Frequently Asked Questions During 2012-2013 Medicaid Reforms

The DD waiver currently provides services to approximately 8,220 people. The waiting list for these services is comprised of approximately 3,762 individuals, and of those, 2,631 are receiving no services and 1,131 are getting some services but waiting for others. As savings from KanCare are generated during its lifespan, the State of Kansas will have the opportunity to direct some of the savings to the DD waiting list. 

For the immediate future, before a substantial amount of the savings from KanCare will be actualized, legislators allotted $3.6 million in State General Funds to help reduce the waiting lists.

Additional initiatives have been pursued as well, specifically the recent signing of HB 2453 which will create job opportunities for Kansans with developmental disabilities. HB 2453 not only promotes employment for Kansans with developmental disabilities, it also decreases the individual’s dependency on Medicaid.  In turn, this saves the state Medicaid system money and helps address the DD waiver waiting list.

The state has ensured that improved health outcomes are a main focus of the contracts with managed care companies. The performance measures for health outcomes begin in the second year of the KanCare contracts. Contractors will not earn their full payments if they fail to achieve meet performance expectations for Kansans.

The state will require KanCare companies to create “health homes” revolving around our consumers’ core health care providers.

These reforms create the most comprehensive set of goals and targeted results in Kansas Medicaid history. These new standards exceed the federal requirements and set Kansas on a path to historic improvement and efficiency.

Savings will be achieved by reducing the number of people who are being kept in institutional settings unnecessarily, decreasing repeated hospitalizations, better managing chronic conditions and coordinating each individual’s overall care. KanCare contractors will be rewarded for paying for preventative care that keeps people healthy, so they don’t get so ill that they need very expensive services. Over time this will help slow the fast-rising costs of the Medicaid system and ensure it continues to function effectively for those who need it.

The KanCare contracts require that contractors use established community partners to deliver care and services. This includes hospitals, nursing homes, physicians, community mental health centers (CMHCs), primary care and safety net clinics, centers for independent living (CILs), area agencies on aging (AAAs), and community developmental disability organizations (CDDOs). The KanCare program will allow these community partners to do an even better job. The state will continue to use CDDOs and other provider groups in their established roles, which are outlined in Kansas law.

The state is planning an extensive educational campaign prior to implementation for all Kansas Medicaid consumers and their families, legal guardians and caregivers.

Persons with developmental disabilities will continue to work with their current case managers. State law ensures community developmental disability organizations (CDDOs) will conduct – either directly or by subcontract – the waiver eligibility assessments, case management and service.

The contracts stipulate that providers must be paid within 30 days or KanCare companies will face financial penalties. To further encourage timely claims, the contracts also include a pay-for-performance measure which requires contractors to process 100 percent of clean claims within 20 days.

The KanCare Advisory Council was appointed in March of 2012 to provide guidance and feedback to the state regarding the implementation, operation, and policies of KanCare.  The appointees on this council represent beneficiaries, providers, and advocates as well as members of the Kansas House of Representatives and Kansas Senate.

Additionally, the KanCare health plan companies will be required to create member advisory boards to receive regular feedback from members enrolled in their health plans. 

Two bills introduced during the 2012 legislative session to create a KanCare Legislative Oversight Committee were never passed by state lawmakers. However, the administration has been very vocal and supportive of a legislative committee tasked with KanCare oversight, and will continue to champion this initiative. In the meantime, the administration looks forward to keeping all legislators, and particularly members of the Joint Health Policy Oversight Committee and the House Home and Community Based Services Committee, engaged in an oversight role for KanCare.

Nearly 75 percent of Kansas Medicaid patients already are part of integrated care.. Coordinating all care – including long-term services -- is critical if we are going to improve the health outcomes of all Kansans enrolled in the program.

A 2010 study by Kansas Medicaid and the KU Medical Center found that Medicaid for Kansans with intellectual and developmental disabilities and those with physical disabilities was fragmented and poorly coordinated. It did not consistently provide the recommended health care that most people take for granted, such as screenings for breast, cervical or colorectal cancer. Lack of care coordination -- and therefore lack of access -- led to increased care costs and poor results. The best way to rearrange this system, which has been separating one kind of care from another, is by coordinating all care for the each individual. KanCare also attaches financial incentives to the system, which are designed to encourage contractors to integrate behavioral care, medical care and long-term services and supports in a way that will provide more effective overall care for each individual.

While Kansas has looked at other states and learned from their models, there is no single state that KanCare is modeled after. In Kansas, nearly two years has been dedicated to study, plan and implement KanCare. Currently, approximately 75 percent of Medicaid consumers in Kansas already are part of managed care programs involving their doctors, hospitals, pharmacists and behavioral health providers. Medicaid consumers currently in managed care will move to ‘integrated care,’ something similar to managed care, but with improved health care outcomes. Kansas has implemented policies to avoid the problems that other states have experienced. Kansas is on the leading edge of implementing an integrated system of care that focuses on Medicaid consumers as individuals with individual needs, not numbers.

Yes. KanCare will take more than a year to phase-in and implement. This time period allows for readiness reviews to be conducted on all three KanCare companies. This systematically ensures that consumers will be properly supported and served by this new system. A significant difference between KanCare and any other in the nation lies in Kansas’ focus on accountability. While Kansas has looked at other states and learned from their models, there is no single state that KanCare is modeled after. 

The state is leveraging private sector experience and innovation while maintaining policy and hands on oversight of the Kansas Medicaid program to ensure improved outcomes and sustainable growth.

The state has included firm protections to maintain state responsibility for KanCare.  These protections include a strong emphasis on data and outcomes. Each contractor is required by the State of Kansas to maintain a Health Information System (HIS) that analyzes and integrates data, and makes that data available to the State of Kansas and Centers for Medicare and Medicaid Services (CMS). These reports will include, but will not be limited to, information on utilization of services, grievances and appeals, and Medicaid trends in enrollment and disenrollment. Further, the usage of an External Quality Review (EQR) of the insurance companies will be conducted annually. This review, consistent with CMS protocols, will study the following:

• The methodology used by the contractor to gather and analyze its data;
• An assessment of quality, timeliness and accessibly to health care services; and
• The extent to which the contractor has made quality improvements based on external recommendations.

The compilation of these reviews will act as a streamlined source of unbiased data which can be acted on by the State of Kansas. The objectivity of the performance measures provided in Attachment J (Appendices 1-11) of the KanCare RFP, coupled with the technical report data,  makes it possible to benchmark the performance of KanCare and monitor the performance of the contractors in relationship to the performance goals of the state.

In the event that the State of Kansas determines that a contractor has failed to provide medically necessary services or follow specified procedures, capitation payments may be withheld. Additionally, liquidated damages will be collected by the State of Kansas should the contractor fail to meet performance requirements.

The KanCare contracts ensure that previous levels of services for consumers and reimbursements to providers werel not reduced.  At the same time, new services were added into the contracts to bridge the gaps in Medicaid, and improve overall coverage.  These new services were incorporated into KanCare based on feedback the state heard from Medicaid providers, stakeholders, and consumers.

New services added through the KanCare program include:

• Heart, lung, and heart/lung combination transplants for adults
  • None of these transplants are currently covered in Medicaid for adults.
• Bariatric surgery
  • The State identified specific requirements that must be met for an individual to receive this previously non-covered service.
• Value-added services
  • Each MCO agreed to provide a set of additional, previously non-covered services to beneficiaries at no cost to the State. 
  • All three MCOs are providing an adult preventive dental benefit as part of their value-added services. 
  • Other services provided by one or more MCOs include things such as rewards programs for healthy behaviors, additional respite care for certain beneficiaries, and career development services for people with disabilities.

Expectations include:

• The State expects KanCare networks to include all Medicaid providers;
• The State conducted readiness reviews of each contractor prior to implementation;
• Clean claims must be processed within 30 days. A pay for performance measure establishes a standard of 100% of clean claims processed within 20 days;
• Persons with developmental disabilities will continue to work with their current case managers if they choose. The statutory role of Community Developmental Disability Organizations will be maintained;
• Contractors will use established community partners to deliver care and services;
• Health homes will revolve around consumers’ core providers.

The three KanCare contractors were selected in a technical, systematic, four-step process.  

• KanCare evaluation teams were formed by members of the state agencies currently involved in the Medicaid program – the Department of Health and Environment, Department on Aging, and Department of Social and Rehabilitation Services – and tasked with the review of all submitted technical and cost proposals. 
• To ensure congruency in the selection process, leaders of the evaluation teams organized to form the evaluation committee. The evaluation committee carefully designed and planned the structure of evaluation sessions to safeguard against bias, and guarantee that each potential bidder would have an equal opportunity to exhibit their approach and experience.
• After the evaluation teams determined that the five bidders proposals merited further consideration, the evaluation committee held two rounds of face-to-face negotiations with each bidder. During these negotiations, bidders gave website demonstrations and answered questions, comments, and concerns from the state. Each negotiation was conducted in the same manner to ensure that the evaluation committee could perform the most accurate comparative analysis. 
• After the two rounds of face-to-face negotiations, the evaluation committee recommended the three contractors that met all technical requisites of KanCare and expectations of the state. These bidders also submitted the lowest-cost proposals.

• Person-centered care coordination
• Clearer accountability
• Agency streamlining and name change
• Financing consolidation