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KanCare: Process and Timeline
Topeka, Kansas • November 13, 2012Kansas Association of Counties
KanCare: Process and Timeline
Topeka, Kansas • November 13, 2012Kansas Association of Counties
Scott C. Brunner
Senior Analyst
Kansas Health Institute
Who’s included in KanCare?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”
Who’s included in KanCare? (continued)
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
What services are covered?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.
Impact on CDDOsImpact 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.
What services are covered? (continued)
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.
What services are covered? (continued)
What services are covered? (continued)
“2.2.4.1The 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.”
.
What is changing…What is changing…
What services are covered? (continued)
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).
Medicaid/CHIP Population and Spending
Medicaid/CHIP Population and Spending
Average Monthly Beneficiaries Expenditures (in Millions)0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
$16,810.0 $139.7 $40,027.0
$610.7 $60,969.0
$1,207.4
$268,038.0
$683.5
Kansas Medicaid and CHIP Population and Spending by Type of Beneficiary
Children and FamiliesPeople with DisabilitiesElderlyOther
FY 2012 Medical Assistance Report
Medicaid and CHIPManaged Care
Medicaid and CHIPManaged Care
Enrollment Expenditures0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
$282,051
$697,483,323
43,542
$2,125,669,463
Fee for ServiceManaged Care
163,882 people are currently in comprehensive managed care
Amerigroup Centene/Sunflower State Health Plan United 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
Section 1115 WaiversSection 1115 Waivers
States request that CMS waive provisions of the Social Security Act and Medicaid requirements
Demonstration projects must promote Medicaid program objectives.
1115 waivers are approved at the discretion of the HHS Secretary through negotiations between a state and CMS.
Section 1115 Waivers (continued)
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.
Cost Neutrality/Cost SavingsCost 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
2013 2014 2015 2016 2017 2018 -
200.0
400.0
600.0
800.0
1,000.0
1,200.0
1,400.0
Annual Costs for Medicaid Populations Groups Before and After KanCare
Children and FamiliesChildren and Families-KanCareElderlyElderly-KanCarePeople with DisabilitiesPeople with Disabilities-KanCareOther Other-KanCare
Expe
nditu
res
(in M
illio
ns)
Key DatesKey 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.
Key Dates (continued)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
Information for policy makers. Health for Kansans.Information for policy makers. Health for Kansans.
Kansas Health InstituteKansas Health Institute
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