Physician input needed: KanCare survey

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KanCare, the stateís managed care Medicaid program, administered by three private insurance companies (Amerigroup of Kansas, Sunflower Health Plan, and UnitedHealthcare Community Plan of Kansas) is approaching its five-year renewal review with CMS. The Kansas Medical Society in collaboration with the Kansas Hospital Association and the Kansas Association of Medically Underserved are performing an external assessment of the KanCare program in order to:

  • Measure provider impressions about KanCareís performance relative to the programís intent, which included improved patient care outcomes and lower cost.
  • Gather provider feedback on adjustment to KanCare that could be considered during the upcoming renewal review with CMS.

As a practicing physicians your experiences with and feedback regarding KanCare is extremely valuable. We solicit your perspective on KanCare in this short, completely anonymous survey. We will be collecting responses until September 22, 2016. You can access the survey through this link:

https://leavittpartners.qualtrics.com/SE/?SID=SV_1QRMCvAjUAxLYc5  

If you have any questions about this survey please contact Ruth Cornwall, KMS Director of Health Care Finance.

 

KanCare delays implementation of "health homes"

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A key component of KanCare is the provision of health homes statewide to both children and adults. Kansas envisions these health homes to be provided through a combination of MCO services and direct provider services.

The term "health home" is unique to Medicaid and refers to a new option to provide coordination of physical and behavioral health care with long term services and support for people with chronic conditions. Health homes expand upon medical home models to include links to community and social support, focusing on the whole person and all the patient's needs to manage their conditions and be as healthy as possible. All the caregivers in a health home communicate with one another so that all of the patient's needs are addressed in a comprehensive manner. The targeted Medicaid population eligible for a health home must have at least two chronic conditions or one chronic condition and be at risk for a second; or one serious and persistent mental health condition. 

Implementation was originally slated for January 1, 2014; however, to ensure a successful rollout of the program, the state is delaying the implementation of Health Homes until July 1, 2014.

The state is currently working with actuaries to develop payment methodology and will pay a Per Member Per Month (PMPM) to the MCOs. The MCOs will then contract with providers for a negotiated rate. The state plans to release additional information about the PMPM in mid-November.

Additional information about Health Homes is available here.

 

Update on KanCare front-end billing claims

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The Kansas Medical Assistance Program (KMAP) website has been updated with General Bulletin 13112 regarding rejected KanCare Front End Billing (FEB) claims. FEB allows providers to submit both traditional KMAP fee-for-service claims as well as KanCare claims through KMAP. FEB is a free service provided as a convenience to providers and submitters.

 

Background: KanCare transition

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KanCare-Logo

After nearly a year of study and numerous meetings with stakeholders and the public, Governor Sam Brownback and Lt. Governor Jeff Colyer, MD, announced the administration's plan to reform the state's $2.5 billion Medicaid program. The plans are guided by a several key principles: improving outcomes and quality, integrating and better coordinating care for the whole person using the health home concept, stabilizing the safety net, encouraging personal responsibility, making Medicaid more economically rational and sustainable over the long term, and doing all of the above while preserving benefits and eligibility, and safeguarding reimbursement for providers.

The state's Medicaid plan has been renamed KanCare, and it will now rely on a significant expansion of managed care to achieve the stated goals. Nearly all Medicaid members will be required to enroll in one of three statewide managed care organizations (MCOs). Currently, about 240,000 pregnant women, children and their families are covered by managed care.

KanCare will rely heavily on implementing better care coordination, including ensuring that behavioral and physical health are better integrated. KanCare will be designed to align incentives for the MCOs, providers, and consumers to improve outcomes and slow the growth in costs. The state expects the program to reduce the growth in Medicaid spending  by 8-10 percent, or $853 million, over the next five years through improved care coordination and achieving improved outcomes.

One of the key strategies of KanCare will be to build strong financial incentives into the MCO contracts to incentivize them to work with providers to improve quality and outcomes. The MCOs will have to meet or exceed a number of nationally recognized performance measures, including improving outcomes in diabetes and asthma care, coronary artery disease, COPD, prenatal care, behavioral health, and others.

PLAN-SPECIFIC HIGHLIGHTS

  • Amerigroup has contracted with Multiplan to develop their network. If you are currently contracted with Multiplan you will be asked to sign an addendum. Multiplan brings a credentialed network to the table. Concerns have been raised about some of the language in the Multiplan contract giving them sole discretion to put you in any or all networks. Amerigroup reports that the contract language is being adjusted by the state so if you signed an early version of the contract you will receive an addendum with updated language. Amerigroup encourages contracting through Multiplan but has indicated that providers may contract directly with them. Amerigroup will observe a timely filing timeframe of 90-days, and has subcontracted with Occular Benefits for all Vision Services. Amerigroup has also announced that it is about to be acquired by Wellpoint, the parent company of Unicare, which is an existing MCO in Kansas Medicaid.
  • UnitedHealthcare plans to build upon their current network already in place. If you already have an existing contract with UHC for their commercial lines of business you may be asked to sign an amendment to your current contract. UHC has indicated they will observe a 90-day timely filing deadline, and has subcontracted with VSP for vision services-Medical ophthalmology services will be billed directly to UHC.
  • Sunflower State Health Plan, a subsidiary of Centene Corporation, has contracted with Wichita-based, ProviDRs Care Network, to meet the State's network adequacy requirement. They are offering direct contracting or you may be asked to sign an amendment to your ProviDRs Care contract. The Sunflower contract has a number of product attachments (Medicare and Commercial exchange). Sunflower will observe a 180-day timely filing deadline, and all vision services will be subcontracted to Opticare.

RESOURCES

For more information, contact Ruth Cornwall at the KMS office.

 

Medicaid RACs

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KMS, in partnership with several other organizations, hosted an educational webinar designed to better inform member physicians about the Medicaid Recovery Audit Contractor program; below you'll find PDFs of the material as it was shared with attendees. Members who have questions about the program or the presentations may contact Ruth Cornwall, KMS Director of Health Care Finance.

 

KMS & KaMPAC dues

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Important reminder

Dues statements have been mailed & payments were due by January 1.

 

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