it, being able to provide services for these children is extremely important at this time.”

Others worry about the effect a more expansive set of essential health benefits might have on the cost of health insurance.Ìý “Any increase in mandates or coverage will increase the cost of providing health care, and we’re already at the tipping point of businesses being able to afford to provide coverage,” said Eric Stafford of the Kansas Chamber of Commerce.

Beverly Gossage, who heads the Greater Kansas City Association of Health Underwriters, shares that concern.ÌýShe predicted that the 10 to 15 percent of state residents who have individual policies will have to pay more.Ìý Gossage says that’s because the so-called essential benefits include coverage that these beneficiaries are not paying for now and may not use.

“Those with individual policies certainly are not looking at those richer benefits,” she said.Ìý“They don’t choose those benefits.ÌýAnd one that really stands out, of course, are those who choose not to have normal maternity in their plans, and this is a requirement in the essential health benefits.”

But cost shouldn’t be the only concern, according to Sheldon Weisgrau.Ìý He heads a nonprofit organization that seeks to help Kansans understand the health overhaul.Ìý Weisgrau says it’s important to remember why Congress included essential health benefits in the law.Ìý “Health care and health insurance are expensive and complex.ÌýThere’s seldom a balance of information between the provider, or seller, and the consumer.Ìý It is reasonable, therefore, for consumers to be protected from products that offer extremely limited coverage and value.”

This story is part of a reporting partnership that includes , Kaiser Health News andÌý NPR.

This <a target="_blank" href="/news/kansas-essential-benefits/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý, Kaiser Health News and

In an ongoing disagreement over how to solve dental care access problems in Kansas, there is one thing no one disputes: the great need.

That need was on display in February when the Kansas Dental Charitable Foundation held its eleventh free clinic of the past decade. Known as the Kansas Mission of Mercy, the clinic was staffed by volunteer dentists in a vacant Walmart store in Kansas City.

Organizer Greg Hill said that patients began arriving at 8 p.m. the night before the clinic opened. They were able to spend the night inside the store. “By 5:30 a.m., there were 1,200 people in the building,” Hill said.

Patients have dental exams at a Kansas Mission of Mercy event in Kansas City, Kansas, in February (Photo by Bryan Thompson/Kansas Public Radio).

At that point, the parking lot had to be closed, because no more patients could be treated in a single day— even with 165 volunteer dentists and many more hygienists and other support staff from all across the state. By the end of the two-day clinic had been treated, adding to the total of approximately 20,000 patients served since Mission of Mercy began in 2002.

Analysts have known for years that Kansas has a severe shortage of dentists, and that shortage is getting worse. The problem is greatest in rural Kansas, especially in the western part of the state.

To deal with the shortage, Fort Hays State University backs the idea of creating a mid-level dental provider — a person whose training and skills fall somewhere between those of a hygienist and a full-fledged dentist.

Hammond is keen to begin training those providers at Fort Hays State, but the proposal faces strong opposition from the Kansas Dental Association and has bogged down in the state legislature.

Hammond points out that it is not just the poor or uninsured who have trouble accessing dental care in western Kansas. Even a college president can have trouble.

“I can’t get dental services where they accept our Delta Dental Blue Cross/Blue Shield plan,” said Hammond. “As a state employee, I get — and pay for — dental insurance, but the dentists in western Kansas don’t accept it.”

Hammond says he’s had to switch dentists three times to find someone who would accept his dental insurance. There are 13 primary care dentists in the Hays area, but Hammond says only a few accept Delta Dental.

“The shortage is impacting not just the indigent, not just the children. It’s impacting all of Kansans in western part of the state,” he said.

A published last fall by the Kansas Department of Health and Environment and the University of Kansas Medical Center counted 1,159 primary care dentists in the 105 counties of Kansas. However, roughly half of them are located in metropolitan Kansas City and Wichita. Add in Topeka and Lawrence, and more than 700 of the state’s dentists are in just four communities.

Most counties in the western half of the state have only one or two dentists, if any. A dozen western counties, plus three more in eastern Kansas, have no dentist at all. Hammond said it’s not hard to understand why dentists are reluctant to set up shop in frontier counties.

“The problem is, the people graduating from dental school are coming out with tremendous debt, and then they have to get a lot of equipment,” Hammond said. “That raises the bar that their practice has to generate a certain amount of resources in order for it to make sense, and so they don’t go to western Kansas and the smaller towns.”

Hammond compared the so-called mid-level dental providers to mid-level medical providers who are already helping meet the need for primary care in rural Kansas.

“We train nurse practitioners that go out to the Hill Citys, the Atwoods, the various different communities throughout the state, and provide medical services. We’re proposing to do the same thing with a mid-level professional in the area of dentistry,” he said.

Hammond said Fort Hays State University is prepared to begin training this new class of dental providers as soon as the legislature approves the proposal. A coalition called the submitted a plan last year. It would create a new type of provider with more training than a dental hygienist, but not as much as a dentist, called a Registered Dental Practitioner, or RDP. The new practitioners would be allowed to fill cavities and do simple extractions of children’s primary teeth.

But the Kansas Dental Association has fought this idea all the way. “The overwhelming majority of dentists are opposed to the registered practitioner model, and it’s not like 99 percent. It’s 99.9 percent,” said Kevin Robertson, who heads the association.

Robertson said the proposal goes too far by allowing RDPs to perform procedures which are, by definition, considered surgery.

“Anything that includes the cutting of the hard surfaces of the tooth is considered surgery,” said Robertson. “The bill is written to allow the extraction of all primary teeth, or meaning baby teeth. Now, a lot of listeners might think, well, baby teeth, I’ve pulled out my son’s or my daughter’s baby teeth. Well, there’s nothing in the proposal that says it has to already be loose.”

And Robertson says what sounds like a simple procedure can suddenly become more than a registered dental practitioner is trained, or licensed, to handle.

“Maybe you’ve snapped off a tooth. You’ve broken it. Maybe the root’s wrapped around the nerve that runs through the jaw, or something like that, and you didn’t know it at the time,” said Robertson. “Those are the types of things that we think could occur and that we’re concerned about.”

Robertson predicted that mid-level providers would actually make it more difficult for dentists to make ends meet in rural areas. He said it would create a two-tiered system of dental care in Kansas: dentists for those in the more-populated areas, and mid-level providers with a lower level of training for rural Kansans.

But others counter that even that scenario would be better than the status quo.

“I would describe no care as second-class care, and that’s the system we have in place now for many Kansans,” said Shannon Cotsoradis, who heads the advocacy group Kansas Action for Children. Cotsoradis is spearheading the Kansas Dental Project, the effort to create licensed, mid-level dental providers.

“Many Kansans, whether they’re low-income, uninsured, or insured through the public health coverage system, can’t access dental care,” Cotsoradis said. “ Our goal is to make sure that all Kansans, regardless of what kind of insurance they may have or whether or not they have insurance at all, can access care, and we believe that adding another member to the Kansas dental team will help ensure that.”

Cotsoradis said the opposition to registered dental practitioners is based on fear and misinformation.

“The research that’s out there says very clearly that mid-level dental providers can provide the same quality and the same level of safety in the care they deliver as a dentist, within their scope of practice, and I would challenge the Kansas Dental Association to produce research that demonstrates something to the contrary,” she said.

Melinda Miner, a dentist in Hays, holds the opposite view of most of her DDS colleagues: She would like to start working with registered dental practitioners.

One of the so-called “dental deserts” identified in the state dental workforce report is just to the south and west of Hays. It’s an area of approximately 500 square miles, where there are no primary care dentists at all. Miner envisions being able to use registered dental practitioners to bring dental care to nearby Trego and Ness counties, which currently have no dentists.

“Our goal would be to open outreach clinics in the surrounding communities for preventive — for cleanings, for check-ups, for small fillings,” Miner said.

Miner said people will drive long distances for major dental problems, but they’re less likely to do so for the kind of routine care that can prevent more serious issues.

“You know, having to take your child out of school, take half a day off work, drive 30 minutes or more to go to the dentist for a routine checkup or preventive care is a lot less likely to happen than if you have a preventive person in your town,” said Miner.

The proposed law would require registered dental practitioners to spend their first 500 hours of practice under the direct supervision of a licensed dentist. That means they’d start out in the Hays clinic, just down the hall from Miner and her husband, who is also a dentist. Once they’re placed in the outreach clinics, they’d be under “general supervision.” Miner said telemedicine would make it possible to supervise a practitioner work without being at the same location.

“All of our x-rays are on the computer. They can call at any time and ask a question. They can send us a photograph or an x-ray, and ask us our opinion. You don’t have to be there in person to watch over somebody,” she said.

Miner sees mid-level providers not as a threat to her practice, but as a way to make it more efficient and to expand her patient base.

“Every dentist can run their practice how they want to, and I don’t want to tell a dentist, ‘Hey, you have to take Medicaid or you have to see people for free, or you have to use a hygienist,’” she said. “There are dentists who don’t want to use hygienists. That’s fine for their practice, but I would prefer if they don’t tell me I can’t do something that would help my practice to be better.”

The Kansas Dental Association does support expanding the role of dental hygienists. They’ve endorsed a bill to create what’s called an Extended Care Permit 3. It would allow specially-trained hygienists, under the sponsorship of a dentist, to provide temporary fillings, adjust dentures, and remove very loose baby teeth. Their services would be aimed at underserved children, senior citizens, and people in various forms of state care or custody. Those favoring creation of Registered Dental Practitioners say this bill would help, but it doesn’t go nearly far enough.

Kansas is among 15 states where advocates are working to expand the dental workforce with mid-level dental providers. So far, Alaska and Minnesota are the only states where these providers have been authorized.

This <a target="_blank" href="/news/kansas-mid-level-dental-providers/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý,ÌýÌýand Kaiser Health News.

It may be a new budget year for Kansas, but it’s the same level of funding for anti-smoking efforts in the state.

And that’s just the problem, anti-tobacco activists say.ÌýKansas falls far short of the federally recommended level of spending for anti-tobacco programs. In fact, the stateÌýÌýfor prevention spending in the American Lung Association’s 2012 State of Tobacco Control report.

Of theÌý$745 million in tobaccoÌýlawsuit-settlement funds and $1.4 billion in tobacco taxes in the past 12 years, less than $11 million has gone specifically for anti-smoking programs.ÌýThe federal Centers for Disease Control say Kansas should have spent about $32 million per year for a wide range of prevention efforts.

AndÌýGov.ÌýSam Brownback’s budgetÌýmakes no change: those funds and taxes will continue to pay for other needs in the state.

One effective tool to help smokers quit is telephone counseling, like the toll-freeÌýhotline, available in all 50 states, 1-800-QuitNow. Kansas spends approximately $1.10 per smoker on its quit line; the CDC recommends it spendÌýalmost 10 times more –Ìý$10.53 per smoker, according to the American Lung Association.

That’s a problem for Mary Jayne Hellebust, whoÌýheads a non-profit advocacy group called theÌý.

“How many people know about the quit line?” asks Hellebust. “Where are the billboards?Ìý Where are the radio announcements?Ìý Where are the television PSAs … that say ‘Hey, we’ve got a quit line.ÌýThis can help you.”

According to the CDC, Kansas should be spending $3.7 million per year just on media.ÌýThe state’s actual budget for anti-tobacco advertising is $90,000.Ìý

The Kansas Department of Health and Environment does produce anti-smoking messages.Ìý A video, found on itsÌý, focuses on the cost of smoking.Ìý “The average smoker spends about $150 a month on cigarettes. That’s almost two thousand dollars a year!Ìý If you’re tired of paying the price, call the Kansas Tobacco Quit Line.”ÌýBut Hellebust questions how many people are seeing that message.

The multi-state lawsuit settlement with the major tobacco companies provides almost double the amount of funding the CDC recommends for the state’s anti-tobacco programs.

But Kansas lawmakers decided in 1999 to devoteÌýmost ofÌýthat money to a special fund for early-childhood programs—things like early education, children’s mental health, and services for infants and toddlers with disabilities.ÌýThat decision has the enthusiastic support of Shannon Cotsoradis, who heads the research and advocacy group, Kansas Action for Children.

“I think there are a lot of reasons that it influences the child’s life in a positive way.Ìý We’re putting them in a positive, nurturing, supportive environment,” Cotsoradis says.Ìý“They’re more likely to get access to things like health care and good nutrition, have positive adult role models.ÌýAll of those things influence whether or not a child engages in risky behaviors in their adolescent years.”

Cotsoradis says that means these programs make kids less likely to use tobacco, even if that’s not the main focus of those dollars.

Kansas Secretary of Health and Environment Dr. Robert Moser supports using settlement funds forÌýchildren’s programs.ÌýAnd he thinks it’s unlikely that Kansas will devote anywhere near $32 million dollarsÌýrecommended by the CDCÌýfor tobacco prevention.

“There are always things we can do with more dollars, but we live in a time where more dollars are not likely [to] be forthcoming, and so now we have to look at, you know, what interventions, what programs have been most effective, so that we focus on those, perhaps, as more higher priority than some others that maybe aren’t as effective,” Moser says.

Danny McGoldrick, research director for the Campaign for Tobacco-Free Kids, argues that Kansas should raise its tax on tobacco – a move that would garner more revenue for the state and would discourage smoking.

It’s been ten years since Kansas raised its cigarette taxÌý–Ìýto 79 centsÌýperÌýpack.ÌýMcGoldrick says the averageÌýnationallyÌýis $1.46.

“The health care costs associated with smoking in Kansas are over $900 million, so when we invest in tobacco prevention, we not only pay for the program, but in the longer term we save health care dollars,” he says.

This <a target="_blank" href="/news/kansas-tobacco/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý,ÌýÌýand Kaiser Health News.

Kansas and Oklahoma are the and states to get the thumbs down from the federal government on their requests to phase in new regulations that could result in health insurance rebates to consumers.

Under the Affordable Care Act, companies that sell individual insurance policies must spend at least 80 cents of each premium dollar on health care or quality improvement for their members. Companies that fall short of the 80 percent standard will have to pay rebates to their customers to make up the difference.

Insurance Commissioner Sandy Praeger and Insurance Commissioner John D. Doak had asked the federal Department of Health and Human Services for waivers that would allow the state to slowly phase in the requirement.

Both requests were denied Wednesday. HHS official Steve Larsen says he’s seen no evidence that the new requirement will destabilize the individual insurance market in Kansas. In fact, Larsen anticipates that none of the eight companies currently writing individual health insurance policies in Kansas will pull out of the state.

“There were four companies that were, to varying degrees, below the 80 percent,” Larsen told reporters, “all of which we concluded were moving toward the 80 percent, or if they didn’t hit the 80 percent, were very profitable, and certainly could sustain paying rebates to consumers to make sure that consumers get value for their premium dollars.”

But at a public hearing last March, Coventry Health Care of Kansas CEO Michael Murphy said his company was relatively new to the individual market, and would need extra time to meet the requirement: “Application of the 80 percent standard will result in unsustainable losses for Coventry’s individual health plan business, and raise major concerns about our ability to continue operating this segment of business in the state of Kansas.”

According to HHS estimates based on 2010 data, the four Kansas companies could have to pay more than $5 million in rebates to 35,000 customers between now and next August. But insurance commissioner Praeger doubts the rebates will be that much.

“I know it won’t be that high,” Praeger said, “because I know that companies that were in the low 70’s, by the end of 2011 were close to 80, so it won’t be that high.”

Praeger anticipates that once companies get past the next couple of years, none of them will have any difficulty meeting the 80 percent standard.Ìý

The nationwide advocacy group, Consumer Watchdog, had urged HHS to deny the Kansas request to phase in the new rules. Spokeswoman Judy Dugan says the 80 percent requirement is the only real financial protection for consumers in the Affordable Care Act.

“The whole idea of this requirement is to get insurance companies to operate more efficiently, and more on behalf of consumers, with less administrative cost—possibly a little less profit—and a lower cost of sale,” Dugan said.

Dugan says it’s possible that some consumers will get rebates this year, but she thinks the main benefit from the new requirement will be seen in the premiums people pay for individual insurance policies. To meet the 80 percent standard, Dugan expects companies to lower their premiums, or to at least hold down future premium increases.Ìý

Of the 17 states that have applied to change the rebate rules, eight have been denied, five were approved with modifications, and three are still under review, according to from the Centers for Medicare and Medicaid. Only Maine got full approval for its request.

The states that are still under review are Texas, North Carolina and Wisconsin.

This <a target="_blank" href="/insurance/kansas-oklahoma-denied-health-law-waivers/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The state has drafted aÌýÌýfrom private contractors willing to provide comprehensive health, mental health and long-term health care services at a fixed rate per person.Ìý State officials say they expectÌýto select three vendors, who will compete for clients.ÌýÌý

At a news conference today, Lt. Gov. Jeff Colyer,Ìýa physician andÌýthe administration’s point man on the Medicaid reform effort,Ìý could slow the growth in Medicaid spending by nearly one percent a year. That wouldÌýsave the state more than $350 million over the next five years and would save the federal government $500 million at the same time.

About 60 percent of Medicaid is funded by the federal government, and federal approval of changes to the state’s Medicaid plan on file with the Centers for Medicare and Medicaid Services will be required before the contracts can be issued.

Colyer emphasized that savings is not the only aim of the plan: “The goal is to get them better care, so instead of ending up at the hospital six times in a year, maybe they’re only in the hospital three or four times, and we can make sure that we are saving money that way, through better outcomes,” Colyer said.

Officials said they also intend to emphasize the use of home and community-based services, which historically have been less costly than the institutional care provided in nursing homes and hospitals.

Anna Lambertson, head of the nonprofit Kansas Health Consumer Coalition,Ìýlikes the emphasis on health outcomes, but wants to see what actually materializes.

“The devil is really in the details.Ìý When I see the details of the RFP and the details of the contract, I think we’ll know a lot more about how that notion will truly be implemented.”

Lambertson says from a consumer perspective, managed care is not as important as care management.

“We want individuals with chronic conditions —Ìýwho we know constitute a significant majority of our Medicaid costs, of our health care costs —Ìýwe want those folks to have access to effective, consumer-friendly care management,” to navigate the health care system, she said.ÌýÌý

The plan would also reorganize social services in the state,Ìýshifting the Division of Disabilities and Behavioral Health Services out of the Kansas Department of Social and Rehabilitation Services into the Kansas Department on Aging.Ìý As part of the move, KDoA will take charge of the state’s mental health services, including the five state hospitals for the mentally ill and developmentally disabled.

If approved, Medicaid clientsÌýwould begin enrolling in one of the comprehensive managed care plans by November 2012.

This <a target="_blank" href="/news/kansas-medicaid-managed-care-brownback-kancare/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includesÌý,Ìý and Kaiser Health News.

A few months ago, Kansas seemed ahead of the game in preparing for an important requirement of the federal health law. The state had started to plan for exchanges — online marketplaces to help individuals and small businesses compare and buy health insurance.

But politics is intervening.

Brownback (Photo by KDOTHQ via Flickr).

Kansas Gov. Sam Brownback never liked the Affordable Care Act, saying “Obamacare [is] an abomination.” As a U.S. senator, he voted against it. And during his campaign for the governor’s office last year, he made a vow: “What we’ll do in Kansas is we’ll do what we’re required to do, but we’re gonna fight it all the way.”

Kansas has since joined the major lawsuit challenging the constitutionality of the law. And in August, Brownback sent back a $31.5 million federal grant. That money was meant to start modernizing computer systems, including the one-stop website called the Kansas Health Insurance Exchange. This online marketplace would allow people to compare and sign up for individual and small group health insurance.

Brownback’s move put Kansas Insurance Commissioner Sandy Praeger in a bit of a bind. Praeger, who is a moderate Republican, was in charge of administering the grant. She says the governor is betting that the new health law will be repealed.

“And they don’t want to do anything that looks like Kansas is moving down a path of implementing, because they think that diminishes the effectiveness of being a part of the lawsuit,” she says. “And I understand that. I mean, they are very committed to repealing Obamacare.”

In conservative Kansas, that may be smart politics, but Praeger worries that it’s not sound policy. If the law is fully implemented in 2014, every state will be required to have an insurance exchange. States that don’t establish their own would have to turn to the federal government.

Praeger

“How do you quantify the cost of individuals not being able to purchase from the plans they want to purchase from because the plan management is taken away from the state, and is directed at the federal level?” she says.

Insurers are still hoping for a state-based exchange.

“We are too busy running our business in a very difficult environment, an environment of uncertainty, to worry about the political wrangling,” says Matt All, the top lawyer for Blue Cross and Blue Shield, which is Kansas’ largest health insurer. “We are solely focused on getting ready for whatever the marketplace is gonna be in 2014, whenever the exchange is supposed to open up.”

All insists that the company will participate no matter who runs the insurance exchange, but he says he wishes he knew the rules the company will have to comply with.

“We don’t know enough yet to be fully ready,” he says. “There are just a few proposed regulations out.”

The timing is tricky. Praeger says lawmakers and the governor have indicated they don’t want to do anything to establish an exchange before the Supreme Court rules on the constitutionality question. And that won’t come before June, at the earliest. Kansas’ 2012 legislative session will have ended by then.

“Well, if we don’t get legislation passed next year and signed by the governor, we won’t have a state exchange, because we won’t be able to certify in January of 2013 that we’ll be ready,” she says.

Praeger is continuing on with her behind-the-scenes planning. She says if Kansas doesn’t have its own exchange, the state could still retain at least some control by partnering with the federal government. But that, too, would require the governor and state lawmakers to cooperate, which doesn’t seem likely in the current political environment.

This <a target="_blank" href="/insurance/kansas-republicans-cant-agree-on-insurance-exchanges/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a reporting partnership that includes Kansas Public Radio, NPR and Kaiser Health News.

It’s a for rural areas: not enough dentists to provide adequate care for the population.

In Kansas and a few other states, advocates and some lawmakers want to solve this problem by creating a new level of dental care. A registered dental practitioner, or RDP, would have more training than a dental hygienist, but less than a dentist. Mid-level dental providers have been practicing in Alaska since 2005, and legislation has recently passed in Minnesota to establish the new level of care. Bills have been introduced in Ohio, New Mexico, Vermont and Washington.

In Kansas, bills were introduced in the state and during the 2011 legislative session, and are awaiting further action next year.ÌýAnd nowÌý, located in western Kansas, is offering to start training these mid-level dental providers–if and when state lawmakers give the idea the green light.Ìý

“Two of the main things that anÌýRDP will be able to do is extractions of … teeth, and basic restoration, so drill and fill,” said Cathy Harding, who heads the . Harding says these providers can help address a of dentists—especially in rural Kansas—that is severe and growing.

The new providers would operate much the way nurse practitioners and physician’s assistants do in medical clinics.ÌýRDPs would be required to work under the supervision of a licensed dentist.ÌýHarding says she’s thrilled that Fort Hays State has agreed to offer a four-year bachelor’s degree program for Registered Dental Practitioners, pending approval by the legislature and the

But while Fort Hays State’s interest shows some momentum building for the proposal, the idea has formidable foes. The opposes it, and the American Dental Association has expressed serious concerns about the concept.ÌýAt a recent legislative hearing, two pediatric dentists testified that the RDPs would not have adequate training for procedures such as tooth extraction and filling cavities.ÌýThey argue that this would mean a two-tiered system of care in Kansas–top quality care for those with the money to pay for dental services, and lower-quality care for those who can’t pay.

That is not the opinion of all Kansas dentists, however.ÌýMelinda Miner, who practices general dentistry in Hays, one of the larger communities in western Kansas, notes that the new providers would be under the direct supervision of a dentist. She says that dentist would be accountable for ensuring that the dental care provided by the RDP meets the appropriate standard of care.Ìý Miner says she visited Alaska this summer and was impressed by the quality of care provided through a similar program there.Ìý

Miner says she was “saddened” that the Kansas Dental Association opposed this new concept without first discussing it with their members.

This <a target="_blank" href="/health-industry/kansas-dental-practitioners/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">