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KanCare: Process and Timeline Topeka, Kansas November 13, 2012 Kansas Association of Counties Scott C. Brunner Senior Analyst Kansas Health Institute.

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Presentation on theme: "KanCare: Process and Timeline Topeka, Kansas November 13, 2012 Kansas Association of Counties Scott C. Brunner Senior Analyst Kansas Health Institute."— Presentation transcript:

1 KanCare: Process and Timeline Topeka, Kansas November 13, 2012 Kansas Association of Counties Scott C. Brunner Senior Analyst Kansas Health Institute

2 What is Managed Care? Different than fee for service.  A Medicaid beneficiary seeks a health care service  A health care provider provides that service  The provider sends a bill to the state  The state pays the bill based on coverage rules and predetermined rates for each service.

3 What is Managed Care?(continued) State leases a network of providers from a health plan or managed care organization (MCO) Health plan negotiates/contracts with providers Providers agree to accept patients from the health plan Health plans pay providers for services delivered

4 What is Managed Care?(continued) Providers must meet access standards, case management requirements, treatment guidelines from the health plan. State enforce performance requirements for the health plans.  Adequate network  Timely access to care  Clinical utilization standards  Quality of care  Payment timeliness

5 Who’s included in KanCare? All Medicaid eligible people  Infants and children (Medicaid and CHIP)  Pregnant women  Low income adults  Persons with disabilities Dual eligible Medicare and Medicaid elderly, foster children and special needs children included through a “waiver”

6 Who’s included in KanCare? (continued) January 1, 2013, all beneficiaries will be assigned to 1 of 3 MCOs. Assignment provides each MCO a fair distribution of age, health needs and location in Kansas 45 day choice period (with CMS approval) 12 month assignment lock

7 What services are covered? All medically necessary services available through the Medicaid State Plan or HCBS waivers. Must be in an “amount, duration and scope” no less than required by Medicaid. Rates paid must be no less than 100% of the Medicaid rate.

8 What services are covered? (continued) MCOs must provide “Health Homes”  Develop a person-centered care plan  Integrate clinical and non-clinical needs and services  Coordinate all services and care management across service settings Required for people with chronic conditions  Mental illness, substance abuse, asthma, diabetes, heart disease and obesity

9 Impact on CDDOs CDDOs maintain statutory role in gate keeping and case management CDDOs must also practice conflict free case management. The contracts include safeguards for provider reimbursement and quality, and provisions aimed at minimizing conflicts across assessment, case management, and service provision.

10 What services are covered? (continued) Community Mental Health Centers (CMHCs) must have a role in providing specialized services, including Targeted Case Management, for adults and children with severe and persistent mental illness.

11 What services are covered? (continued) “ The CONTRACTOR(S) shall: not CONTRACT for services with any provider who also provides either case management or functional eligibility assessments, in order to achieve conflict-free case management for LTC and HCBS services.”.

12 What is changing…

13 What services are covered? (continued) Case management for the FE, PD, and TBI waiver will be assumed by the MCOs. Aging and Disability Resource Center (ADRC) will assume responsibility for screening and eligibility for HCBS from Centers for Independent Living (CIL) and Area Agencies on Aging (AAA).

14 Medicaid/CHIP Population and Spending

15 Medicaid and CHIP Managed Care 163,882 people are currently in comprehensive managed care

16 Who are the MCOs? Amerigroup Centene/Sunflower Health Plan United HealthCare

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20 AmerigroupCentene/Sunflower State Health PlanUnited HealthCare Debit card based incentive to purchase health items. Smoking Cessation Free cell phone and minutes Preteen fitness programs Vouchers for Weight Management Programs Transportation for caregivers to medical appointments Transportation to community locations Over the counter Drugs provided through the mail Free Allergy preventative bedding Free home pest control Free Career Development training Free professional clothing GED preparation assistance Additional respite care for families of people with Developmental disabilities, severe emotional disturbance, or frail elderly. Adult Teeth Whitening Relationship counseling Entertainment discount coupons Adult preventive dental Bariatric Surgery CentAccount Debit card based incentive plan Connections Plus free, preprogrammed cell phones In home telemonitoring Appointment escorts for persons with mental illness or developmental disabilities Home visits for new mothers. Baby Showers-group classes for new mothers Start Smart birthday-quarterly education session for children Smoking cessation workbook Adopt a school programs Incentive for followup behavioral health appointments Adult preventive dental Bariatric surgery Prepaid debit card based incentive Infant care books and online reminders for appointments Membership in 4H, YMCA, or Boys or Girls Club Coverage for sports physicals Weight watchers and $50 reward for workout gear $50 gift card for completing pediatric obesity program Micro grants for schools that implement obesity programs Mobile applications for health tracking Free cell phones for high risk members Community services searchable database Enhanced vision benefits with different frame selection and contact lens substitution Additional podiatry benefits Sesame Street programs for asthma, healthy habits, and nutrition Mental health education for peers and family members Empower Kansas employment support for people with disabilities Adult preventive dental Bariatric surgery

21 Section 1115 Waivers States request that CMS waive provisions of the Social Security Act and Medicaid requirements Demonstration projects must promote Medicaid program objectives waivers are approved at the discretion of the HHS Secretary through negotiations between a state and CMS.

22 Section 1115 Waivers (continued) Must be budget neutral to the federal government. Waiver approval establishes a per person cap on federal outlay over the life of the waiver.

23 Cost Neutrality/Cost Savings $1.1 billion in savings over the 5 years of the proposed waiver.  $440 million from the Long Term Care population (Skilled Nursing Facility and ICFMR)  $152 million from Non Dual SSI  $131 million from Wavier populations Savings are from all services provided to the population

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25 1115 Waiver Transparency Regulations From Kaiser Commission on Medicaid and the Uninsured publication #8292, March August 6 August 21 September 20 October 5

26 Key Dates October 5, 2012—Earliest CMS approval October 12, 2012—90% of provider network in place. October 19, 2012 – Go/No Go on Assignment October 24, 2012—Initial beneficiary assignment to MCO.

27 Key Dates (continued) Early November—Initial assignment letters to beneficiaries. November 16, 2012—100% of provider network in place. End of November—Pre-enrollment meetings. January 1, 2013—Start of MCO contract. Subject to CMS approval of the 1115 waiver Subject to CMS approval of the contracts

28 Information for policy makers. Health for Kansans. Kansas Health Institute


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