In Lieu of Services Policy

Notice as of January 1, 2024:
KanCare MCOs may provide In Lieu of Services (ILOS) that are not covered under the State Plan, that have obtained CMS approval in their state managed care plan contract and are in accordance with the following six principles from 42 CFR § 438.3(a).

1. ILOSs must advance the objectives of the Medicaid program.
2. ILOSs must be cost effective.
3. ILOSs must be medically appropriate.
4. ILOSs must be provided in a manner that preserves enrollee rights and protections.
5. ILOSs must be subject to appropriate monitoring and oversight.
6. ILOSs must be subject to retrospective evaluation, when applicable.

In accordance with CMS guidance, KanCare has developed a new detailed list of In Lieu of Services that may be provided to targeted populations to avoid institutionalization. Those listed services in the attachment below are the only allowable In Lieu of Services that may be offered to the member. CMS and State approved In Lieu of Services are offered to members as a choice from the KanCare MCOs and may not require a member to receive an In Lieu of Service instead of a State Plan covered service.

Early and Periodic Screening, Diagnostic, & Treatment

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidance requires Kansas Medicaid to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan for children under the age of 21. These services are considered covered services and are not in lieu of services.

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.

  • Early: Assessing and identifying problems early
  • Periodic: Checking children's health at periodic, age-appropriate intervals
  • Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems
  • Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and
  • Treatment: Control, correct or reduce health problems found.