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.