kancare implementation update becky ross medicaid initiatives coordinator kdhe/division of health...

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


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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


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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


4

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


5

Contract ApprovalsContract Approvals

• Amerigroup– Physician and Allied Health– Ancillary Services– Facilities– Hybrid (PAH and Facility)– Hybrid (PAH and Ancillary)– Nursing– FQHC/RHC– HCBS


6

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


7

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


8

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


9

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


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http://www.kancare.ks.gov/

http://www.kancare.ks.gov/

For More InformationFor More Information

• HP Managed care unit helpline (1-866-305-5147)

• http://www.kancare.ks.gov (New website!)


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Questions?Questions?


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kancare implementation update becky ross medicaid initiatives coordinator kdhe/division of health...

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