KanCare ImplementationUpdate
KanCare ImplementationUpdate
Becky Ross
Medicaid Initiatives Coordinator
KDHE/Division of Health Care Finance
Kansas Medical Society Webinar 9/6/2012
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KanCare Basics:What is Covered?KanCare Basics:What is Covered?
• All Medicaid services covered now– Physical health care, including pharmacy, dental,
vision, NEMT– Behavioral health care, including treatment for
mental illness and substance use disorders– Long term supports and services, including
nursing facilities, ICFs/MR, and HCBS waiver services
• DD waiver services and targeted case management will be delayed one year
Kansas Medical Society Webinar 9/6/2012
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KanCare Basics: Who is Covered?KanCare Basics: Who is Covered?
• All Medicaid and CHIP beneficiaries
• Excluded populations include:– SOBRA– MediKan– PACE
• Native Americans will have the option to be in KanCare
• LEA and ECI carved out
Kansas Medical Society Webinar 9/6/2012
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KanCare Basics:What Stays the Same?
KanCare Basics:What Stays the Same?
• Eligibility requirements
• Current services
• Current rates
• Medicaid ID numbers
• Eligibility review dates
• KAN Be Healthy benefits
Kansas Medical Society Webinar 9/6/2012
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Implementation ProgressImplementation Progress
• Process– Internal implementation teams– External workgroups– Weekly meetings with MCOs– Consultants helping with readiness reviews
and work plan
• Contracts– Templates being reviewed and approved by
contracts, program and legal staff
Kansas Medical Society Webinar 9/6/2012
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Contract ApprovalsContract Approvals
• Amerigroup– Physician and Allied Health– Ancillary Services– Facilities– Hybrid (PAH and Facility)– Hybrid (PAH and Ancillary)– Nursing– FQHC/RHC– HCBS
Kansas Medical Society Webinar 9/6/2012
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Contract ApprovalsContract Approvals
• Sunflower– Physician– Hospital– Nursing– HCBS
• United Healthcare– Small Medical Group and Medical Group– Pharmacy– FQHC/RHC– Hospital Local and National– Nursing – HCBS
Kansas Medical Society Webinar 9/6/2012
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MCO SubcontractorsMCO Subcontractors
Amerigroup Sunflower United
Pharmacy Benefits Manager (PBM) CVS Caremark US Script OptumRX
Behavioral Health
Amerigroup will not use a behavioral health subcontractor Cenpatico
Optum Behavioral Health (also known as United Behavioral Health)
Dental Services Scion Dental DentaQuest Scion Dental
Vision Services Occular Benefits Opticare VSP
Non-emergency Medical Transportation (NEMT) Access2Care
Medical Transportation Management (MTM) Logisticare
Kansas Medical Society Webinar 9/6/2012
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Readiness ReviewsReadiness Reviews
• Network adequacy reports due monthly from MCOs
• Onsite readiness reviews beginning this week– Each will be preceded by a desk review– Teams of KHDE and KDADS staff will perform
onsite reviews– Review IT, financial, administrative and
clinical systems
Kansas Medical Society Webinar 9/6/2012
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EducationEducation
• First tour (July 30 – August 2)– About 200 of over 1,000 Q&As posted (http://
www.kancare.ks.gov) New website!– Lessons learned
• Second tour (September 24 – 27)– Four teams, twelve cities– Teleconference on the 27th
Kansas Medical Society Webinar 9/6/2012
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For More InformationFor More Information
• HP Managed care unit helpline (1-866-305-5147)
• http://www.kancare.ks.gov (New website!)
Kansas Medical Society Webinar 9/6/2012
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Questions?Questions?
Kansas Medical Society Webinar 9/6/2012
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