By Dave Ranney
KHI News Service

OSAWATOMIE — A key lawmaker says he’ll encourage his legislative colleagues to support additional funding for Osawatomie State Hospital.

“There’s a huge amount of duress out there,” said House Majority Leader Jene Vickrey, a Louisburg Republican, referring to the 206-bed facility for adults with serious mental illness who’ve been deemed a danger to themselves or others.
“As soon as we go back into session,” Vickrey said, “several of us, I’m sure, will be meeting with the governor’s staff to find out what we need to do to get people the treatment they need.”

Federal officials in November threatened to terminate the hospital’s Medicaid payments — $6.8 million in the current fiscal year — after inspectors cited the hospital for not doing enough to ensure proper medical care. In one instance, a patient had to have a toe amputated. Another patient was taken to another hospital’s intensive care unit after the patient’s blood clots went untreated due to a communication mix-up.

Federal officials agreed to a temporary lifting of the threat last month after the Kansas Department for Aging and Disability Services filed a plan for correcting the hospital’s deficiencies.

The plan included suspending voluntary admissions whenever the hospital’s census exceeds 185 patients and no longer taking patients whose “sole diagnosis is anti‐social personality syndrome, substance use disorder, or an organic mental disorder such as trauma or dementia.”

Prior to the survey, admissions to Osawatomie State Hospital had been at record and near-record levels, causing dozens of patients to be triple-bunked in rooms meant for two.

Vickrey said he dreaded the potential “tragedies that can occur when someone needs this level of mental health treatment and can’t get it.”

Room in the budget?

This year’s legislative session begins Monday. Gov. Sam Brownback will deliver the annual State of the State address Thursday evening, when he is expected to outline his administration’s plan for offsetting a projected $294 million deficit for the second half of the current fiscal year and a $436 million in the fiscal year that begins July 1.

The state’s budget situation means any spending increase will be challenging. But Vickrey said that if Brownback’s office doesn’t propose additional funding for the hospital, he “certainly” will.

“We can’t fix everything for everybody, but we need to have the appropriate bed space in our (state) hospital system for the people who need to be there,” he said.

Vickrey said many of his constituents work at the state hospital. “It’s a very tough situation out there,” he said. “What people tell me is that there have always been high censuses over the years, but they’d peak and go back down. Now, it seems like they’ve peaked and not gone down.”

When federal surveyors first arrived at the hospital in October, the hospital was caring for 250 patients, which meant that more than 40 patients were triple bunked in rooms meant for two.

The hospital campus is in Rep. Kevin Jones’ district.

“I’m not an expert on this,” said Jones, a Republican from Wellsville. “It seems like every time I go out there, things are fine. But I have constituents tell me some pretty terrible things have happened. I think there needs to be a lot more focus on the system and how it works. Because, ultimately, if there’s going to be a solution, it’s going to come down to the funding.”

Jones said he, too, will encourage his legislative colleagues to put more money in the hospital’s budget. But he’s not optimistic.

“We can try,” he said. “I don’t think any legislator can look at what’s going on and want to take money away, but everybody is going to have something that they want to see funded, that they feel passionate about. I just hope we can protect what’s there now.”

Spending at the hospital declined slightly from $29.1 million in fiscal 2010 to $28.2 million in fiscal 2013. Lawmakers added $3.6 million to the hospital’s budget in fiscal 2014 and 2015 to offset the costs of a 30-bed expansion that followed a KDADS decision to downsize its Rainbow Mental Health Facility in Kansas City.

Studying the system

KDADS officials, addressing a meeting of the Kansas Mental Health Coalition last month, said that increasing the Osawatomie State Hospital budget may not be the most efficient way to improve the state’s approach to treating the mentally ill.

“The question, really, is whether our resources are dedicated to the right places,” said Gina Meier-Hummel, commissioner of community services and programs at KDADS. “And, perhaps, are we investing in the wrong places? Do we need to reinvest in certain other places?”

Meier-Hummel said KDADS is conducting a study to find the most efficient way to fund the state’s mental health system and determining the most appropriate role for the state hospitals.

Osawatomie State Hospital is one of two state-run mental health facilities in Kansas. The other is in Larned.

Angela de Rocha, a KDADS spokesperson, said the study should be completed sometime this summer.

She also confirmed reports that a surveyor from The Joint Commission, a national organization that accredits hospitals, spent two days at Osawatomie State Hospital shortly before Christmas.

The surveyor, de Rocha said, cited the hospital for “structural problems” in some rooms that might allow suicidal patients to hang themselves, and problems in medication management and infection control.

Hospital officials, she said, have been “conscientiously addressing the problem areas that were identified” by The Joint Commission surveyor.

De Rocha also announced that Bill Rein, a longtime KDADS attorney, has been named director of the state’s two mental health hospitals and its two hospitals — in Topeka and Parsons — for people with severe developmental disabilities. In that role he will oversee Jerry Rea, superintendent of Osawatomie State Hospital and Parsons State Hospital and Training Center.

Dave Ranney is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

KANSAS CITY, Mo. (AP) — A 22-year-old Kansas City man has been sentenced to 30 years in prison for killing a University of Missouri-Kansas City student and shooting three others during a home invasion near the school.
Alonzo Ruff pleaded guilty in October to the March 21, 2013, shooting death of 23-year-old Aaron Markarian of Warrensburg. Police say intruders robbed eight people in the home, including the four who were shot.
Police said Markarian lived in the home, where the occupants had invited several people to a party.
Ruff pleaded guilty to second-degree murder, three counts of assault, robbery and five counts of armed criminal action. The sentence was part of a deal with prosecutors in exchange for his plea.
He was sentenced Friday to 30 years on each count, with the sentences running concurrently.

WASHINGTON – U.S. Senator Claire McCaskill released the following statement after the National Highway Traffic Safety Administration (NHTSA) announced it has issued a $70 million fine to Honda—the largest fine in the agency’s 40 year history—for failing to report death, injury, and warranty claims to the agency over a 12-year period as required by federal law:

“This is exactly the direction NHTSA needs to be heading as it pursues more aggressive auto safety oversight and enforcement,” said McCaskill, former Chairman of the Subcommittee on Consumer Protection, Product Safety, and Insurance. “When I questioned Administrator Rosekind at his hearing, I made clear that companies like Honda and GM must fear and respect the agency—because if the agency isn’t feared or respected, it cannot effectively police the safety of cars on the road in this country.”

NHTSA’s two $35 million fines of Honda, for a combined $70 million, represent the largest fine in the agency’s 43 year history. Combined with civil penalties issued to General Motors, Hyundai, Ferrari and others earlier in the year, NHTSA issued fines totaling more than $126 million in 2014, more than all fines in the rest of its 43 year history combined.

After NHTSA issued a $35 million fine to General Motors this summer, McCaskill criticized the mandatory cap on civil penalties and issued her support for Transportation Secretary Foxx’s request to increase the cap. She has introduced legislation to eliminate those caps altogether.

In December, McCaskill questioned NHTSA Administrator Dr. Mark Rosekind at his confirmation hearing on how the agency can better exercise authority and oversight of the auto industry, in light of ignition switch problems at General Motors and airbag malfunctions at Takata that have both been linked to consumer deaths. Rosekind was confirmed by the Senate in December and took office on Monday.

This past year, McCaskill led the Senate’s investigation into recent recalls at General Motors. McCaskill led three Senate hearings into issues surrounding 2.6 million vehicles recalled for defective ignition switches that have been linked to a number of deaths, and also held a hearing on bipartisan rental car safety legislation that she has introduced.

In November, McCaskill called on the Justice Department to consider criminal charges against Takata, an airbag company which identified and then covered up airbag safety problems that resulted in five deaths. McCaskill subsequently grilled automakers on their lackluster response to the more than 14 million vehicles currently subject to recalls or service campaigns due to airbag rupture risks.

By Mike Sherry
Heartland Health Monitor

KANSAS CITY, Mo. — A Maryland company that has reaped millions of dollars in federal health reform grants for work across the country is drawing fire for its performance in the Kansas City area.

Critics say that Advanced Patient Advocacy (APA), a privately held company, has been slow off the mark in its role as a “navigator” organization, charged with helping consumers find coverage through the health insurance marketplace established by the Affordable Care Act.

Critics also question whether the company, which houses its local staff in for-profit hospitals owned by Nashville, Tenn.-based HCA, is fulfilling its obligation under a nearly $400,000 grant to conduct outreach and education activities in the community.

Local health reform advocates are unsure why the federal Centers for Medicare and Medicaid Services (CMS) chose APA for Missouri-side work when last year’s grantee seemed to be doing a good job – and when some people here were unhappy with previous navigation work done locally by APA.

“For $400,000, what are we getting for our tax dollars? I would like the answer to that question,” said Elizabeth Darr, a retired OB-GYN who has been active helping people sign up for health coverage.

CMS’s choice of APA to serve the Missouri side of the state line this year baffled some members of the local marketplace enrollment network, who meet regularly through the bi-state Regional Health Care Initiative. The initiative is headed by Scott Lakin, a former Missouri insurance commissioner.

Lakin said some members of the marketplace committee gave low marks to APA for its enrollment efforts in Kansas last year. He also said he was disappointed that company representatives did not attend meetings of the marketplace committee last year or at the start of this enrollment period – though he is encouraged by the company’s recent participation.

APA officials say the company’s slow start this year is due in part to CMS releasing funds only in October. They say they’re now busy making up lost ground.
Previous navigator got high marks

APA replaced Shepherd’s Center Central, a Kansas City, Mo.-based nonprofit that provides Medicare counseling and other services in the metropolitan area to middle-aged and older adults.
Shepherd’s Center was part of a statewide consortium established by Primaris, a health care consulting firm based in Columbia, Mo., which received a $1.1 million navigation grant for the first open enrollment period.

The enrollment community gave high marks to Shepherd’s Center for the cadre of committed workers it put together to serve as navigators during the first enrollment period.

Primaris officials, too, said they were disappointed at not getting their grant renewed and were proud of their accomplishments in the first year, especially given the early challenges they faced when the federal enrollment website, healthcare.gov, was plagued with technical problems.

The consortium enrolled about 1,500 people in marketplace plans, said Robin Corderman, a consumer assistance program manager with Primaris and one of its affiliates. In all, she said, the consortium made contact with nearly 40,000 consumers.

Corderman said Primaris has tried for months to get feedback on its grant application from CMS, with its initial inquiry coming the day the agency announced the second round of grants.

“We have received nothing,” she said.

In response to questions submitted by Heartland Health Monitor about APA’s selection, CMS was willing to provide only background information about the bidding process.

The agency said via email that an objective review panel scored grant applications, in part based on applicants’ prior performance.

CMS said it was aware of concerns raised about APA’s performance thus far in Missouri and was working with the company to iron out issues. It said it would continue to monitor the situation.

U.S. Rep. Emanuel Cleaver, a Kansas City Democrat, also is keeping tabs on the situation, according to a statement from his office.

“Congressman Cleaver is focused on ensuring that all of his constituents have good access to quality health care and he has heard from some individuals concerned about our region, and he is monitoring the situation closely,” the statement said.

Understanding the options

As of October, a year after the start of the first open enrollment period, 7.1 million people nationwide had enrolled in marketplace plans, according to the Department of Health and Human Services (HHS). Of that number, 57,000 Kansans and 152,335 Missourians signed up for a marketplace plan.

So far, 6.5 million consumers have selected a plan or were automatically re-enrolled at healthcare.gov in the first five weeks of the current open enrollment period, which runs from Nov. 15 through Feb. 15. That figure does not include numbers from state-operated exchanges.

Navigators are part of an extensive consumer-assistance network established under the health reform law to help consumers – many of them obtaining health insurance for the first time – understand their options in the health insurance marketplace. On Sept. 8, HHS announced it was awarding $60 million in navigator grants to organizations around the country for the 2014-2015 enrollment period.

APA received a total of $1.7 million in grants to act as a navigator in four states: Missouri, Tennessee, Virginia and West Virginia. In the previous enrollment period, APA was awarded $1.4 million to provide navigation services in four other states: Florida, Kansas, Virginia and West Virginia.

Sense of mission

The chief executive of APA, Kevin Groner, once served in the Peace Corps. APA’s chief marketing officer, Rodney Napier, said Groner founded the company in 2000 with that same purpose of serving others.

Through contracts with about 100 hospitals across the country, Napier said, the company works with uninsured patients to see if they are eligible for coverage through any number of approaches, including Medicaid or even car insurance if the hospital visit is related to an automobile accident.

Napier said company officials view the navigator program as a natural extension of that service.

Although the company knew of its award in September, it did not have its full contingent of four local navigators in place until last week – six weeks after the start of open enrollment.

Napier explains that APA did not have access to salary funds from CMS until the end of October.

“We made up that ground as quickly as we possibly could,” he said.

Napier also said the company fulfills its outreach and education obligations by participating in events like community health fairs. It focuses a lot of its activities on hospitals, however, because he said that’s where people can talk confidentially about their health care needs.

Napier noted that APA’s existing relationships with hospitals also allow it to stretch its federal grant through the use of in-kind hospital services such as meeting rooms and copying machines.

Some local critics are wary of those relationships, saying APA’s participation as a navigator amounts to a private company using federal dollars to pad the bottom line of hospitals by ensuring that more of their patients have a payer source.

Napier said that APA keeps a strict firewall between staff working on traditional APA services and the people it hires as navigators. He said its hospital customers want it that way and, in any case, it’s an accounting requirement of the federal grant.

“Our heart is in the right place – it’s what we have been doing for 14 years, it’s what our company has been founded on,” he said. “That is what we wake up every day doing, with or without a navigator program.”

Mike Sherry is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

JEFFERSON CITY (AP) – The Missouri Department of Social Services is releasing $4.5 million to help low-income residents pay their heating bills as temperatures drop across the state.

Gov. Jay Nixon on Friday announced those additional federal funds put the total available to Missourians this winter at $18.6 million.

The Low-Income Home Energy Assistance Program will pay energy companies for households without heat or at risk of having their heat turned off.

Missourians with an income at or below 135 percent of the poverty level – under $27,000 a year for a family of three – can receive $800 in assistance through the Energy Crisis Intervention Program. Those with $3,000 or less in bank accounts, retirement or investments are eligible.

The program helped more than 146,000 Missouri households in fiscal year 2014.

JIM SALTER, Associated Press
DAVID A. LIEB, Associated Press

ST. LOUIS (AP) — Interviews with several elected officials and newly released records show some of Missouri’s top leaders tried to pressure Ferguson Police Chief Tom Jackson to resign after the fatal shooting of Michael Brown.

Ferguson Mayor James Knowles III told The Associated Press Friday there were several meetings where pressure was applied.

Jackson never resigned.

Missouri House Speaker John Diehl and U.S. Sen. Claire McCaskill confirmed they both attended a meeting where efforts to oust Jackson were discussed, while a grand jury was still considering the case.

Records provided to AP under an open records request include a Nov. 10 email from St. Louis County Police Chief Jon Belmar to an assistant that appears to describe the meeting. It references the potential timing of Jackson’s “separation” and identifies a potential successor.

WASHINGTON D.C. – U.S. Senator Roy Blunt (Mo.) issued the following statement today regarding the Nebraska Supreme Court decision on the Keystone XL Pipeline:

“The Keystone XL Pipeline could support tens of thousands of jobs and invest billions in our economy. President Obama is out of excuses. It’s time to approve this common-sense job-creating infrastructure project and put Americans back to work.”

This week, Blunt spoke about the importance of passing legislation to approve the construction of the Keystone XL Pipeline at the Senate Republican Leadership Stakeout and on the Senate floor.