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Delivery System Reform Incentive Payment
What is the Delivery System Reform Incentive Payment (DSRIP) Pool?
CMS Approval of Kansas DSRIP Proposals
The Special Terms and Conditions of the Section 1115 Waiver for the KanCare program require the State of Kansas to create a Delivery System Reform Incentive Payment ( DSRIP) program to support participating hospitals’ efforts to enhance access to care, the quality of care, and the health of the patients and families they serve. The first year of the 1115 waiver will be used to develop the DSRIP program, and participating hospitals will conduct qualifying projects in years two through five. For more information on the DSRIP program, please read the Delivery System Reform Incentive Payment Overview.
DSRIP Historical Information on Planning and Funding and Mechanics Protocols
KDHE recently submitted a working draft of the DSRIP Planning and Funding and Mechanics Protocols to CMS for review and approval. The protocols are a requirement for the DSRIP program and define the program goals, structure, a list of potential projects and metrics, and reimbursement guidelines.
The State is seeking input from interested stakeholders on the protocols document and other facets of the DSRIP program.
To review the draft protocols, please read DSRIP Draft Protocols.
To provide input or feedback to the State regarding the protocols, send an email to KanCare@kdheks.gov.
Who Can Participate in the DSRIP Pool?
Currently, there are two hospitals participating in the DSRIP pool: The University of Kansas Hospital, and Children’s Mercy Hospital. These hospitals are eligible for participation based on their status as a Large Public Teaching Hospital or Border City Children’s Hospital.
DSRIP Timeline
- January 1, 2013 - KanCare launch
- March 31, 2013 - State submits DSRIP Pool Focus Areas to CMS
- May 31, 2013 - State submits initial drafts of Planning Protocol and Funding & Mechanics Protocol to CMS
- July 31, 2013 - Target date for final approval of protocols by CMS
- September 30, 2013 - Hospitals submit initial DSRIP plans to CMS
- December 31, 2013 - Target date for final approval of hospital plans by CMS
- January 1, 2014 - Hospitals with approved DSRIP plans can begin receiving funding from DSRIP pool
- April 30, 2014 - If hospital DSRIP plan not approved, hospital may not participate in DSRIP pool in 2014
Proposed Focus Areas
On March 29, 2013, the State submitted the DSRIP Focus Areas Report for CMS proposing the following focus areas for the DSRIP Pool:
- Increase access to services, including primary care and preventive services
- Increase the effective and efficient use of population health management through health information technology (HIT)
- Increase integration of the health care delivery system, including medical, behavioral health, and social services
- Promote physical activity through encouraging and marketing the benefits of physical activity and expanding access and opportunities for physical activity
- Improve health literacy, including nutrition education and tobacco use prevention and control
- Expand health and wellness programs and develop incentives for participation in these programs
- Expand chronic and complex care management models
- Promote healthy communities, including access to clean air and water and healthy food and lifestyle choices
CMS will review the proposed focus areas and provide input or approval to the State.
Resources
DSRIP Programs in Other States
Quality Management
Below are some of the quality measurement tools that are being used to ensure high quality of care in KanCare.
- Delivery System Reform Incentive Payment
- Centers for Medicare & Medicaid Services Special Terms Conditions Reporting - Annual and Quarterly Reports
- External Quality Review Reports
- Network Adequacy
- KanCare Quality Dashboard
Quality Management Strategy (QMS)
The Kansas Department of Health & Environment (KDHE) and the Kansas Department for aging and Disability Services (KDADS) changed its Quality Management Strategy (QMS) to match the Code of Federal Regulations (CFR) at 42 CFR 438.340 in July 2018. KDHE and KDADS are responsible for updating the QMS no less than once every three years and, as needed, based on progress, comments from partners, and/or changes in legislative, State or Federal policies.
Performance Improvement Projects
The Centers for Medicare and Medicaid Services (CMS) requires Managed Care Organizations (MCO) to conduct performance improvement projects (PIPs) per 42 CFR 438330 and 4571240(b). A PIP is a pilot project designed to improve member health and quality of life. KanCare 2.0 requires each MCO to conduct at least 5 State approved PIPs. The Human Papillomavirus (HPV) PIP is done together by all three MCOs. The MCOs must also conduct an additional PIP on Kan Be Healthy (KBH), our childhood Early Periodic Screening Diagnostic and Testing (EPSDT) program, when the MCOs’ overall rates drop below 85%.
KanCare 2.0 Performance Improvement Projects
Health Plan Accreditation
As of November 2023, the State of Kansas contracts with three Managed Care Organizations (MCOs). Each of the three KanCare health plans and their subcontractors is required to obtain accreditation by the National Committee for Quality Assurance (NCQA). The NCQA is an independent, 501 (c) (3) non-profit organization that assesses and scores the performance of health plans nationally. Plans are evaluated in the areas of quality management and improvement, utilization management, provider credentialing and consumers’ rights and responsibilities. By requiring the KanCare health plans to become NCQA accredited, we will ensure that each plan is deemed capable of providing the highest quality of care and service to Medicaid consumers. See their rankings.
Evaluation Design
Under the terms of the KanCare Section 1115 demonstration, the State was to submit a proposed evaluation design for the demonstration to CMS within 120 days. The draft evaluation design incorporates measures from the KanCare contracts related directly to the goals of the KanCare program, which are to:
After CMS and stakeholder feedback, the State submitted a final draft design for CMS review.
KanCare Evaluation Design 2020
KanCare Program External Quality Review Reports
Kansas uses KanCare, a managed care delivery system, to implement its Medicaid Section 1115 demonstration program that operates concurrently with the State’s Section 1915(c) Home and Community-Based Services (HCBS) waivers. Kansas has contracted with three managed care organizations (MCOs) to deliver services to KanCare beneficiaries. The goals of KanCare are to provide efficient and effective health care services and ensure coordination of care and integration of physical and behavioral health services for children, pregnant women, and parents in the State’s Medicaid and Children’s Health Insurance Program (CHIP) programs.
Federal statutes (42 C.F.R. 438, subpart E & section 2103(f)(3) & C.F.R. 457.1240 & 1250) mandate that states using a managed care delivery system for all or some of their Medicaid and/or CHIP beneficiaries contract with a qualified independent external quality review organization (EQRO) to conduct an annual external quality review (EQR). The purpose of the annual review is to assess and monitor the quality of care provided to Medicaid and CHIP beneficiaries enrolled in the managed care organizations (MCOs) and to identify opportunities for quality improvement.
Kansas Department of Health and Environment (KDHE), Division of Health Care Finance (DHCF) currently contracts with the Kansas Foundation for Medical Care (KFMC) to serve as the EQRO for KanCare. The EQR-related activities are intended to (1) improve states’ ability to oversee and manage the MCOs they contract with for services, and (2) help MCOs improve their performance with respect to quality, timeliness, and access to care.
The posted reports are the annual EQR technical report, which summarizes findings on KanCare access and quality of care. The following activities were evaluated for each MCO:
- Information Systems Capabilities Assessment (ISCA)
- Performance Measure Validation (PMV)
- Review of Compliance with Medicaid and CHIP Managed Care Regulations (Compliance Review)
- Quality Assessment and Performance Improvement (QAPI)
- Performance Improvement Project (PIP) Validation
- Consumer Assessment of Health Care Providers and Systems (CAHPS® 1 ) Survey Validation
- Provider Survey Validation
KFMC also conducted the Home and Community Based Services (HCBS) CAHPS Survey and the Mental Health (MH) Consumer Perception Survey to evaluate the KanCare program, reflecting combined MCO performance.
Effective implementation of the EQR-related activities will facilitate Kansas’s efforts to purchase high-value care (rather than volume) and to achieve higher performing health care delivery systems for our Medicaid and CHIP beneficiaries.
Current External Quality Review Report
Historical External Quality Review Reports
Network Adequacy Reporting
The State sets rules for how many providers the three KanCare health plans are required to have. These rules are listed in the file below called the GeoAccess Standards. The maps and reports below show:
- where providers are located
- number of each provider type
- number of locations for each provider type
- percent of members who have providers located within the rules
The State works with the health plans to review and evaluate the MCOs’ reports. The MCOs continue to grow their provider networks and must have plans to improve access for all KanCare members.
You can also search the plans’ online provider directories for specific providers.
Reports & Maps
Current Network & GeoAccess Standards
Network & GeoAccess History
Quality Management Strategy and Encounter Audits
Quality Management Strategy (QMS)
KanCare Quality Management Strategy
The Kansas Department of Health & Environment (KDHE) and the Kansas Department for Aging and Disability Services (KDADS) updated its Quality Management Strategy (QMS) to match the Code of Federal Regulations (CFR) at 42 CFR 438.340 in December 2021. KDHE and KDADS are responsible for updating the QMS no less than once every three years and, as needed, based on progress, comments from partners, and/or changes in legislative, State or Federal policies.
The purpose of the QMS is to keep the State’s focus on the goals of KanCare and activities that bring about growth. The QMS aims to build a culture that is focused on outcomes, uses our resources efficiently, sets realistic and attainable goals and provides a path to hold managed care contractors responsible.
The KanCare QMS acts as a roadmap outlining methods to maximize health outcomes and the quality of life for all members to achieve the highest level of dignity, independence and choice through the delivery of holistic, person-centered and coordinated care and promote employment and independent living supports.
Encounter Data Audits
2024
2023
2022
2021
2020
2019
Quality Management Strategy (QMS) Historical Data
- KanCare 2.0 - Quality Management Strategy
- Quality Management Strategy KDHE Public Input Response
- KanCare QMS Evaluation Report 7.6.18
Quality Dashboard and Pay for Performance (P4P)
Quality Dashboard
P4P
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