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2014 TNCO Managed Care Conference The Sky IS NOT Falling: Making Managed Care Manageable The Kansas Experience Lori B. Feldkamp.

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Presentation on theme: "2014 TNCO Managed Care Conference The Sky IS NOT Falling: Making Managed Care Manageable The Kansas Experience Lori B. Feldkamp."— Presentation transcript:

1 2014 TNCO Managed Care Conference The Sky IS NOT Falling: Making Managed Care Manageable The Kansas Experience Lori B. Feldkamp

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4  November, 2010 – Governor Sam Brownback  Kansas Medicaid Transformation Project  Lt. Gov. Jeff Colyer, M.D. – Lead  Fall, 2011 – Requests for Proposal  Three commercial managed care companies will be awarded contracts  “Will save Kansans $1 billion over 10 years while increasing services without cutting provider payments or cutting those who need services off Medicaid”  Includes ALL Medicaid services and more than 360,000 consumers (all waiver services including I/DD long term care) &

5  Parents/Guardians/Consumers  Community Members/Local Government  Providers/State Association – Interhab  I/DD Pilot Project  One year “carve-out” for I/DD (ICF/MR IN)

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8  I/DD Pilot Project – Not yet implemented  I/DD In KanCare - Unless Legislature Intervenes  I/DD LTC Services IN KanCare – January 1, 2014

9  December 27, 2013 – CMS needs additional information to approve 1115 waiver amendment to include I/DD service in KanCare  Guarantees of Prompt Payments  Ombudsman – greater independence  Notices in the state’s 1915C waiver and proposed 1115C waiver amendment  Underserved waiting list ONE MONTH DELAY

10  I/DD Services begin under KanCare  Payment edits removed by MCOs (180 continuity of care period)  Ombudsman – Kansas Dept. of Aging and Disability Services (KDADS)  State of Kansas must eliminate I/DD Underserved Waiting List in 12 months.

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12  The GOOD  Additional services for Underserved  MCOs Care Coordinators friendly and try to be helpful  Comprehensive assessments – medically driven  Nursing, nutritional and behavioral specialists to assist  Value Added Benefits

13  The NOT SO GOOD  Loss of local providers - Medical/Surgical services  Medication authorizations and Auto-Assigned PCP  Confusion over TCM role and MCO Care Coordinator  Communication – Automated lines, authorization to speak with MCO, enrollment packets  General lack of knowledge of I/DD services  Receiving bills for medical services not paid by MCO  Delays in medical procedures - prior authorizations  It’s all about medical outcomes

14  The GOOD  Potential service growth - underserved waiting list  Most providers being paid timely during 180 day continuity of care period  No service reductions or rate changes during 180 day continuity of care period  Desire of MCOs to work on employment issues

15  The NOT SO GOOD  Three entities instead of one  Increased administrative overhead costs  Credentialing/Contracting  MCO Lack of experience in I/DD services – waiver rules, etc.  MCO Care Coordinator Turnover - Reorganization  Capacity to serve 1,400 on underserved list  It’s all about medical outcomes

16  Before KanCare  Batch Claims – Weekly  365 Day Deadline  Client Obligation – Known  Disallowed Claims – Minimal  Customer Service - Online  Plans of Care –  Annual  One Page  One format  Cash Flow - Stable  After KanCare  Batch Claims – Daily  90 Day Deadline  Client Obligation – ????  Disallowed Claims – Increasing  Customer Service – Phone/Fax  Plans of Care –  Monthly  Multiple Pages  Different formats  Cash Flow – Not so much

17  What if the health plan doesn’t pay my claim quickly? The contract with the health plan requires payment of all “clean claims” within 30 days. There is also a performance incentive payment for paying claims more quickly.  What is a “clean claim”? A clean claim means one that can be processed without obtaining additional information from the provider of the service or from a third party.  Source:

18 Claims experience at Big Lakes ONLY

19 Based on Big Lakes Financials

20  2013  Net Operating Losses of $110 million +  None of the MCOs met benchmarks for timeliness in claims processing – 20 days (clean) 60 days (all)  2014 (January – June)  Net Operating Losses of $72.6 million “Administration officials put government “savings” from Kancare’s first year in range of $55 - $250 million, depending on how they are calculated” Source –

21 Proactive not Reactionary Approach Increase Public Awareness Meaningful pilot project Contracting with MCOs for I/DD Shape policy and processes  State Infrastructure MCO Oversight Information Management “If we do not hang together, we shall surely hang separately” – Ben Franklin

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23  MCO Contract Renewals – 2016  MCOs are losing money  Unserved Waiting List – 3,000+  Savings in KanCare to fund???  Health Homes – August 1, 2014  MCO’s are “Lead Entity”  Targeted Case Management  SMI / Chronic Conditions

24 CMS - HCBS Integration Rule KANCARE Dept. of Labor – Companionship Rules Health Homes State Medicaid Budget Waiting Lists Affordable Care Act Political Environment HCBS Waiver Renewal Changes in State Government (MCO Contracts)

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27 Contact Information Lori B. Feldkamp, President & CEO Big Lakes Developmental Center, Inc Hayes Drive Manhattan, KS For more information about KanCare:


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