Presented by: Shawn Sullivan, Secretary Kansas Department for Aging and Disability Services

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

2. 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

3. 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.

4. 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.

5. 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

6. OrganizationalStructure

7. 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

8. Organizational Structure Department Commissions: • Commission on Aging • Community Services and Programs Commission • Survey, Certification, and Credentialing Commission • Financial and Information Services Commission

9. Commissionon 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 -Quality Assurance programs • Client Assessment, Referral and Evaluation (CARE) program • Aging and Disability Resource Centers (ADRCs)

10. Commissionon 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

11. Commissionon 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

12. Community Services andPrograms 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

13. Community Services andPrograms Commission Budget Proposal for CSP Commission • HCBS Waivers • Behavioral Health Programs • Problem Gambling and Addictions Fund • Mental Health Initiative • PACE

14. Community Services andPrograms 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 • Caseload is flat. SGF is lower due to FMAP change. All funds budget is flat. • 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.

15. Community Services andPrograms 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 • 45persons served • 283 on waiting list • Caseload is flat. SGF is lower due to FMAP change. All funds budget is flat. • TA Waiver • 391 served • Caseload is flat. SGF is lower due to FMAP change. All funds budget is flat.

16. Problem Gamblingand 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. • KDADSis exploring options to backfill the revenue.

17. 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 ofresources to public mental health system in FY 2014

18. Regional RecoverySupport 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.

19. Increased effectivenessfor 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

20. 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.

21. Community Services andPrograms 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

22. 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

23. Financial & InformationServices 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

24. Financial & InformationServices 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.

25. Nursing Facility Provider Assessment

26. 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.