KanCare: Reinventing Medicaid for Kansas

KanCare

Frequently Asked Questions about Nursing Facilities for Mental Health (NF-MH)

Are NF-MH services included in KanCare?
They are for NF-MH residents who are under the age of 22 and over the age of 64. For persons age 22-64, NF-MH services will continue to be billed and paid for fee for service (FFS).

Do NF-MH facilities need to contract with all three KanCare managed care organizations (MCOs)?
Yes, if they want to continue serving all their under age 22 and over age 64 patients. These patients are eligible for KanCare and will be allowed to choose their MCO from among the three.

Can each NF-MH get a list of which patients are assigned to which MCO?
No such list is available, but the NF-MH staff can look up MCO assignments on the Kansas Medical Assistance Program s (KMAP) website by using the patients’ Medicaid identification numbers.

Not all of our NF-MH’s patients received a KanCare enrollment packet. Why?
Remember that only NF/MH patients under 22 and over 64 are eligible for KanCare. If a patient is under 22 or over 64 and needs a replacement enrollment packet, please call the KanCare Enrollment Center at 1-866-305-5147.

Do NF-MHs need to retain their KMAP Medicaid provider identification number?
Yes. You will still need it to bill for the patients aged 22-64 and to look up MCO assignments for the under 22 and over 64 patients, as well as to verify Medicaid eligibility

Will NF-MHs need to bill three MCOs and KMAP for our patients?
FFS claims must be billed through KMAP. You can bill the MCOs for those patients who are in KanCare and bill KMAP for the non-KanCare FFS patients, or you can submit all your claims to the KMAP front-end billing (FEB) solution. If you submit all claims to KMAP, we will send your MCO claims to the appropriate MCO. Using FEB will not allow you to adjust any MCO claims through KMAP, nor will your payment for MCO claims come from KMAP.

What does an NF-MH do if they discover they have a resident in the age range of 22-64 assigned to a KanCare plan?
Please contact the Department for Children and Families (DCF) office in your area and let them know so the error can be corrected. You can find DCF offices here.

What happens when someone in the NF-MH turns 65 while there? How will the system know to change him or her to KanCare eligible?
The change occurs automatically through exchange of information with the Social Security Administration and Medicare. The facility does not need to notify the local DCF office.

What happens when a Medicaid beneficiary age 22-64 who is enrolled with a plan enters an NF-MH? How is the beneficiary informed that he or she is no longer in KanCare but now is FFS Medicaid? How is the MCO notified that this person is no longer a member of their plan? How is the provider notified?
The DCF office will change information in the eligibility system. That change will go to the MCO in the daily file from the State. The facility should know that patients age 22-64 are not eligible for KanCare and should inform the beneficiary when he or she enters the NF-MH.

What happens when a Medicaid eligible beneficiary age 22-64 leaves an NF-MH? Will they be enrolled with a plan then? How will all parties be notified?
The facility or the beneficiary needs to notify the local DCF office so the eligibility record can be updated. That update will result in updated information being passed to the assigned/chosen MCO and the MCO will contact the beneficiary since he or she is now the MCO’s member.