Payment

OCK Payment Rates

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General Payment Information

The OneCare Kansas (OCK) model is a partnership between KanCare managed care organizations (MCOs) and various OCK partner entities. These OCK partners will vary according to the needs of the consumer and the expertise of the OCK partner.  

Basic Payment Structure

  1. The State will pay each MCO a “per member per month” (PMPM) payment for each member enrolled in OneCare Kansas.
  2. The MCO will contract with OneCare Kansas (OCK) partners to provide the six core OCK services. Payment will be negotiated. Most often, the MCO will pay the OCK partner an agreed-upon PMPM, but other arrangements (e.g., shared savings model, incentive payments for outcomes) may be negotiated. All of this will be negotiated and described in their contract. The State will review and approve such non-PMPM payment arrangements.  

Payment Principles

  1. State payments to the MCOs will be structured to be adequate in ensuring quality services are sustainable.
  2. MCO payments to OneCare Kansas (OCK) partners will be structured to be adequate in ensuring quality OCK services are sustainable.
  3. State OCK payments to the MCOs will be actuarially sound.  

Payment Parameters
In developing the OneCare Kansas (OCK) payments to the MCOs, the following may be taken into account, as applicable:

  1. Staffing Costs – Some OCK partners will need to hire additional staff to perform some of the six core services. The State will need to estimate the appropriate ratio of certain staff to OCK member. This ratio could vary depending on the needs of the OCK population.
  2. Geographic Variation - Some OCK services may be more expensive in some parts of the state than others due to cost of living differences, transportation costs, ability to attract certain kinds of staff, etc.
  3. Members Needs - Some OCK members will be more expensive to serve than others. Payments may be tiered, or risk adjusted, based on age, acuity (the severity of a patient’s conditions), or other demographic factors.
  4. OCK Partner Size - Because some small providers may be the only ones who can provide OCK services in certain rural areas, consideration may be given to incentives to encourage small practices or agencies to become OCK partners.