KanCare: Reinventing Medicaid for Kansas

Providers

Frequently Asked Questions

1115 waiver

1.  Under the 1115 waiver, what are the member plan choices?
The member health plans are UnitedHealthcare, Amerigroup Kansas and Sunflower State Health Plan.

2.  What’s the status of the CMS 1115 waiver?
The State formally submitted the 1115 waiver demonstration application on August 6, 2012.  However the State has been working with CMS on a weekly basis since the beginning of the year.  We plan to have approval in time to implement KanCare on January 1, 2013.

3.  When will the waiver be resubmitted to CMS?
 It was submitted August 6, 2012.

4.  What is a safety net care pool for hospitals?
 The State’s KanCare proposal includes the creation of up to four safety net pools to permit direct payments to hospitals based on those hospitals’ uncompensated costs associated with providing care to Medicaid consumers and the uninsured. The Section 1115 application includes details about each pool.

5.  What will happen if the waiver is approved by January 1 regarding the care of children in foster care?
Children in foster care will be assigned to one of the three KanCare health plans. Their designated health care decision maker may choose another plan within the specified timeframe, and then the children will remain with the plan chosen for the rest of the year. If a child moves to another foster family, s/he will stay with that plan unless there is “good cause” to switch. Since all three plans cover the entire state, movement to another family is not “good cause” to switch. The following are good causes:

• The plan does not, because of moral or religious objections, cover the service the enrollee seeks.
• The enrollee needs related services (for example a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and the enrollee’s primary care provider or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk.
• Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the enrollee’s health care needs.

Affordable Care Act

1.  Is this program compliant with Obamacare, under its jurisdiction or totally separate from it?
KanCare was designed independent of the ACA but will allow the State to better respond to any federal mandates.

2.  What will happen if Kansas opts out of ACA?
Assuming this question is related to Medicaid expansion, the Governor has said the State will make that decision after the November election.

3.  Will Kansas expand Medicaid eligibility as indicated in the latest Federal Healthcare legislation?
Consistent with what the Governor has indicated, the State will make that decision after the November election.

Aging and Disability Resource Center (ADRC)

1.  What are the steps to becoming ADRC? Can an agency which has provided HCBS services become an ADRC?
A request for proposal (RFP) for a statewide ADRC was released in the Spring of 2012.  The closing date for the (RFP) was April 3, 2012.    The ADRC is nearing the end of the procurement process.  The announcement date is still pending.

2.  What is the status of “conflict free” eligibility/ADRCs? Will this be decided and the process clearly outlined prior to KanCare implementation?
The ADRC will be responsible for functional assessments for Nursing Facility and three Home and Community Based Service Medicaid programs (Frail Elderly, Physically Disabled and Traumatic Brain Injury).  This will provide for conflict free functional eligibility.  The ADRC is nearing the end of the procurement process.  The announcement date is still pending.

3.  When will we have the ADRC announced?
The ADRC is nearing the end of the procurement process.  The announcement date is still pending.

4.  With five months until KanCare goes into effect, who are in the providers for the ADRCs? When will the ADRCs begin meeting with the beneficiaries?
 The ADRC is nearing the end of the procurement process.  The announcement date is still pending.  It is anticipated that the ADRC will be available for options counseling in November 2012.

5.  What are the disability resource centers you mentioned? What will they do? And where will they be?
The ADRC will be responsible for functional assessments for Nursing Facility and three Home and Community Based Service Medicaid programs (Frail Elderly, Physically Disabled and Traumatic Brain Injury).  This will provide for conflict free functional eligibility.  The ADRC is nearing the end of the procurement process.  The announcement date is still pending.

Assisted Living

1.  Are you going to start paying for assisted living?  If so, what will be your payment methodology?
Medicaid beneficiaries may access HCBS covered services in assisted living facilities under KanCare. The HCBS service rates will continue to be set by the state. 

2.  My mom is 92 and in about four to five months, she will run out of money. How will KanCare help her to stay in her current assisted living facility?
Once your mother is eligible to receive Medicaid benefits, she will enroll in one of the three KanCare health plans. The health plan will assign her a care coordinator who will work with your mother, and her assisted living provider to develop a plan of care for her. The KanCare health plan will reimburse the assisted living provider for the services in the plan of care they provide.

3.  Are there any differences between services received as a permanent resident of an Assisted Living Facility and a Nursing Home? Could you please provide scenarios for both?
Assisted Living Facilities and Nursing Facilities fall under different licensure regulations. Both regulations can be found at http://www.aging.ks.gov/PolicyInfo_and_Regs/ACH_Current_Regs/ACH_Reg_Index.html. Assisted living facilities provide different services according to the model they have chosen. Some may focus on memory care; others may serve individuals with high levels of personal care needs. Nursing facilities are required to provide a full range of services including 24 hour a day nursing care.

Authenticare

1.  Will the MCO's be loading authorizations into Authenticare?
The MCOs will provide Waiver authorizations to the state, which will then be loaded into Authenticare.                               

Behavioral Health & Substance Abuse

1.  Where do addiction services fall in this network of services?
Behavioral health services include mental health as well as addiction services.  The two have been merged.  All behavioral health services will be provided through the KanCare health plans.

2.  Who handles the substance abuse block grant funds?
The block grant funds will continue to be managed by ValueOptions-Kansas

3.  Will the forms change from what was used with KHS?
Yes. Under KanCare, all behavioral health services as well as physical health and other services are managed by each of the three MCOs.  While the substance will be familiar, each MCO will have some unique features in their forms and their own processes.  We are currently working with the MCOs to streamline and standardize as many forms and processes as we can.

4.  Will the KCPC still be used to authorize substance abuse services?
Yes. It will be used to authorize services until we can come up with a better alternative.

5.  Will people with autism—children and adults—have access to behavioral health care including ABA?
All benefits available to Medicaid members prior to KanCare will be available under KanCare.

6.  Will MCOs oversee substance abuse?
Yes, for those substance use disorder services that are paid for by Medicaid.  Value Options will continue to manage non-Medicaid funded SUD services.

7.  Mental health is often a chronic condition, what is considered “better managing chronic conditions for this population?
Good care management would include identifying the person's needs comprehensively, and working with the person to get those needs addressed proactively, using prevention and interventions in a timely and effective manner.  In addition, it includes managing conditions so that people can avoid hospitalizations when feasible.

8.  What is considered an adequacy of network for mental health providers?
Network adequacy is based upon the ability of members to get services from qualified providers within the timelines identified in the KanCare program requirements. The network as it currently stands is considered adequate, and KanCare will likely add additional private practitioners to the network above and beyond what is currently in place.

9.  Who will determine member eligibility for PRTF admission?
CMHCs (Community Mental Health Centers)

11.  Will MCO change the state requirements for training that rehab provider for mental health services?
No.  The state, along with a stakeholder group, sets the training standards for all mental health providers.  The MCO will not change these.

11.  Behavioral Health Question: How does the transition work?
All plans will work with the state and other managed care plans to identify those clients who need transitioning to our new MCO’s. MCO’s will honor existing authorizations for a period of time to aid in this transition. All clients will be transitioned with no disruption of services. All services that are available now will be available under our KanCare program.

12.  How will new psychiatric CPT codes affect Behavioral Health services payments by MCO?
MCO will cover services as defined by the State.

Care Coordination

1.  Is the care coordinator a RN or LPN?
Care coordinators are most often RNs.

2.  We will have children in all three MCOs, will they all address the waiver recipients services and case managers/assessors the same way?
All waiver services, except for DD waiver services in the first year, will be provided by each MCO. The MCOs must provide the services as specified in the waivers currently.  All three will provide case management either directly or indirectly. So there may be some differences across the three MCOs, but we want members to have choices.

3.  Who will perform the care coordination for Medicaid beneficiaries? How is this accessed?
The MCOs will employ care coordinators who will be assigned to members based upon a variety of criteria, including multiple chronic conditions, particular diseases or other factors.  The MCO you are enrolled with will contact you with information about your care coordinator.

4.  What about a person who doesn’t want the care coordinator? Who determines whether we need a care coordinator?
The MCO will make that determination. They will decide based on your conditions and health services needs. If you believe you do not need one, you can say so.

5.  What does the care coordinator know about an individual consumer’s non-medical needs (preferred lifestyle choices)?
A care coordinator will talk with the member, other providers, guardians, etc. to get a complete picture of the member’s needs and preferences.

6.  What if my father’s nursing home is not enrolled with a provider that supports his complex (Parkinsons) medication regime? Will he be forced to change nursing homes? What if I don’t like my care coordinator or do not believe they are responsive to my needs?
All MCOs must attempt to contract with all existing Medicaid providers. They must pay them the current Medicaid rates. There is no incentive for a nursing facility not to contract with an MCO. If an MCO doesn't contract with your father's nursing facility, he can select a different MCO. If you have problems or issues with the assigned care coordinator, you can contact the MCO Customer Service Unit and explain why you want a different one. The MCOs have stringent grievance and appeals requirements they must meet. The MCOs will also be required to follow the State’s formulary (covered drugs list) and preferred drug list.

7.  What is the background, education or credentials of the care coordinator?
Most care coordinators will be nurses, but some may be social workers.

8.  What will happen if a care coordinator decides a client is receiving an unnecessary service?
The care coordinator doesn't make such a decision without consultation with other relevant providers and talking with the consumer.

9.  What’s the patient-care coordinator ratio? Will care coordinators be nurses, social workers, or insurance liaison people?
Different coordinators will have different caseloads, depending upon the complexity of the needs of members. Generally, coordinators will be nurses.

10.  Where does “care coordinator” come from for people with mental health services with both Medicare and Medicaid coverage?
The MCO will provide a care coordinator who will work with any case manager you have in the mental health service system.

11.  Who is the care coordinator employed by?
The KanCare health plan employs the care coordinator.

12.  Will care coordination be able to override doctor’s orders or preferences?
No. As long as a service is covered and is medically necessary, it will be paid for.

13.  Will health home care coordination be face-to-face or via phone? Will you maintain same coordinator ongoing?
All MCOS have care coordination now for people with multiple or complex conditions. Health homes are sort of an extra coordination designed for one provider to be responsible for communicating to all others and coordinating the member's care and ensuring information is shared across all providers. Health homes won't begin until the end of 2013. Care coordination can be both telephonic and face-to-face, depending on the needs of the members.

14.  Will self-direct care givers be included in the coordination of care?
Yes, if the member needs care coordination, all the providers will be part of the care that is coordinated.

15.  Will the care coordinator work with legal guardians of adults before attempting to make changes to ongoing care?
Yes, guardians will be part of the process, as long as proper permissions are available.

16.  If a beneficiary refuses a service (i.e. flu shot) will they still be required to receive it?
No, but their health plan will encourage them to get all needed services and become engaged in their own care.

Case Management

1.  Is the state telling targeted case managers that they are no longer needed?  Will thousands be out of work?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

2.  What will be the job duties of MCO case managers? And how will that impact what current targeted case managers with HCBS provide?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

3.  Who will do case management for people?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

4.  FAQ states that MCOs contract with existing providers. Are MCOs taking over case management on waivered consumers or is this service being contracted?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

5.  It is my understanding that MCOs will provide HCBS case management directly or indirectly.  When will the MCOs determine if they are contracting with current HCBS providers for case management?  Is there a deadline for this to be determined?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

6.  So, are TCMs going to be phased out eventually?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

7.  We currently have managers through Area Agency on Aging, will we continue to have them as case managers for our residents? How will their plans of care change? Will the facility be required to keep weekly care logs?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

8.  What is the role of MCO case management vs. role of HCBS provider case management?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

9.  What will happen to current TBI and PD case managers?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

10.  Will current providers of case management for all waivers contract with or be employed by the insurance companies? Will the state be rewriting article 63?
No decision has been made to revise Article 63. These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan. For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors. By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case

11.  Will HCBS targeted case management continue as it is now?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan. For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors. By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case

12.  Will I keep my case manager?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan. For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors. By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case

13.  Will patients need a referral from their case manager to see a specialist such as an eye doctor?
No, however, a Care Coordinator may assist a person to establish a referral and make arrangements for an appointment with such a specialist.

14.  Will current PD clients/consumers keep their case managers?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

15.  When do you plan to notify current HCBS/case management about these changes? 
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

16.  Between now and the end of December the existing case managers for the HCBS waivers are losing their jobs or moving to the MCOs. If we have a problem with a beneficiary coverage, who do we call?
Every agency providing targeted case management is responsible for ensuring that the service continues to be made available until it is taken over by the KanCare MCOs. The state has provided transition guidance to all current providers regarding the successful completion of this work until KanCare is initiated. If you have a specific situation to work through, you should contact the KDADS program manager responsible for the program area involved.

17.  Will MCO's limit visits and phone contacts with each individual by case manager?
Each of the MCOs will have their own internal work processes, but the bottom line requirement is that the needs of each member get addressed. If you have any questions or concerns once the KanCare program is initiated, you will have contact names and numbers at the MCO who can ensure you understand the processes and options available.

Choosing a Health Plan

1.  How often can members change plans within a year?
Members can only change during the initial choice period, and will be locked into a plan for one year after that. There will be an annual choice period for each member.

Co-pays

1.  Do any of the MCOs have copays for PCPs?
Consumers in KanCare will not pay a co-pay. 

2.  Will any copays need to be paid for office visits?
Consumers in KanCare will not pay a co-pay. 

3.  Will part D copays still be paid by MCOs?
Yes, if Medicaid pays for your copay now, this will continue in KanCare.                                                                            

Coverage

1.  Is the KBH exam still being offered?
Yes, all KanBeHealthy exams and screenings will be covered in KanCare as they are now.

2.  My son was just put on Health Connect what will happen after December 31st?
Your son will receive an enrollment packet for KanCare this fall. You will need to review the three health plans and choose which KanCare plan you would like for him to have. He will continue getting his services through Health Connect until December 31st. On January 1, he will receive all of his current services through the KanCare plan you chose for him.

3.  Are hospice services part of KanCare?
Hospice services are a part of KanCare.

4.  How will allergy shots and other injections be paid for?
The services covered now will continue to be covered in KanCare.

5.  How will KanCare MCOs choose services to be approved or denied?
KanCare guarantees that all of the current services consumers receive will be covered under the program.  Coverage will always be based on individual need and medical necessity.

6.  Will all benefits have the same limits and allowances?
KanCare guarantees at minimum the current scope of services and reimbursement. 

7.  Will individuals be able to continue to receive treatment in Colorado?
If that is where they have already established their care, our goal is for that to continue.  We certainly recognize that Denver is a lot closer than Kansas City for some consumers.  We will consider mileage and transportation costs when considering out of state services.

8.  Will Medicaid cover podiatry?
Yes, currently the coverage is for members 21 and under. With the implementation of KanCare, limited services will be available for members over 21. 

9.  Will Medicaid pay for Chiropractor services?
Chiropractic services are currently only paid on Medicare crossover claims.

10.  Will there be caps on services?
Yes. Services will be based on medical necessity and controls for utilization management. However, you will still receive all of the services you are receiving today.

11.  Will there be therapy reimbursement for medical residents that are inpatient and need Part B therapy services?
If it is a service that is covered now will continue to be covered in KanCare.

12.  Will all benefits have the same limits and allowances?
The MCOs may opt to be more generous, but they at least have to provide what we currently provide in Medicaid. 

13.  The last time I presented my United Healthcare card at a minor emergency center they would not take down the information from it because they said United Healthcare would not pay anything.  Will the minor emergency centers take these KanCare plans including United Healthcare? 
Each of the KanCare health plans is responsible for getting as many providers in their network as possible. This includes minor emergency centers. It is always the provider's choice if they want to be in the network or not. The State has told each of the health plans that they must do everything they can to get all current Medicaid providers (plus new providers) into their network.

14.  What adult preventative services will be covered?
All adult preventative services that are covered in Medicaid for you now will be covered under KanCare. Additionally, each of the KanCare health plans will cover preventive dental care for adults. This preventive service varies slightly in each of the plans, but generally they will now cover dental exams, cleanings, and x-rays.

15.  Will I be able to see my eye doctor and medical doctors are on the health plans?
If your current providers sign up to be part of the health plans' networks, you will still be able to see them. If your doctors only sign up with one of the three plans, you can choose to be in that plan and still see them.

16.  Will the duodenal switch type of weight loss surgery be covered, as it already is by Medicare?
Because weight loss surgery is a newly-covered service, the State will work to define the parameters of coverage in a Medicaid State Plan Amendment. Although the specific coverage guidelines have not all been defined at this time, the State does not intend to limit coverage of this service to a particular methodology. The State will limit which Medicaid beneficiaries qualify for the service. For example, consumers must have participated in a medically supervised weight loss program for at least six months before receiving the service.

17.  Will we still need to choose or change plan D in October?
Yes. If you also have coverage through the Medicare program, you will still need to select your Part D plan during open enrollment for Medicare.

18.  Is there a phone number to call to make sure certain services will be covered so I’m not left with extra costs?
Yes. You will need to contact your KanCare health plan if you are not sure if a service is covered. Everything that you are receiving now will be covered by your plan, but new services might also be covered so you need to call if you are not sure.

19.  Are providers going to be required to apply existing Medicaid coverage guidelines as well as policies developed by the MCOs?
Each of the KanCare health plans will use a transparent system of utilization management and coverage guidelines.  In most cases, the plans will use either Milliman or Interqual.  If another set of guidelines is used, they must be transparent and available to providers upon request.

20.  Will one company do all eyes, dental, etc?
Each MCO must provide the full range of covered Medicaid services.  This includes vision, dental and other covered services.

21.  How does this affect the Durable Medical Equipment Supplies (DME)?

The scope of the service is the same.  It will be provided through KanCare so DME providers will need to sign up with the plans. 

Credentialing

1.  Current provider credentialing is not carrying over to the MCOs so all providers will have to be recredentialed with MCOs?
Yes, all providers will need to enroll with the MCOs of their choice.  The application for Hospitals, LTC, other facilities and waivered services can be found on the KanCare website or each MCO's website.  The enrollment for clinicians can be done through CAQH.

2.  What is involved in the credentialing process? 
The application for Hospitals, LTC, other facilities and waivered services can be found on the KanCare website or each MCOs website.  The enrollment for clinicians can be done through CAQH. The provider will also need to supply the licensing information also to the MCO.

3.  Will all 3 MCOs be contacting providers with credentialing packets or are the providers responsible for contacting the 3 MCOs to become contracted?
The MCOs will try to reach out to all current providers.  However, if you have not been contacted by all three MCOs, you should reach out to them directly.  All providers will need to enroll with the MCOs of their choice.  The application for Hospitals, LTC, other facilities and waivered services can be found on the KanCare website or each MCOs website.  The enrollment for clinicians can be done through CAQH.

4.  Will the CAQH be used for provider enrollment information?
Yes

5.  Will there be a single provider credentialing program for all 3 MCOs?
The State has worked with all three MCOs to develop a standardized credentialing process.  Each provider is responsible for enrolling with all 3 MCOs.

6.  Where can “standardized credentialing be found?
The standardized approved application can be found on the KanCare website for LTC, hospitals and the waiver service programs.  For all other providers, use the CAQH application that can be found at www.caqh.org.

7.  What is the pre-certification (credentialing) process for each new provider? 
For those providers who do not use the CAQH format, the State has worked with the MCOs to develop a single form that you can fill out once that will work for all three MCOs. 

8.  Do the MCOs require providers to be board certified to be eligible to be credentialed? Or can they be board eligible?
The provider should be board certified. 

9.  What is the pre-certification (credentialing) process for each new provider? 
For those providers who do not use the CAQH format, the state is working with the MCOs to have a single form that you can fill out once that will work for all three MCOs. 

10.  When you complete the standardized application form, can we send 1 form to all 3 MCOs?
As designed, the form is standardized with the option of checking one of three boxes for which MCO you intend to submit it to.  Because the form is standardized, you have the option of filling it out once and making copies to then be sent to all three MCOs, you will not need to go through the rigorous exercise of filling out three very different applications.

11.  If a Kansas Medicaid provider, will we be contacted to apply automatically? Will they use CAQH?
There is a standardized application for the waivered service providers and facilities which will include Hospitals and Long Term Care.  All other provider types would use CAQH.

12.  Application process?
All providers will need to enroll with the MCOs of their choice.  The application for Hospitals, LTC, other facilities and waivered services can be found on the KanCare website or each MCOs website.  The enrollment for clinicians can be done through CAQH.

13.  Do all MCOs accept CAQH for provider applications?
If you are a clinician, you would be using the CAQH form.

14.  Will the application forms change? Does each MCO have a separate one?
The application for Medicaid will not change. The application to enroll as a provider with each MCO will be somewhat different with each MCO. The credentialing process will be the same across all MCOs.

Critical Access Hospitals

1.  How will CAH facilities be paid?  Are we still going to receive our costs or will we be paid some other way?
The State has developed hospital-specific cost adjustment factors (CAF) that will be applied to the fee-for-service baseline to account for each CAH's costs and Medicaid experience

2.  Will CAHs be paid on a cost basis?
The State has developed hospital-specific cost adjustment factors (CAF) that will be applied to the fee-for-service baseline to account for each CAH's costs and Medicaid experience

Dental

1.  Is there an obligation on the part of the providers to see all age populations of patients for dental/oral surgery?
Adults will only have preventive dental care. Any provider can limit his patient panel size and see only existing patients. You will need to indicate that to the MCOs you sign up with.

2.  Other than preventative services will additional dental services be provided, like dentures?
Only checkups, cleanings and x-rays will be provided to adults at this time.

3.  Generally, how will the dental program work?
Under Medicaid now, we currently cover dental services for children.  While dental used to be under a managed care arrangement several years ago, it then became part of the fee-for-service program.  Under KanCare it will again be part of the managed care environment.  The plans will be providing the same dental services that are currently available for children.  They will also include some adult preventive dental care as a value-added service.  Dentists are encouraged to sign up with all three MCOs to provide dental care to Medicaid patients. 

4.  Have more dentists in Kansas agreed to take Medicaid? KanCare?
With the value-added benefit of adult preventative dental that the MCOs are providing, the expectation would be that more dental providers will sign up because a wider breadth of services are covered. 

5.  How are you going to recruit new dentists?
The MCOs are currently communicating with dental providers about expanding their networks, and how the new services offered by KanCare will benefit their integration into the program.

6.  How does this affect dental providers?
Under Medicaid now, we currently cover dental services for children.  While dental used to be under a managed care arrangement several years ago, it then became part of the fee-for-service program.  Under KanCare it will again be part of the managed care environment.  The plans will be providing the same dental services that are currently available for children.  They will also include some adult preventive dental care as a value-added service.  Dentists are encouraged to sign up with all three MCOs to provide dental care to Medicaid patients. 

7.  Is the current dental through HP being discontinued into the MCOs? Or will it also still be available? 
Under Medicaid now, we currently cover dental services for children.  While dental used to be under a managed care arrangement several years ago, it then became part of the fee-for-service program.  Under KanCare it will again be part of the managed care environment.  The plans will be providing the same dental services that are currently available for children.  They will also include some adult preventive dental care as a value-added service.  Dentists are encouraged to sign up with all three MCOs to provide dental care to Medicaid patients. Providers will also be able to bill MCOs directly or through a billing clearinghouse managed by HP.

8.  Will clients need to be assigned to a dental provider?
No. Clients can choose a dental provider based on who is in the network of their MCO. 

9.  Will dental providers still use KMAP website for claims?
Yes.  They will have the option to bill through KMAP or bill the MCOs directly. If they use KMAP (HP), the claim will be sent on to the MCOs for payment.

10.  When my mother needed tooth care, for extraction, she tried to get it from Medicare of Medicaid but lots of dentists were refusing to be in the program.  I had to keep calling dentists, even in Kansas City, to try to find one.  They didn’t want to be in the program because they never got paid.  Will this be the case with this program (dentists not wanting to be in it/hard to find a dentist)? 
MCOs are working hard to build the best networks possible. The additional dental benefit for adults may encourage some more dentists to sign up. In addition, MCOs can pay MORE than the current rate; they choose to help encourage providers to sign up.

11.  Why does dental care exclude treatment for adults?
Dental services are not a required Medicaid service. Many states, including Kansas, are struggling with the size of their Medicaid budgets. Unfortunately some services can't be covered.

12.  Will any dental services be discontinued for children?
No.

13.  Will there be any other expanded dental care, other than preventative for the frail elderly or physically disabled?
Not at this time. The preventive services for adults are being offered at no cost to the State, by the MCOs.

14.  Will there be coordination with MTM for dental trips?
Each MCO must provide or arrange for transportation to medically necessary services; this includes dental services. MTM will no longer be the statewide transportation broker after December 31, 2012; the MCOs will provide information about how to access their transportation.

15.  How will providers be recruited to work with your service providers such as dental services?
Each MCO is working with a dental services subcontractor. For Amerigroup and United, that is Scion Dental and for Sunflower, it is DentaQuest. These companies are working to sign up current and new dental providers for their networks.

16.  What happens if dental service providers refuse to contract with Medicaid dental contracts?
Dental providers who do not contract with the MCOs’ dental services subcontractors will be considered out of network and may be paid less for services provided to Medicaid members.

Developmental Disabilities Waiver

1.  How does MR/DD carve out affect signing contracts for this program?
If a MR/DD provider will be providing only DD waiver services or TCM, they will need to begin contracting with MCOs no later than January 2014.  You certainly could do it sooner.  If you will provide other services to members on the DD waiver (such as transportation) you need to enroll now with the MCOs if you wish to continue providing those services after January 1, 2013.

2.  I/DD population have a 12-month delayed implementation--will they have access to all value added services immediately when KanCare first starts in 1/1/2013?
Yes.  Members with an intellectual or developmental disability are eligible for value-added services because they will be enrolled in KanCare on January 1, 2013 for all physical health (non-waiver) services. 

3.  HCBS DD Targeted Case Management?
At this time, people who use TCM services in the DD service system will continue to access them through the CDDOs around the state, in keeping with Kansas’ DD Reform Act of 1995. 

4.  How does the I/DD carve out affect signing contracts for this program?
If an I/DD provider will be providing only DD waiver services or TCM, they will need to begin contracting with MCOs so that the process is complete by January 2014.  They certainly could do it sooner.  For providers who provide other services to consumers with DD (such as transportation), they should sign up with the MCOs now to continue providing those services after January.

5.  Persons with DD/ID, will they be assigned to an MCO or have a choice in signing up?
Yes. Even though the DD waiver services will not be in KanCare until January 2014, persons with I/DD will still be assigned an MCO for their medical services such as regular doctor visits. They can choose a different plan if they think it would be better for them.

6.  What roles will CDDOs have?
CDDOs will continue to have their statutory role of assisting the state in managing the public DD service system.  They will be expected to assist the state in providing clear and accurate information about KanCare to the providers and members in their area.

7.  What happens to supportive home care, day services, and residential services after one year?
After one year these services will become the responsibility of the MCOs, but will still be provided by current service providers if they choose to be part of KanCare.

8.  Why are the DD waiver services taking a year to switch?
Advocates for the Developmental Disability system were successful in securing a one-year implementation delay for HCBS Developmental Disability services.  This means the HCBS services under the DD waiver and DD targeted case management will not be included in KanCare for one year unless the person chooses to participate in the DD Pilot Program.  Consumers on the DD waiver will retain their current targeted case manager, and will work with a care coordinator from the MCO if they have complex health needs.

9.  Will care managers be replacing the case managers that DD adults now have? What kind of training will care managers have?
No. People receiving developmental disability services on the DD waiver; such as Day, Residential and Case Management, will experience no change with regard to those services during the first year of KanCare. Care managers employed by the MCOs are generally highly trained social workers or nurses and are responsible for helping people address their health care needs comprehensively.

10.  Will the value added services for the ABD population be available to person on the MR/DD waiver, even though this waiver has been carved out for one year?
Yes

11.  Will MR/DD providers be included in this first wave of contracting or delayed until 2013?
If you provide only DD waiver services, you will be delayed until 2013 unless you volunteer to participate in the pilot for 2013.  If you provide other non-waiver services to DD consumers (such as transportation), you need to contract with the MCOs now.

12.  If they (DD consumers) sign up for the pilot program, will they have a new case manager or the same one?
The DD pilot project will have no impact on your ability to pick your case manager. If a member decides to participate in the pilot project that member’s Targeted Case Manager will be expect to support the member in doing so.

13.  Who will deal with the DD waiver?
For the first year of the KanCare program, DD waiver services will remain just as they are today. (All other services being used by people who also use the DD waiver will be part of the KanCare program.) In the second year of the KanCare program, DD waiver services will also become part of the program, and will be managed by the KanCare MCOs in collaboration with the existing CDDOs and community service providers.

14.  Will HCBS DD waiver providers who currently provide wellness monitoring for their consumers continue to do so or will the MCOs begin providing or arranging for that service?
Wellness Monitoring is an HCBS DD waiver service, and will continue to be provided as it is currently.

Disabilities

1.  My daughter is currently on Medicare due to her disabilities.  Are the changes with KanCare/Medicaid for next year going to change for her as well?
KanCare applies to Medicaid recipients as opposed to Medicare recipients. If your daughter receives some of her services through Medicaid, these changes will apply to her Medicaid benefits.

2.  What will happen to the individuals with disabilities if the providers aren’t meeting outcomes as determined by the MCOs?
MCOs will work with providers to ensure clear roles of accountability and define corrective action with regard to outcomes. Persons receiving services will retain choice of providers.

3.  Will someone on disability with Kansas Medicaid be required to be in a managed plan?
A person receiving Medicaid services for a disability will be in a managed care plan for their health services. If a person is receiving HCBS Developmental Disability Services or DD targeted case management, those specific services will not be included in KanCare until 2014.

Eligibility

1.  My daughter has a Medicaid card.  She is 17, a senior in High School and was adopted 10 years ago through SRS.  She has a mental illness that requires a number of medications.  When she graduates from high school, will she lose this Medicaid/KanCare care?  Will she have to apply to receive it as an adult?  What do I need to do now as her mother to be sure she will be covered as an adult?
Graduating for High School does not affect eligibility. KanCare can cover children up to the age of 19. After the age of 19 she will have to apply to see if she is eligible as an adult.

2.  So when the moms have the babies will their coverage still end?
Eligibility for KanCare will not be any different than it is for Medicaid. So if mom was on a Medicaid plan that ended two months after her baby was born, that will remain the same.

3.  What age does it cover for children? I have a 16 year old daughter. Will it only cover her until she is 18 or out of high school?
KanCare will cover children up to the age of 19. High school status does not affect eligibility.

4.  Is the application form going to change for new applicants?
Only slightly. The application will include a place for consumers to indicate which plan they'd like to be assigned to. No other changes will be made.

5.  My children are covered, but I am not. Will the income guidelines change for parents so they can get the coverage they need?
Income guidelines are not changing. 

6.  My daughter’s son, who is 6, has a medical card.  Both of them have BC/BS, which my husband and I pay for.  Would she be eligible also for a medical card?
There are many eligibility rules that determine if a person can be approved for coverage, such as household income. Many of our programs do allow individuals to have private health insurance and also be eligible for KanCare.

7.  The annual review of eligibility:  the form stinks, I find it confusing.  Can it be electronic with information filled in from last year and then we just update it?
We are in the process of designing an online review form. This will be available in the Fall of 2013.

8.  Currently as a state facility, patients between the ages of 21 to 64 are not entitled to Medicaid benefits, will this change with managed care?
No.  Residents of the state psychiatric hospitals age 21 to 64 will continue to be ineligible for Medicaid under KanCare.

9.  How will monthly nursing home liabilities work?
Eligibility staff will continue to determine the amount of the nursing home patient liability based on the applicant’s income.  The payment of this liability will be paid directly to the nursing facility.

10.  Are eligibility criteria for Medicaid staying the same?
Yes

11.  What amount of income is necessary to qualify for KanCare?
KanCare serves many different groups of people. The income limit is different, depending on which group you are in. You can find more information about the income guidelines on the DHCF web page. http://www.kdheks.gov/hcf

12.  Previously, we sent applications to the state.  Medicaid decides how the consumer or member qualifies.  Does the member now decide who to send the application to?  Or do we still send to the state first?
The application process for Medicaid is not changing with KanCare.  Applications can still be filed at the local DCF office or at the Clearinghouse for family programs.  An application for assistance will still be required to be processed within 45 days from the date of receipt. The eligibility process will continue to be the State's responsibility.  

13.  Will applications change?
Only slightly.  The application will include a place for consumers to indicate which plan they'd like to be assigned to.

14.  Will there be a change in how the patients sign up for Medicaid?
No

15.  Will the process remain the same for applying for Medicaid?
Yes. KanCare is not going to change the way people become, or don’t become, eligible for Medicaid.  The applications that you are currently using or having people fill out will still be the same after January 1st.  The places where consumers can submit applications will not be changing either.

16.  Do the companies have a plan as to how to assist in creating financial ineligibility?
If you are referring to Medicaid financial ineligibility, the MCOs are not responsibility for determining Medicaid eligibility or ineligibility.

17.  Where/how will those new to the system apply for member eligibility?
Eligibility for KanCare will not be any different than it is for Medicaid.  You will still fill out the application and go through the process. This can be done either through your local DCF office or the clearinghouse.

18.  What plan-MCO/KMAP will handle QMB, medically needy, etc?
Medically needy and QMB beneficiaries will be part of the KanCare program. If a beneficiary is QMB-only they will remain in the fee-for-service program.

Health Homes

1.  Are any MCOs paying incentive for Medical Home models on PQRI reporting?
They have certainly done so in other states and indicated a willingness to do so in Kansas.  When you talk with them about signing up for their networks, please ask about this.

2.  Are any MCOs paying incentives for Medical Home models or PQRI reporting?
In terms of the health homes we will be having discussions with providers, the MCOs, and stakeholders about both the payment structure and the incentives.  However, if you currently are a provider that feels like you are doing something that sets you apart from other providers right now, have that conversation with the MCOs to ask about incentives.  We certainly have not precluded the MCOs from providing any of those. 

3.  How are health homes different than independent service coordination for people with intellectual disabilities?
Health homes are more comprehensive than independent service coordination. A health home is one provider who takes responsibility for coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

4.  We currently provide immunizations and Kan Be Healthy physicals. Will patients still be able to come to our facility or will they need to get these done at their health home?
They can still receive these services with you as long as you are enrolled in the MCO's network.

5.  What or who can be a health home?
Any provider who can meet the standards that will be developed later in the year and can provide the following:  coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

6.  Who can be a health home?
Right now we are in the process of developing the health home model in Kansas.  We have required the plans to provide health homes to persons with severe and persistent mental illness or diabetes, or both, by the end of the first year of KanCare.  By the end of the second year the plans will be providing health homes to other persons with complex conditions.  What we are looking for with health homes is providing individuals who have particularly difficult conditions, or combinations of conditions, that require something extra beyond the care coordinator that is provided to all patients in KanCare.  

7.  Who are the care coordinators for the health homes?
That will vary depending on which provider is the health home. MCOs will still have care coordinators for people not in health homes.

8.  "Health Home" Providers…what providers are defined as members of a team?
Which providers are parts of a health home team will differ with each person, depending on what services a member needs. For example, someone with mental illness and diabetes might have a Community Mental Health Center, a primary care doctor, a specialty doctor, a pharmacist and a dietician who are all part of the health home team with the MCO. The CMHC might be the designated health home provider or it might be the one of the other providers. Whichever one is the designated health home must meet the yet-to-be specified provider standards.

9.  How does it affect home health providers that serve multiple counties?
These providers will need to contract with the MCOs and let them know which counties you are capable of serving.

HealthWave

1.  Are these plans in addition to the current plans such as Unicare?
No, we have extended our contracts with Coventry and Unicare through the end of this calendar year, but they will expire when KanCare starts in January 2013.  Each consumer will be a part of one of the three new plans (Amerigroup, Sunflower, or United).

2.  Are Unicare and Children’s Mercy programs going away?
Yes. All of the HealthWave program will be assigned to the KanCare program starting January 2013, and members in HealthWave will be enrolled with one of the three new MCOs.

3.  Does KanCare include Children’s Mercy and Unicare or are these plans not affected?
These plans will go away and consumers will choose one of the three new MCOs.

4.  Medicaid will become KanCare?
Yes. The Medicaid and HealthWave program will all be molded into KanCare, with a very few exceptions (SOBRA, etc.).  So, almost all populations will be enrolled in the KanCare program. 

5.  Will there be different branches of KanCare as there are for Medicaid & HealthWave?  I’m tired of our patients being on Medicaid one month, and then Unicare the next. 
KanCare is one program for everyone.  So the guidelines are all set up for the MCOs.  We would like the patients to be more secure in having a consistent provider engaged in their care that will also include working with one managed care company.  After a consumer chooses their MCO, they will remain with that same MCO for one year, unless they have a good cause reason to change.

6.  What is the difference between KanCare and HealthWave Medicaid?
KanCare is the new name for HealthWave and Medicaid.

7.  Why did everyone with HealthWave not get a letter?
Everyone with HealthWave was mailed a postcard telling them about the Educational Tours. All HealthWave members will receive a letter in October/November preparing them for the change. If you did not receive a letter, please check to make sure we have your most recent address.

Home and Community Based Services (HCBS)

1.  Is the care coordinator replacing the case manager for individuals on the HCBS waiver?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

2.  Is the home health coordinator employed by the provider, the MCO or the state of Kansas?
A Care Coordinator is generally employed by the MCO.

3.  Are the 3 MCOs familiar with the TA assisted waiver eligibility and case management specifics?
Yes.  Extensive information has been provided to the MCOs about both of those subjects, and the MCOs are also having many discussions with providers and members so they can understand first hand all there is to know about those services. 

4.  As an HCBS provider for Alzheimer and dementia, do any of the MCOs reward/incentive programs better outcomes, value add? Are there provisions for this population supervision, socialization, transportation? Any provisions for caregivers for the aging population, education, support, respite?
Each of the MCOs will be responsible for working with providers to ensure strong provider networks, clear roles of accountability, and identified outcomes are met for members. All current services will be covered under KanCare (including transportation to medical appointments).  Additional value-added services may be offered, such as additional education programs, support, and additional respite care.

5.  Can a HCBS provider give FMS services and targeted case manager services for a PD waiver consumer at the same time?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

6.  Do all three MCOs cover in home monitoring or emergency response units? (Currently covered under the HCBS waiver program)
All services that are covered today will continue to be covered.

7.  Do you have plans to expand HCBS services in rural counties of Western KS?
While Kansas has a rich array of HCBS services and providers, certainly we will continue to monitor and work with the MCOs and other relevant stakeholders to ensure that Kansans who need HCBS services can access them wherever they are across the state. 

8.  Do you have to contract separately for Medicaid and HCBS with each of the MCOs?
Yes.  The processes to contract and credential with each of the three MCOs will be streamlined and standardized as much as feasible.  You may only need one contract with each of the three MCOs for both regular Medicaid and HCBS waiver services.

9.  How soon will waiver Consumers know who will conduct their eligibility assessments?
Decisions as to conducting assessments on a go-forward basis will be made and communicated prior to KanCare launch (and probably in October).  Until KanCare launches, these assessments will continue to be managed as they currently are.

10.  How will the MCOs process or collect HCBS consumer client obligations?
The processes vary by MCO, however, each will maintain an established process.

11.  Regarding providers for HCBS-Autism: If the worker/provider currently uses an agency for bill/pay functions, can the agency complete the contract process from them as well?
A provider can use whatever resource they want to use in completing the network credentialing and contracting processes with the KanCare MCOs.

12.  When will we know how KanCare will affect the HCBS technology assisted waiver?
Considerable information has already been provided to all Medicaid providers about the transition to KanCare, and additional information sessions as well as written materials will continue to be available. All services for the TA waiver will be provided through the KanCare MCOs.

13.  Will community based services for SED youth be open for all providers?
No.  Unless and until there is an access or qualify deficiency, these services will be limited to the CMHCs as providers.

14.  Will the SED/SPMI/HCBS waivers be a part of KanCare and the MCOs?
Yes, except for DD waiver services and case management.  These services will have a delayed entry to KanCare until January 2014.

15.  With the one agency model who will do case management for HCBS TBI waiver consumers? Will this put all the current case management companies out of business? Will this be run more like an insurance company or will they still come back three to four years later to audit and regroup if they don’t like the documentation?
These operational criteria have been established regarding targeted case management:
• TCM for people who have serious and persistent mental illness (adults) or severe emotional disturbance (youth) will continue to be accessed through the Community Mental Health Centers around the state, where the specialized clinical expertise for those services is available.
• TCM for people who use the developmental disability service system will continue to be accessed through the Community Developmental Disability Organizations around the state, in keeping with Kansas’ Developmental Disabilities Reform Act of 1995.
• All other TCM services will become the responsibility of the three KanCare plan organizations, and will be provided under the direction of the KanCare plan.  For the Physical Disability, Frail Elderly and Traumatic Brain Injury waivers, targeted case management will be provided directly by local KanCare plan employees or limited subcontractors.  By combining this service with more comprehensive care management, members will have better support to address their needs holistically.
• There is no TCM service in the substance use disorder system; the specialized case management service in that system will continue as is.

16.  What happens if an HCBS group home chooses not to contract with all 3 of the MCOs and one of its clients is assigned to an MCO they do not contract with?
Each person will have the opportunity to choose whichever MCO they want; and choice of service providers within the network will always be an option for the person.

17.  Will limited license providers continue to be able to provide HCBS services?
Yes.

18.  Will CDDOs help coordinate HCBS providers to contract?
All HCBS services for the Developmental Disability service system will be delayed for one year. Development of a DD Pilot Project is underway and the work of this team of stakeholders will inform state process and implementation decisions.

19.  Will the predicted cost savings be used to end the waiting list for HCBS services?
KanCare may have an indirect impact on the PD wait list; however, a number of efforts are underway by the state currently to establish informed resolution to the issue. 

20.  Will there be KanCare for home health services?
Any service a person currently receives under Medicaid will be available under KanCare.

21.  Will we be able to stay in our own home with home health care? Will you help pay for the aide? Will you help update my CPAP marking?
Any service you currently receive under Medicaid, you will continue to receive under KanCare.

22.  My son is on the TA waiver.  He has complex case and receives care at Children Mercy Hospital and has a PCP.  We as parents manage his care, how will the case manager change that?
The care coordinator provided by the MCOs will be able to assist you and provide additional resources to manage your son's care.

23.  What agency/company will manage the HCBS SED waiver now managed through KHS and KDADS?
The MCOs will have agreements with the CMHCs who will continue to provide community based SED waiver services. The state will maintain operating authority.

ID Cards

1.  Will the MCO be identified on the patient's ID card?
Yes.  Each consumer will receive an ID card from their health plan that clearly identifies the MCO they are assigned to.

2.  Are you going to provide on-line insurance cards?
Yes. Consumers can print a temporary card after enrolling on-line, so that can be used while waiting for the hard copy to arrive in the mail.

3.  When these new programs start up, will all current Medicaid/Unicare patients be assigned new beneficiary ID numbers or be assigned new members?
Everybody’s Medicaid ID number will stay the same. Each member will be assigned to a new MCO and will receive a new card from their MCO.  

4.  What will cards look like?
Each consumer will receive a new ID card with the KanCare logo and the name of their MCO on it.  It will also show their Medicaid ID number, which will not change.

5.  Will patients’ stop having the current Kansas Medicaid card and will these cards clearly indicate which MCO covers the patient?
Yes. The white plastic Medicaid cards that consumers currently have will go away. Each consumer will get a new card from their KanCare health plan. This card will clearly show which plan the consumer is assigned to.

6.  Will there be any medical cards? (That aren't one of the 3 MCO's)
Members enrolled in KanCare will use their KanCare card to get all Medicaid services. Consumers on the DD waiver will still use their current card to get waiver services until 2014.

7.  Will the MCOs create their one unique beneficiary ID in addition to the Medicaid ID number?
No. The plans will use the current Medicaid ID numbers.

Kan Be Healthy

1.  Will there still be KBH requirements (for children)?
Yes. The Kan Be Healthy program for children will remain in place in KanCare.                                                                     

KanCare General Questions

1.  Is this like an HMO?
It is similar to an HMO, but with an emphasis on quality and outcomes for consumers.

2.  Is Unicare and Children’s Mercy programs going away?
Yes.  All consumers in the HealthWave program with Coventry (Children's Mercy) Family Health Partners and Unicare will be enrolled in one of the three new KanCare MCOs.

3.  Kansas just implemented new software for vehicle tags, which had hand a number of problems and issues.
What assurances can you provide that the same types of issues will not surface with KanCare?
KanCare is not a computer program. It is a health care program that will offer Medicaid members a choice of three very experienced managed care organizations. These organizations have brought up similar programs in many other states.

4.  Patients that now have regular FFS Medicaid: will this insurance go away?  Are all patients going to managed care, including nursing home patients?
All consumers in the fee-for-service program (with few exceptions such as SOBRA)  will become part of KanCare.  All nursing facility patients will become part of KanCare.

5.  Several other states have implemented a similar plan and failed. Why do you think KanCare will succeed?
Although KanCare is not modeled after any particular state, we did learn from other states in building the program. We have built a number of important safeguards into the contracts to ensure that consumers receive high quality care and providers are paid on time.

6.  The state’s slides mentioned requiring providers to have an EQHR or Health Information System and require reporting to the HIE:
Are any provider types exempt?  Are RHCs exempt?
When is the deadline to comply?
What is the penalty for non-compliance?

Providers will not be required to have an electronic health record or HIT system, although it is encouraged.  The three health plans will be required to have an HIT system.

7.  Trying to understand who pays for what?
The MCOs will be paid a per member, per month fee by the state.  Providers will be paid by the MCOs for providing services, and reimbursement must be at least the current fee-for-service Medicaid rates for in-network providers.

8.  We had a 4-day notice of this presentation, how do you plan on getting the word out to educate all of the Medicaid population?
The State will hold two additional rounds of public education meetings, and more notice will be provided in advance. Each Medicaid consumer will also receive an enrollment packet in the mail this fall. That packet will describe the changes and give consumers information about the three plans and how to make a choice. Consumers can call with questions or go onto the KanCare website if they need more information. They can also attend the next meetings or talk to an outreach worker near them about their choices. Soon there will also be Aging and Disability Resource centers located across the State that can help consumers make a plan choice.

9.  What do I do if I have a problem?
If you have a problem you should contact your health plan first and file what is called a grievance. The health plan will have people or "advocates" available that can help you get an answer when you have problems. If your health plan cannot or does not help you, the State may get involved to help resolve the problem.

10.  What evidence is there that all 3 MCOs are reaching out and are aware of Kansas’ strong culture of family nurse practitioners, certified nurse midwives and 3 state-licensed free standing birth centers?
The State has required the three MCOs to contract will all existing Medicaid providers. It is in their best interest to have the most robust provider network possible in order to meet stringent access requirements and to serve all Medicaid members well.

11.  What is a “risk based managed care system?
Managed care is a system of delivering services to consumers. It means that instead of the State paying providers directly for every service they provide, we will now pay a health plan to coordinate all of the care a person receives. The plan will be paid a per-person rate, and will be responsible for all of the care their assigned members need. Managed care is considered "risk-based" because the health plans will receive a fixed rate for each of their members. They are responsible for providing all of the care each member needs, and it may cost more or less than what the plan is being paid by the State.

12.  Block grant payments for non-medical populations?
Programs funded by a block grant will not be a part of KanCare.  Only Medicaid-funded services will be included in KanCare.

13.  What is meant by “managed care” exactly?
Managed care is a system of delivering services to consumers. It means that instead of the State paying providers directly for every service they provide, we will now pay a health plan to coordinate all of the care a person receives. The plan will be paid a per-person rate, and will be responsible for all of the care their assigned members need.

14.  Have dates been set for KanCare workshops specific to KDADs (waiver) services?
Yes.  These meetings were held the last two weeks of August.

15.  What is robust competition and who recruits providers?
MCOs will recruit providers.  Robust competition will occur because the three MCOs will compete to have consumers enroll in their health plan.  Consumers can choose based on which providers are enrolled in the plans, the value-added services offered, and overall quality.

16.  How do you plan to decrease hospitalizations? (A lot of Medicaid patients want to be hospitalized)
Our goal is to decrease unnecessary hospitalizations.  There are times when there is either lack of particular support within the community, or within the families, and hospitalizations may be the best choice for the patient. The goal overall is to provide the right type of service, at the right time, in the right place.

17.  Is any agency working with consumers to reduce dependence on KanCare and return to workforce?
As part of our Section 1115 Waiver application we’ve proposed a number of pilot projects to increase the opportunities for employment; building on the Working Healthy and work programs for those who have disabilities, as well as building an off-ramp for those who don’t have disabilities but are facing the eligibility cliff if their income becomes too high.  In addition, outside of KanCare the legislature passed some legislation incentivizing those who employ persons with disabilities through awarding contract preference to employers who contract with the state and employ, and provide insurance to, individuals with disabilities.  In addition, some pay-for-performance measures challenge the plans to increase opportunities for their members with disabilities to seek and retain employment.

18.  Medicaid will become KanCare?
Yes.  The Medicaid and HealthWave programs will all be folded into KanCare, with a very few exceptions (SOBRA, etc.).  Nearly all Medicaid populations will be enrolled in the KanCare program. 

19.  Will individuals be forced to change doctors?
No.  A patient can choose their health plan and choose a doctor within their plan. In some cases, providers can continue to provide care to patients as an out of network provider, but may receive a reduced payment rate.

20.  Will all 3 providers be across the entire state?
Yes.  All three health plans must have statewide coverage.

21.  Are any of the new companies locking in the providers like Unicare does?
Yes, we will still have a lock in program as it currently exists in the Medicaid system now.

22.  How will managed care reduce fragmentation?
Each of the KanCare health plans will be paid a set rate to coordinate all of the care any individual receives.  Consumers with complex needs will receive a care coordinator from their health plan who will work with the consumer and all of their providers to ensure that they are meeting the consumer's various needs holistically.

23.  Is there a required reporting? Weekly?
MCOs will report numerous things to the State on at varying frequencies.  There will be reports on customer service, grievances and appeals, quality, claims, submissions and payment, financial information and many other items.  Reports are submitted weekly, monthly, quarterly and annually for different items.

24.  What factors were considered when choosing the companies? Was there a board? If so, who was included to represent?
A team of more than 65 subject matter experts from the Kansas Department on Health and Environment and Kansas Department on Aging and Disability Services (then SRS and KDOA) evaluated all proposals over a period of several months.  The criteria included previous experience of the plans in providing similar services, their understanding of the KanCare program, their ability to meet all requirements of the request for proposals, and cost. The evaluation team followed State protocols for procurement of a contract.

25.  What will be the member grievance procedure for denied services be?
If a member needs to file a grievance they can contact a member advocate that will help them file a grievance with their MCO. If the grievance is still not settled to the member's satisfaction, the member advocate can help them file a grievance with the State.

26.  When will doctors and providers join these different plans?
The health plans are getting doctors and providers to join their plans now. They will continue to ask providers to sign up even after January 1. Their goal is to have all the providers in their network that they can. When you choose your plan this fall, you will get a list of all the providers that are in the plans' networks at that time. They are required to have their networks nearly complete by the time you receive your enrollment packet.

27.  Who is on the governor’s KanCare advisory council? How were they chosen?
There are about 20 people on the Governor's KanCare Advisory Council. The council includes people who represent consumers, providers, and other important groups who will be impacted by KanCare. The Council was nominated by the Governor. The Governor chose people to represent a broad range of interests, including doctors and hospitals, behavioral health providers, community based services providers, consumers from the current HealthWave population, and people with disabilities.

28.  Will all Medicaid programs convert to a standard KanCare option?
All current Medicaid programs (with very few exceptions) will become part of KanCare. This includes HealthWave, Health Connect, fee-for-service Medicaid, the ValueOptions and Kansas Health Solutions programs for behavioral health and medical transportation currently provided by MTM. Each of the three KanCare health plans will be responsible for providing all of the services currently covered by Kansas Medicaid.

29.  Will customer service calls be worked here in the U.S. by medical billing educated staff?
Yes. Each health plan is required to have their customer service center in the State of Kansas.

30.  Who, at KDHE, has primary responsibility for operational and implementation issues with the MCOs?
The program will be managed by both KDHE and KDADS, but Dr. Robert Moser as the Secretary of KDHE, which is the single state Medicaid agency has the ultimate authority and responsibility.

31.  Why did the State of Kansas go with 3 separate plans?
We are required by the federal government to offer a choice of at least two plans when we provide Medicaid through managed care.  We believed choice was important and decided three would provide sufficient choice.

32.  Will providers be required to use electronic health records?
No, although we encourage all providers to move in that direction to help better coordinate care and prevent duplicative services.

33.  How will the state police the actions of the managed care organizations?
The state will ensure compliance with the contract, including that MCOs meet the quality standards outlined - 15 of which are tied money withheld from their payments until they earn it back by meeting the quality standard.  The contract also contains numerous liquidated damages requirements that mean the MCOs pay the State money if they fail to perform in a certain area.  In addition, the federal government reviews the State's program annually and can also conduct unscheduled audits.

34.  Will the KanCare MCOs be required to follow the regular Medicaid diagnosis restrictions?
The State requires the MCOs to follow the existing medical necessity requirements as outlined in state regulations.

35.  The MCOs are great in that they have agreed to pay the current rates or higher for this contract. How long are the contracts?
The MCOs have a three year contract with the option to extend it annually for two more years.

36.  Will Kansas Health Solutions continue?
Kansas Health Solutions will no longer be the PAHP (managed mental health community based services) contract. However, KHS may have some different ongoing role in the Medicaid program.

37.  Will managed care providers change the decision making process?
The State has emphasized that the health plans must provide consumer-centric services, so the member will be a central point in the decision-making process for services.

38.  How are residents and families being educated about the changes?
The State is holding numerous educational meetings and has established a dedicated website for the program, containing all the information from the educational meetings. In addition, the State is working with providers, especially community service providers to help educate members and their families. State staff also answer daily questions submitted via a KanCare e-mail box and a telephone number. The State’s fiscal agent, HP, also answers questions daily about the program.

39.  How will health outcomes be measured to track KanCare/MCO impact on consumers/beneficiaries?
The contracts with the three managed care health plans have numerous outcomes measurements that the plans are required to meet. Some of these will be tied to large amounts of money, amounting to about 500 million dollars over five years, if they do not meet certain specified targets. These measures look at physical health, behavioral health and long term supports and services. They include measures for quality of life as well as good health and proper management of chronic conditions.

40.  As service coordinators, we have seen a significant decrease in medical, psychological and mental health providers that will accept Medicaid patients. How will this system improve this situation?
The three KanCare health plans are national health insurance companies which have extensive experience signing up providers for their networks. They all have worked in the Medicaid market for some time and are very competent at contracting with providers. They also have more flexibility than the State does in negotiating contracts with providers.

Kansas Medical Assistance Program (KMAP)

1.  What effect will MCOs have on KMAP?
KMAP will be available for historical claim search, and member eligibility. For Providers to be reimbursed for services rendered to an MCO member, the provider must be enrolled with the member(s) MCO.

2.  Is KMAP going away?
No.  Providers can still use KMAP to check eligibility and plan assignments after January 1.
KMAP

3.  Is MMIS KMAP?
Yes.

4.  Is the State of Kansas going to have one single website to verify which MCO consumer is assigned to?
Yes.  That will be the KMAP site, and will work just as it does today. 

5.  Patient Lists?
KMAP will continue to be utilized to confirm eligibility and indicate which plan a member is in.

6.  What about KMAP website?  Is that MMIS?  No mention of ambulance services?
The KMAP website will remain.  The KMAP website is for the FFS Medicaid program and Medicaid providers.  Ambulance services will be covered as they are currently covered today.

7.  What happens with the KMAP website and provider numbers?
The KMAP website and provider numbers remain.

8.  Will I still check eligibility on KMAP website or one of the 3 “MCO” websites?
Either option will be available.

9.  Will KMAP continue, or will providers be required to gain reimbursement from each of the three contractors?
KMAP will be available for historical claim search, and to check member eligibility and plan assignment. The State is also establishing a front door claims billing interface that will be part of the KMAP/MMIS system. For Providers to be reimbursed for services rendered to an MCO member, the provider must be enrolled with the member's MCO. They can submit claims to the single State interface, the MCO directly, or to an established commercial clearinghouse.

10.  Will KMAP still accept claims and how long after the first of the year and who do we send old claims to?
KMAP will still accept claims for the current fee for program where the service was provided prior to midnight on December 31, 2012.  Current timely filing standards for these claims will apply. 

11.  Will the current KMAP provider manuals remain in place?
Yes.  How long they will remain has not been determined.

12.  Will there be a centralized website (similar to KMAP) where eligibility can be verified?
Yes.  KMAP will remain for historical claim search, and to check member eligibility and plan assignment.

13.  Will we be able to continue to check patient eligibility on the KMAP site or will we have to go to each site to check patient eligibility?
Either option will be available.

14.  Will we still be able to look-up on one website the carrier for a client?
Yes.  KMAP will remain for historical claim search, and to check member eligibility and plan assignment.

15.  Will we still be able to check eligibility on the KMAP website after January 1, 2013?
Yes

16.  Will we still be able to look-up on one website the carrier for a client?
Yes, you will be able to verify which MCO the person is assigned to.

17.  Will we have a website like KMAP instead of 3 different websites for general information? 
All of your KanCare resources and information will be on one website. KMAP will also continue. The three health plans will have information on the KanCare website in addition to the Member and Provider resources on their individual websites, which you will use depending on which plan you’re partnered with.

Local Education Agencies

1.  Will Medicaid for LEAs be affected by these changes effective January 1st?
No.  Services provided to children through local education agencies are not included in KanCare, but MCOs will coordinate with the LEAs since they will also be serving those children when they are not at school.

2.  Does KanCare apply to school districts?
Those services that are provided to students in the school districts will not be part of the KanCare program, those claims and services will still be paid for by the state.  However, if those students who receive services are enrolled in Medicaid, the rest of the services they receive outside of the school district will come from the KanCare health plan.

3.  How will these changes affect the educational providers? 
Those services that are provided to students in the school districts will not be part of the KanCare program, those claims and services will still be paid for by the state.  However, if those students who receive services are enrolled in Medicaid, the rest of the services they receive outside of the school district will come from the KanCare health plan.

4.  Will public schools contract with each MCO?
No. Do not need to contract.  But we are expecting the MCOs to coordinate with you, so do not be alarmed if the MCOs contact you. 

Long Term Care (LTC)

1.  For LTC, what frequency of eligibility reporting will be required, i.e., weekly, monthly?
The current eligibility requirements are not changing under KanCare.  Currently, an annual eligibility review is required of Medicaid beneficiaries. 

2.  How will a LTC facility’s current population be divided among the MCOs?
They will be divided equally among all three MCOs.  That is generally the same for all Medicaid populations.  When we make our initial selections in October, we will be leveling the playing field for all three MCOS by assigning them an equal number and case mix for their initial membership.

3.  How will long-term care providers be chosen?
The state has required the health plans to offer contracts to all current Medicaid providers.  Consumers will continue to choose their long term care providers as they do now.

4.  What changes are expected in long-term care and supports? 
All the current services will remain, but will be provided through the MCOs.  Providers should contract with the three MCOs to continue providing services to all Medicaid consumers.

5.  Will individuals be able to remain in own homes and/or chose where they live and receive care?
Yes.  Consumer will still have a choice in where they wish to live, and their care coordinator can help them receive the services they need to stay in their home or another community setting.

Managed Care Organizations (MCOs)

1.  Are benefits managed by each MCO outsourced? (i.e., UHC uses Optimum Health) Is the fee schedule determined by CMS or by the MCO for these services?
Each MCO may use some different sub-contractors for vision, dental, behavioral health, transportation, etc.  The MCOs must pay at least what is paid now in the Medicaid program.

2.  Are the three KanCare providers operating like HMO’s, PPO’s, or indemnity insurance models?
HMOs

3.  Does Cenpatico have different authorization requirements for behavioral health services than sunflower and united in presentation? 
No.

4.  For MCOs, what is your experience working with LTSS consumers who self-direct (ie, hire, train, direct and schedule their own personal care attendants?
Each of the KanCare health plans was required to demonstrate experience in providing the same type of program to similar beneficiaries in other states.  This included working with consumers who receive home and community based services and self-direct their care.

5.  How efficient are the call centers?
Each health plan must have a call center in the State of Kansas to help consumers and providers.  The call center staff must be trained to answer questions and help you get the information you need.  The State will make sure that the call centers are answering calls quickly and helping people as efficiently as possible.

6.  How will the MCOs communicate with their Consumers?
The MCOs will communicate by letter and will each have their own call center.  They may also reach out to consumers by phone for health screenings and other information.

7.  I’m hearing that each insurer is going to have its own call center. Isn’t that creating 3 times the work for us? Are procedures not going to be standardized?
A number of procedures will be standardized across the three MCOs, but call centers will be unique in order to specifically serve each MCOs members and providers.

8.  Why are there three MCOs instead of consolidation?
Kansas is required by federal rules to offer beneficiaries a choice of health plans.  Kansas chose to offer three statewide plans to ensure consumers had a choice among all three plans, and to encourage competition among the three.

9.  Will Authenticare continue to be used for reimbursement with MCOs?
Yes. The health plans must continue to use Authenticare.

10.  Will benefits and authorizations requirements differ between each MCO?
All benefits currently covered in the Medicaid program will continue to be covered under KanCare.  Authorization requirements may differ, but the State mandates those requirements be transparent to providers.  The same medical necessity definition used currently in the Medicaid program will continue to be followed by the KanCare MCOs.

11.  Will MCOs provide training for billers?
Yes.  Each health plan will hold training sessions for providers.  Please contact the health plan(s) you are working with for more information.

12.  Will we know who is on the MCOs’ advisory councils? How can we serve on these councils?
Yes, each health plan will hold public meetings of their member advisory councils. Some health plans will also have additional council that involves providers.  If you are interested in serving, you should reach out to each health plan directly.

13.  Why is it necessary for all headquarters to be in Johnson County?
The state required each health plan to establish headquarters within two hours' driving distance of Topeka.  The health plans were free to establish their headquarters anywhere within that limitation.

14.  Amerigroup will not use a behavioral health subcontractor. What does this mean?
This means that Amerigroup will cover all behavioral health (including mental health and substance use disorder) services in house, and will not use a separate company to provide this service set. Behavioral health providers should contract directly with Amerigroup.

15.  For jobs within the Managed care companies--do you have a web site of jobs you are offering?
See the websites below for jobs information:
Amerigroup: www.amerigroup.com/about-amerigroup/careers
United: http://careers.unitedhealthgroup.com
Sunflower: www.centene.com  and www.sunflowerstatehealth.com

16.  What happens if the appeal process does not work? Can we go through the insurance commissioner or will there be any other recourse for providers?
If you are not satisfied with the outcome of your appeal, you can access the State Fair Hearing System.

Member Enrollment & Assignment

1.  Generally, how does the assignment and choice process work?
People who receive a medical card now will receive a letter about the tail end of October, which till tell them the MCO they are assigned to as of January. We will select the MCO for them based on who their doctor was and where there medical bills have been coming in and we are going to make sure that that provider will be signed up with the MCO that is being picked for that person. Between October and December, that entire time is available to determine if a better plan would be a better option. Then in January, once they start having experience with the plan, if they decide to switch plans they have 90 days to change. Now they can change doctors without changing the MCO, they just have to choose a doctor that is in that MCO. After the 90 day choice period, they will be locked in to a plan until the end of 2013.

2.  Will individuals be forced to change doctors?
No. Absolutely not, again, that goes against the idea of continuity of care.  Our goal is for the provider to be someone that the patient is accustomed to working with.  We are hoping the provider will sign up to continue to provide care to that patient.

3.  Will members be assigned their PCPs?
Essentially folks will choose their PCPs.  MCOs do have a process in place that would assign a member to a PCP if the member has not chosen one.  But the patient may then choose to select a different PCP if they wanted

4.  Can patients change between plans throughout the year?
Members can only change plans at open enrollment or if they have a break in eligibility of more than 60 days.

5.  Will the members be able to change MCOs often? 
Members can only change plans at open enrollment or if they have a break in eligibility of more than 60 days.

6.  Who chooses which MCO nursing home residents are enrolled in?
Nursing facilities can, and should, contract with all three MCOs.  We require the MCOs to make every effort to include all existing providers in their networks.  People in nursing facilities will be able to choose from among the MCOs their facility has contracted with.

7.  Will Consumers be able to move from MCO to MCO on a monthly basis?
No.  Consumers will have an open enrollment period each year.  After that period, they will be required to stay in one plan for a year unless they have a good cause reason to switch plans.

8.  Are family members all on the same plan?
Families can choose what is best for them.  Individual family members may choose a different plan because of the provider network, for example.

9.  How do we decide which resident to assign to which company?
The residents themselves will make the choice.  They will receive a packet of information with their initial assignment and information about all three plans so that they can make an informed choice.

10.  How will the state/KanCare divide the state with the MCOs, or are the members selecting their own MCO no matter where they live?
The three MCOs will all have statewide networks.  Consumers can choose any of the three MCOs, no matter where they live.

11.  If you are assigned one of the companies can members change to another one?
Yes. Consumers will receive an enrollment packet this fall with information. It will include a chart that compares each MCO. The packet will also tell consumers how to check if their current providers are enrolled in each plan. Consumers can choose a different plan anytime after they receive this packet (they will receive it this fall) until 90 days after January 1. Following that 90 day choice period (which will end April 4), members will be locked into their plans for one year.

12.  Member sign-up.  Will consumers be automatically assigned to one of the three contracts based on their Primary Care Physician (PCP), or do they have to fill out new applications?
Consumers will be automatically assigned to a new MCO based on history of their medical bills and who their PCP was in the past.  They can change to a different plan if they choose to do so.

13.  What is being done to match patient with current PCP?
The initial assignment will be done based on billing history.  The consumer can then change their PCP if they prefer a different one. 

14.  What is the process to change the PCP and how long does it take to change PCP?
That is at the option of the member.  They will have to contact the MCO; a process which is defined in the member handbook.

15.  Who is working with the current Medicaid patients to understand what they need to do for coverage as of January 1, 2013 in selecting a new plan?
Consumers have a number of options.  They can contact their local outreach worker for information.  They can also call the State's consumer assistance line with questions, or attend an educational meeting.  The State will hold another round of meetings across the State in October that will focus on helping consumers choose a plan.

16.  What are some of the things that would not be considered a qualifying or continuing circumstance?
Members can only change plans after their initial choice period if they have a good cause reason, such as a service not available in network or a quality of care issue. Otherwise they are in their plan for one year.

17.  Where do you find what the health plans provide?
All three health plans will provide everything that is currently covered in Medicaid. A list of the extra (value-added) services that each plan will provide will be in your enrollment packet. It will also be listed on the KanCare website when the enrollment period starts.

18.  Is there an advocate who will help each beneficiary review the information and choose the best plan?
The State will hold meetings in October across the State that will focus on helping consumers make a plan choice. Consumers can talk to an outreach worker near them about their choices. Soon there will also be Aging and Disability Resource centers located across the State that can help consumers make a plan choice. Consumers can always call the State's consumer assistance line with questions or go onto the KanCare website if they need more information.  KDHE, KDADS, and SCHIC members can help.

19.  When is new information being sent? 
Consumers will receive a welcome letter and enrollment packet in November. The enrollment packet will have information about KanCare and the health plans. It will describe the health plans and how they can make a choice. They also have been invited to KanCare education meetings this fall to learn more.

20.  Who will help eligible members review the different provider networks, added value services and other benefits?
The people at KDHE can help, the people at KDADs can help, your SHIC (State Health Insurance Counselors) members can help, and we also have outreach members located throughout the state.  Consumers can also call if they have questions.

21.  Who’s going to help decide which companies a person should pick?
The people at KDHE can help, the people at KDADs can help, your SHIC (State Health Insurance Counselors) members can help, and we also have outreach members located throughout the state.  Consumers can also call if they have questions.

22.  Will we get complete information about what each plan offers, including value added services?
Yes. Consumers' enrollment packet will include information about how to decide if the doctors they want to see are in the plan. It will also have information about the value added services offered by each of the three plans.

23.  Will the PCP change?
Consumers do have the option to change their PCP. 

24.  What plan will people be automatically enrolled in? How is this determined?
People will be enrolled in one of the three MCO plan based on where their current providers are enrolled and their billing history.

25.  When will the final managed care choice be due?
Consumers must make their choice by December 31st for it to be in effect on January 1, 2013.  However, after that time, they can still change their plan until February 14, 2013.  After February 14, they will be in their plan for one year.

26.  Will patients stay with same MCO (assigned/chosen) or will they be moved to different MCO as their financial/medical requirements/etc. change?
Financial or Medical changes will not change the MCO a consumer is assigned to.  Consumers are enrolled for one year, and can only change during that time if there is a good cause reason, such as quality of care. 

27.  What type of KanCare materials have been distributed to HealthWave/Medicaid recipients?
Consumers will receive a welcome letter and enrollment packet in November.  The enrollment packet will have information about KanCare and the health plans.  It will describe the health plans and how they can make a choice. They also have been invited to KanCare educational meetings that cover what consumers will need to know about the program.

28.  Is the patient able to change their PCP after the 90 day enrollment period?
Yes.

29.  What if my neurologist is on one plan and my family doctor is on a different plan.  What am I supposed to do?
You can still see providers that are out of network.  But, the provider won't be paid the full amount for the service.

Mental Health and Substance Abuse

1.  Will psychiatric hospitalization have a different set of criteria than already in place?
Each MCO will assess the medical necessity of the service using the Kansas definition of medical necessity.                         

Miscellaneous

1.  Where does the non-compliant individual come in?
This is a challenge, but the goal is for all patients to be engaged in their own care.  This means helping them understand their medications, diagnoses, treatment, care plan, supports available, and what they can do to live a healthier life. That will take a number of people engaged in that patients care.  All providers and the MCO should be involved in improving health literacy and patient engagement. 

2.  Will job openings be listed on websites?
Yes. Each MCO will be marketing for new positions in a number of venues, including online.

3.  How will the WIC program be affected? 
The WIC program will not be affected by KanCare

4.  Will the current access points remain where they are?
Yes. The access points across the state will still exist, and they will be maintained/monitored by the Department of Children and Families.

5.  Will the MCO direct post-acute care services?
Most post-acute services are related to Medicare benefits, so in that instance whoever was the Medicare provider would be more involved or possibly instruct them.  But if someone is Medicaid only, then the MCOs would become the primary manager of post-acute services.

6.  Will there be a uniform guideline on diabetic supplies, for example, testing maximum guidelines for all three MCOs to follow?
Each of the KanCare health plans will use a transparent system of utilization management and coverage guidelines.  In most cases, the plans will use either Milliman or Interqual.  If another set of guidelines is used, they must be transparent and available to providers upon request.

7.  Who will manage the AAPS block grant like value options does now?
Value Options will continue to manage non-Medicaid funded substance use disorder services.

8.  What resources will there be for homeless Consumers?
The MCOs will work with CMHCs and other community providers to contact members who are homeless and connect them with a care coordinator.  CMHCs will work with these members to help them select an MCO that will meet their needs.

9.  Which clearing house will all 3 MCOs be associated with?  Or will we need to determine this individually?
You will be able to use any billing clearinghouse available, bill the MCOs directly or submit claims to the State's current fiscal agent, HP.

10.  Will there be any changes to the Medicaid cost reporting for FQHC’s?
Federally Qualified Health Centers will continue to provide cost reports. MCOs will be required to pay the PPS rate to FQHCs. The State is considering rebasing/updating the PPS rate.

11.  Will the plans have options for EFTs or ERAs?
Yes

12.  What if any is the involvement of Children’s Mercy with each of the plans?
Each of the KanCare health plans will be required to contract with specialty children's hospitals. Children's Mercy should contract with all three health plans if they expect to continue serving all current Medicaid consumers.

13.  Where are you going to get all of the help?
MCOs are working hard to hire staff for care managers, coordinators, member service representatives and provider service representatives.  They must demonstrate to the State they have sufficient staff to perform all the required functions.

14.  What would constitute a denial?
Payment could be denied, if you provide a service you are not contracted with the MCO to provide, if the person was not eligible for Medicaid at the time the service was provided, or you provided a service that is not covered in KanCare.

Money Follows the Person

1.  Will money follow the person be available to help people transition back into the community from a nursing home?
Yes.

Nursing Facility

1.  Are all patients going to managed care, including nursing home patients?
Yes. All Medicaid beneficiaries residing in nursing homes will receive managed care through KanCare.

2.  Are we still going to be paid based on our costs or will there be some other method of payment for our long-term care residents?
Yes.  The state will continue to set reimbursement rates for nursing homes based on the current cost based, case mix adjusted methodology. 

3.  As a SNF we assist our Medicaid residents with Medicaid applications.  What kind of information is being sent to current Medicaid residents?
The Medicaid application process is not changing under KanCare.  Current Medicaid residents will begin receiving information packets from the state in November, with information regarding the health plan they have enrolled in, detail and summary information on all three health plans including the value added services, and instructions for identifying the providers in each plan network, and instructions for changing health plans if they choose to do so.

4.  Do nursing home facilities contract with all 3 companies?
Yes. It is highly advisable for nursing homes to contract with all 3 health plans. 

5.  If an individual is in a nursing facility, will they still receive the Wellness Rewards cards?
Yes.

6.  Residents in our nursing home get their medications from a local pharmacy or a “specialty” (LTC) pharmacy provider.  Will this change once they are enrolled in KanCare?
If the pharmacies that contract with your nursing home to provide medication services are contracted with the MCO of a beneficiary in your nursing home, they will be able to provide medication services for that patient. For this reason, it is very important for pharmacies that provide services to nursing homes to contract with all 3 MCOs in order to continue to provide medication services to anyone who may become a resident of the facility they provide services to. Nursing homes themselves are free to continue to contract with any pharmacy that is in an MCOs network.

7.  What criteria will be used to decide if a resident stays in LTC or they move to another level of care?
KanCare will not require any nursing home resident to move from their nursing home.  Nursing home residents will have opportunities to speak to their care coordinators about their health status and long term health goals.  IF a resident’s goals include moving to another environment, the care coordinator will work with the resident, family, and other providers to determine if and how such a resident could be successful with such a move.

8.  What will be the process for residents of a long term facility who are currently private pay but exhaust their resources after January?
Long term care residents seeking Medicaid benefits will still need to go through the financial and functional eligibility process. 

9.  What would constitute a denial in a nursing facility?
Examples could include: a claim which is not submitted timely, a claim submitted for a service not covered by Medicaid, a claim for a specialty service that requires prior authorization, or a claim submitted for someone not receiving benefits through Medicaid. 

10.  Will nursing facilities still receive per diem rate?
Yes.  The current methodology will continue, the rates will be set by the state and the MCOs will be required to pay you 100%.

11.  Will nursing homes, or hospital LTC residents be divided into different groups of 3 providers--have to bill 3 places?
Yes. Residents, within a nursing facility, can possibly be in all three plans.  In regards to the billing process, currently the state is working with the three MCOs to have a single billing option for providers.  

12.  For nursing homes, current rates change quarterly set by the state. How will this process change with the MCO contracts?
The State will continue to set the Nursing Facility rates using the current process.  The rate set by the State will be the floor payment required for the MCOs. 

13.  SNF care questions: Do the rates of reimbursement fluctuate quarterly like they do now, based on the Kansas case mix listing? Will authorization for payment be given for a Medicaid pending recipient?
Nursing Facility rates will continue to be adjusted quarterly under the current process. 

14.  Will our facility per diem rates still be calculated using the same formula?
For nursing facilities, yes. 

15.  Will our rate still be figured by the same process?
For nursing facilities, yes. 

16.  Will the state continue to set the room and board rates for nursing homes?
The State will continue to set the nursing facility rates. 

17.  Will the state set the rate for nursing homes or will the facilities negotiate this rate with the managed care companies?
The State will continue to set the Nursing Facility rate. 

18.  A nursing home resident has an x-ray done at the hospital, whose responsibility is it to preauthorize the hospitals or nursing home?
Each health plan has procedures for seeking and obtaining a prior authorization for service. Generally speaking, either the member's care coordinator, or the entity providing the service will be responsible for seeking the PA.

19.  When we receive all the packets for our residents in the nursing home, will the family, (if they have any) be responsible to sign off on the plan if the resident is not able to speak or write?
Residents receiving Medicaid benefits will be automatically enrolled in one of the three health plans using an algorithm that matches the member with a health plan network that includes their current providers. The resident or their responsible party may select a different health plan if they choose. A resident or responsible party does not need to take further action to affirm the automatic assignment if they choose to stay with that health plan.

20.  Will they still receive the $63.00/month if you're in a nursing home and on KanCare instead of on Medicaid?
Yes. The protected income levels will not change due to KanCare.

21.  Does the State notify MCO's CML scores regarding nursing facilities?
Yes. Nursing home rates will continue to be adjusted quarterly based on Case Mix Index. The state will provide this information to each health plan in advance of the effective dates.

22.  Will we be able to bill and correct room and board claims on KMAP for nursing homes?
Billing will be available through KMAP; however adjustments and other actions will have to be performed through each health plan specifically

23.  How will having MCOs pay nursing homes affect our Medicaid cost reports and where they are submitted, etc?
Cost reports will still be submitted by nursing homes to KDADS, the state agency.

24.  Who creates the care plan for a resident? Is the current care plan to be continued or a new one created?
Nursing homes will continue to be responsible for developing and implementing individualized care plans for their residents. The care planning process in nursing homes will not change.

Program of All-Inclusive Care for the Elderly (PACE)

1.  How will PACE receive referrals, through MCO or direct from community?
PACE will continue to receive referrals as it does today.  Additionally, under KanCare individuals who are functionally eligible for nursing home services may seek information and assistance in choosing a health plan or a PACE plan from an Aging and Disability Resource Center

Pay for Performance

1.  What is the penalty if clean claims payments are not met w/in 20 days?  Who gets the penalty?  Is this the State or hospital (provider)?
The MCO will not receive a portion of their capitation payments back if they do not pay claims timely.  The penalty will be borne by the MCOs, not providers.

2.  Where do we find the 6 outcome measure for year one and the 15 quality measures for year 2 and 3?
This information is contained in Attachment J - State Quality Strategy posted on the KanCare website.

3.  How will the plans be financially incentivized to keep people healthy? Will providers receive this incentive?
In years 2-5 the plans are subject to a 5% holdback that must be re-earned through health quality measures.  Providers are not subject to the State holdback provision but plans may include health quality incentives in provider contracts. 

4.  Other states have found that for-profit MCOs have produced reduced quality healthcare while not-for-profit MCOs produced higher quality health care. What safeguards are in place to put quality health care in Kansas as a higher priority than profits from the 3 MCOs contracts?
The state will ensure compliance with the contract, including that MCOs meet the quality standards outlined - 15 of which are tied to money withheld from their payments until they earn it back by meeting the quality standard.  Attachment J of the RFP (found here http://www.kdheks.gov/hcf/kancare/index.htm ) contains a robust set of quality measures spanning physical, behavioral and long term care.  The State will be monitoring these measures closely and sharing many of them publicly.  The MCOs must also form Member Advisory Councils to provide input into MCO operations.

5.  Will the MCOs be passing the 3 to 5 percent withhold on to providers?
No.  The state will withhold this capitation from the health plans up front, at the beginning of each contract year.  The health plan will be accountable for the outcomes of the pay for performance program and must offer 100% of fee-for-service rates to all providers unless another reimbursement is negotiated by the provider.

Pharmacy

1.  Any change in excluded Meds & drugs previously paid by Medicaid?
The MCOs will be required to follow the current Medicaid Preferred Drug List. They will also receive a list of the medications that the state currently covers, and will be required to cover these as well.

2.  How can we get copy of MAC drug lists from the 3 MCOs?
 The MCOs are required to publish up-to-date MAC rates on a secure website that is accessible to pharmacy providers.

3.  Is there a max allowable for each MCO? Dollar amount per year?
The maximum allowable charge rates will be accessible via a central website for all of the MCOS. You will be able to link onto that and click to see what the methodology was to determine the maximum allowable charge.

4.  How will billing be affected? Will we have to switch pharmacies if we aren’t using one listed on the slide?
Pharmacy billing will still be done through the point of sale to the PBM of an MCO. See the previous question for an explanation of pharmacy choice.

5.  How will pharmacy services be handled for nursing facilities?
Pharmacies that provide services for nursing facilities will be able to continue to provide pharmacy services for those beneficiaries who are in MCOs that the pharmacy has contracted with. Nursing facilities can continue to  use their local pharmacies for services, provided that those pharmacies have contracted with the MCOs.

6.  I am currently working my way through the pharmacy and DME provider re-enrollment paperwork that was sent out last winter. It is due by Dec. 31, 2012. Does KanCare have any impact on those? Are they still required as well as the $540 fee?
 If a provider wants to keep their FFS provider number active then they will need to complete the required revalidation.  If a provider has the potential to see a beneficiary that is in one of the carved out populations they would want to keep that number active.  Also, if they want to continue to use the secure portion of the KMAP Website, they will need to keep their FFS provider number active. For providers that any of these scenarios apply to, the re-enrollment paperwork and $540 fee will need to be completed.

7.  What happens now to Medicare part of the drug plans?
Medicare will continue to serve as primary insurance for patients that are eligible for both Medicare and Medicaid. The MCOs will then be responsible for picking up any copays that remain after Medicare has paid.

8.  What happens to the small hometown pharmacies who may not contract with MCOs?
The MCOs are required to offer contracts to every current Medicaid provider. For pharmacies, these contracts must include the $3.40 dispensing fee and reimbursement similar to our current rates. Each pharmacy then has the option to not contract with the MCOs, but these pharmacies will not be left out of the MCOs’ network development plans.

9.  Where does MTM figure in this? Will the services continue to be private?
MTM services will be provided by a qualifying patient’s local MTM-credentialed pharmacist. These services will include a complete review of the patient’s current drug therapy, checking for interactions, dosing problems, duplicate therapies, and adverse effects, among other clinical considerations. These services will be a private, in-person interaction between the pharmacist and patient.

10.  Why not Walgreens and Walmart for prescriptions?
The MCOs are required to attempt to contract with current Medicaid provider pharmacies. Beneficiaries will be able to go to any pharmacy in their MCOs network. The Pharmacy Benefit Managers each MCO is associated with (Amerigroup: CVS/Caremark; Sunflower: US Script; United: OptumRX) are responsible for claims processing and administration of pharmacy benefits, and are not meant to indicate that, for example, a beneficiary can only use a CVS pharmacy.

11.  Will all drugs covered still be based on WAC pricing? A lot of drugs still have no WAC price. DME supplies, can these items still be adjudicated through a clearinghouse?
 The MCOs will have the option of using their own pricing methodologies (AWP, WAC, etc.), so their reimbursement may or may not be WAC-based. For DME supplies, providers can submit claims to the State’s MMIS front door billing interface, or to an established private clearinghouse.  They can also submit claims directly to the KanCare health plans.

12.  Will every plan provide a $3.40 pharmacy dispensing fee?
Yes, each MCO is required to offer a $3.40 per claim dispensing fee to pharmacies.

13.  Will MCOs be able to require participants to use Out of State DMEs and pharmacies that they have relationships with instead of Kansas owned DMEs and Pharmacies?
No, MCO plans are required to use pharmacies in Kansas or border cities (i.e. Kansas City, Missouri) to serve beneficiaries.

14.  Will Medicaid clients get their medications through the MCO instead of their local pharmacy?
No, the MCOs will contract with local pharmacies through their PBMs. Beneficiaries will then have the option of using pharmacies that are in their MCOs network.

15.  Will people be required to use the MCO pharmacy or will they still have a choice?
Beneficiaries will have the choice of any pharmacy that is available in their MCOs network. MCOs are encouraged to contract with all current Medicaid provider pharmacies.

16.  Will there still be only certain manufacturers of a drug covered, for example, Tylenol covered but only certain NDCs by rebated manufacturers to state?
The MCOs will have the option to cover NDCs that are non-federally-rebated, but will be encouraged to only cover NDCs that are federally rebated.

17.  Will LTC residents have pharmacy choice?
LTC facilities will be able to contract with any pharmacy provider who has also contracted with the MCOs. These pharmacies will then be able to provide medication services to those LTC residents whose MCO they have contracted with.

18.  Will the drug formulary only allow for a 30 day supply or will there be opportunity for a longer one?
The plans have the opportunity to allow for longer days supply. Fee-for-service Medicaid currently has a 31-day supply limit, so plans must at least meet or exceed this standard.

19.  Do any of the plans cover Medication Therapy Management?
Yes. All plans will be required to have a medication therapy management program.

Prior Authorization

1.  Will Kansas Medicaid authorizations cross over to the new MCO, or will a new authorization need to begin January 1, 2013 with the MCO patient is assigned to?
Our intention is to send all of that information to the MCOs, with the expectation that continuity of care will continue.  If something was covered through the end of March 2013, for example, we would expect the MCOs to be reasonable in continue to allow that service or treatment to be provided.

2.  Are authorization requests done on-line?
MCOs must operate and maintain a PA system to support automated and manual PA determinations and responses

3.  Do MCOs provide a “list” of services that need prior authorization?
The MCOs must disclose all criteria they use for utilization management.

4.  Emergency Room:  Prior authorization for CT’s or other advanced services?
Members shall have access to emergency services without PA, even if the emergency services provider does not have a subcontract with the MCO.

5.  Explain the prior authorization process: will there be an easier or quicker process?
We are requiring the plans to provide the opportunity for electronic prior authorization submission, as well as a secure response.  Certainly, it will not be limited to just electronic forms either. 

6.  What hours will an authorization service agent be available (prior authorization)?
The MCO will be expected to have a service agent available during designated business hours for prior authorization considerations. Current hours are 7:30 am to 5:30 pm M-F.

7.  Will all MCOs use a single Pre-authorization service?
The MCOs will not be required to use a single pre-authorization service.

8.  Will prior authorization be required for dialysis services?
No. However, if you are an out-of-network provider then prior-authorization would be required.

9.  Will the provider line for prior authorizations be 24/7 and answered by someone who can make the decision?
No. The MCOs must respond to PA requests in  a timely manner, if prior authorization of any service in the treatment plan is required.

10.  How will we know what each MCO requires for authorization for service?
Each MCO will provide a list of services requiring PA. If you do not receive one in the contracting process or in the provider manual, you should ask for one from the MCOs.

Provider Contracts

1.  As a CMHC, do we have to contract with all 3 companies?  Same CPT codes as we currently bill?
It is the choice of the provider; however we encourage the providers to enroll with all three.  If the consumer is enrolled with an MCO who the provider is not contracting with, the provider would be paid as a out-of-network provider with a lower reimbursement rate.

2.  Doctors, dentists, eye doctors: will they have to sign up with all three companies? 
This is the provider's choice, but we encourage the provider to enroll with all three.

3.  If you are a Head Start Medicaid dental provider, do we need to contract with each MCO?
We encourage that all providers contract with all MCOs.  However, this is a provider's choice.

4.  Are there new effective dates for providers, or will we use our existing effective date?
The effective dates will remain the same for the Fee For Service population.  The effective date for providers enrolled with the MCOs will have the effective date of 01/01/2013 if the enrollment is prior to the 01/01/2013.  If the provider enrolls with an MCO after the 01/01/2013 date the effective date will be the date the application was received by the MCO.

5.  Will there be one provider manual that will be used by all three or will there be three separate provider manuals?
There will be three provider manuals one from each of the MCOs.  This is due to add-on services which would be different for each MCO.

6.  Will providers be paid mileage to serve rural clients in home?
MCOs must pay providers at least the current fee for service Medicaid rates.  If mileage is included in the current rate, it will be paid. MCOs may pay more than current rate in order to increase access and improve their provider networks.

7.  As a provider (HCBS) do we need to sign contracts with all three MCO to ensure we can serve all persons?
Yes

8.  Can PCPs set a limit on the # of patients they will accept?
Yes.  Each of the plans allow for that. 

9.  Can providers sign up for only certain plans, or do they have to sign up for all 3?
It is best if you sign up with all three because the goal is to have a level playing field for all the plans.  Additionally, if you have clients enrolled in all of the plans, then it would behoove you to do the same. 

10.  Can we contract w/MCO w/out being listed on provider lists?
Yes

11.  Do we need a provider contract with each new insurance company?
Yes.  You will be required to have a contract with each organization.  The contracts will look different but one thing that will be the same is that we have some specific requirements that are in the contract between the state and the MCOs that regardless of what the provider agreement says, the contract between the state and the MCO will prevail.  So the protections such as timely claims, and claims review will be included in your contract with the MCO. 

12.  Do you have to first be a Medicaid provider to enroll in the MCOs?
No. The expectation we have on the plans is that they enroll all the current providers first, so they will be working that out but you certainly will have an opportunity to enroll.

13.  I am willing to contract with an MCO for Medicaid patients.  Can an MCO require that I contract for their commercial business as well, if I only want Medicaid?
No.  They cannot require that.

14.  Is there an application fee for providers?
No.

15.  Will all 3 MCOs be contacting providers with credentialing packets or are the providers responsible for contacting the 3 MCOs to become contracted?
The state has shared a provider list with each of the plans, so they have your contact information if you are currently a Medicaid provider.  You should be hearing from the MCOs, however, if you have not, or you are not a current Medicaid provider, please contact them.

16.  Will providers/hospitals need to be enrolled with each MCO, or one main enrollment with Medicaid/State of Kansas?
Each provider and hospital would need to enroll with each MCO.

17.  Will there be one provider Handbook or will each MCO have its own?
Each MCO will have its own provider handbook.  We are encouraging them to look at the state provider handbook and have them adopt the format.

18.  As providers do we have to re-apply to be providers?
Yes, you will need to apply with each of the MCOs.

19.  Are updated contracts being sent by all MCOs?
All providers will need to enroll with the MCOs of their choice.  The application for Hospitals, LTC, other facilities and waivered services can be found on the KanCare website or each MCOs website.  The enrollment for clinicians can be done through CAQH.

20.  If we have no contract, but are a current Medicaid provider, then the contract we are signing will be only for Medicaid. Is that correct?
No, in order to maintain your status as a Medicaid provider you must enroll with at least one of the MCOs, preferably all three. You do not have to contract with any MCO for commercial plans in oder to contract with them as a KanCare provider.

21.  Do employed hospital physicians fall under the hospital contract or do each employed provider need to apply?
If the physician is contracted with the hospital they would not need to apply.

22.  Does limited health care and others include home health and hospice services in their contracts?
No

23.  So, if we contract with Amerigroup in Kansas, we see a Texas patient here in Kansas, will you pay? Do we have to contract with every state individually?
You will need to be contracted with that patient’s home state.

24.  We are an ophthalmology office and see mainly older patients, we do not see any children. Can this be allowed to be stated in our contract?
A provider does have the option to limit their practice if they so choose.

25.  I am willing to contract with an MCO for Medicaid patients.  Can an MCO require that I contract for their commercial business as well, if I only want Medicaid?
No

26.  What happens if the provider does not contract with all three companies?
Any MCO you do not contract with will consider you out of network and you will be reimbursed at 90% of FFS.

27.  If a provider is owned by a hospital or they also own doctor’s office or a nursing home, will the hospital apply for one contract for all of them or will each entity need to apply for their own contracts?
No, each provider type and specialty would need to enroll as a separate entity.

28.  We are a hospital-based home health and hospice, will we need a contract separately for the hospital?
Yes

29.  What does “each provider must maintain a health information system mean?
This refers to the MCOs, who must maintain an electronic system for paying claims and reporting data.

30.  When will we know that we have been approved as a provider by each of the MCOs?
If you have completed credentialing packets and returned signed contracts you will be approved, but those two activities must occur.

31.  WPPA charged a fee to join, will Sunflower require this?
No

32.  Will nursing facilities who are also HCBS providers have to sign 2 different contracts?
You would sign one contract with amendments for additional services.

33.  Will the forms change from what was used with KHS? 
Yes.

34.  We are an RHC, hospital based. We have 7 providers. Do we enroll as a group or individuals?
Both.

35.  How do we know for sure we are signed up with each MCO? Will each MCO contact providers that are currently providing service?
If you are a provider, you aren't automatically signed up with an MCO.  You must contact them and ask for a contract to sign.  The MCOs will be contacting providers, but don't wait for them to do that.  Use these websites to get in touch with them:  
Amerigroup Kansas, Inc. -  www.kansas.amerigroup.com
Sunflower State Health Plan -  http://www.sunflowerstatehealth.com/
UnitedHealthcare Community Plan of Kansas - www.uhccommunityplan.com

36.  Will the MCOs be offering “incentives” for current providers to sign up with them?
They may.  We require them to make every effort to sign up all existing Medicaid providers and to offer at least the current reimbursement rate.  They can offer higher rates to ensure certain types of providers join their networks.

37.  When will more detailed information be given to providers, such as specific services that require pre certs, claims submissions, etc.?
Providers should ask for this information during their contracting process with the KanCare health plans.

38.  What is the enrollment process to become providers to all 3 managed care organizations?
Contacting each MCO and going through their process. 

39.  Will provider-based providers (for example, ER providers) have to be individually enrolled for each MCO?
No

40.  Will the MCOs be able to finalize the contracts with the providers by January 1, 2013, so there would be no delay in payments?
Yes

41.  Will all providers be offered the same fee schedule? Is there any negotiation?
The MCOs must pay at least what Medicaid pays today for all services currently covered.  You can negotiate as a provider if you would like to do so.

42.  Kansas Medicaid providers numbers will no longer be utilized beginning 1/1/13?
No, you will still have a provider number with KMAP due to some member coverage which will still be fee for service.

43.  What are payer ID numbers? How do I obtain?
The Medicaid provider number is linked to the provider's FEIN number.

44.  MCOs are to incorporate current providers, but to what extent and capacity? Is this at the discretion of each MCO?
Each KanCare health plan will offer network participation to all current Medicaid providers. The health plans must offer participation at no less than 100% of the current Medicaid fee-for-service rates.

45.  How will we know what hospital we have to go to?
You would check with your MCO to see which hospitals in your area are enrolled with them. 

46.  If a person is assigned a primary care home doctor, will he or she still be able to go to the health dept for family planning services, vaccinations, STI testing, etc?
Yes

47.  What if PCP doesn’t join the KanCare network--but patient wants to continue in their care?
We are insisting that our managed care providers do everything they can to ensure continuity of care with each patient's providers.  It is the responsibility of the MCOs to get the provider to enroll in their network or transition the patient to a new provider.  In some cases, providers can continue as an out of network provider, but may receive a reduced payment rate.

48.  Will there be a grace period for providers in the event they treat a patient who is assigned to a plan that the provider is not contracted with? The current MCOs allowed this for 6 months.
The MCOs have provisions for this and will work to set up single case contracts, but will also encourage the provider to sign up for their network.

49.  What steps will KDHE and/or the MCOs take to expand the number of contracted PCP physicians?
One of the benefits of managed care is that the MCOs have the flexibility to go out and be more robust and aggressive in developing a provider network. This could mean offering different reimbursement structures if necessary to get providers to join their networks. 

50.  Are the Topeka physicians and hospitals on the KanCare provider panels for all three plans?
It would be the providers’ choice to enroll with all three.  We are encouraging the providers to enroll with all three.  The first review of the MCOs provider network will not be until sometime in September.

51.  Will every provider be in every network?
Our goal is to have all current Medicaid providers contract with each of the MCOs.

52.  When will the provider panels for each plan be published so beneficiaries can choose which plan to choose?
They should be available by the time members receive their first assignment notice in late October.

53.  Will patients be able to see specialists in Colorado? 
The State has told the MCOs we want in-state providers to have preference, but we know that in some areas of the state there are not enough specialists, so people may have to see doctors who are out of state.  The MCOs will try to get these doctors in their networks and will work with you to make sure you can see an appropriate provider.

54.  Will the 3 MCOs be taking over other networks? 
No

55.  Are there specific qualifications to contract with the MCO's?
Each provider will need to be credentialed by the MCOs using either the CAQH form or the standardized credentialing forms that the State developed in conjunction with the MCOs.

Provider Network

1.  Are all medical providers expected to participate in all of the 3 plans?
The State has required all MCOs to offer network participation to every current Medicaid provider. It is strongly recommended that every provider sign up with all three plans to continue to see all of their current Medicaid patients. It is the provider's decision and providers are able to negotiate their contracts with the MCOs.

2.  Will MCO's be looking at specific quality measures or benchmarks from providers and can payments be reduced if providers do not meet those quality measures?
Providers must be offered at least 100% of the current fee for service rates. A provider can choose to enter into an incentive arrangement with an MCO if they wish, but the MCOs cannot require this. MCOs will likely have quality programs and encourage participation from providers, but payments cannot be reduced to providers unless the provider agrees to that arrangement in advance.

3.  Will we still be able to print PCP list?
Yes. This will be available online from each of the MCOs.

Public Health Departments

1.  Will the health department sign up for all three health plans?
Yes.  Public health departments should contract with all three MCOs to continue providing services to Medicaid consumers after January 1.

2.  Where does public health department fit into plans? Don’t see us on list.
Local public health departments will be important parts of the MCOs networks, as KAN Be Healthy providers and to provide other prevention and wellness services.  The MCOs must make every effort to contract with all existing Medicaid providers, including health departments.

3.  Are health departments going to be assigned as a Medicaid patient's health home?
It depends on if the health department is where the patient looks and seeks to get all their services.  If the health department does not provide all those services that the patient is seeking, then the health department would be evaluated on their capacity and capability to coordinate the care.  So the state is not excluding any provider from being in charge of the health home, but there will be several requirements that will be developed over the next year.  As we develop those we will let providers know so if an interest is there to be a health home, providers can tell whether or not those requirements fit into their service model or not. 

4.  How will contracting and credentialing work for health departments that do not have a doctor or staff?
You'll be credentialed as a facility.

5.   
How will health departments be utilized in a patients care?
They will continue to be used as they are today, provided they sign up to be in the MCOs' networks.

6.  If a person is assigned a primary care home doctor, will he or she still be able to go to the health department for family planning services, vaccinations, STI testing, etc?
Yes. This goes along with our theme of coordinating care.

7.  No MCO mentioned contracting with local public health department. Are there plans to contract and what services will be contracted?
Yes.  All MCOs want to contract with local health departments for any of the services they currently provide and any they are eligible to provide.

8.  Not one MCO mentioned local county health departments as providers.  Why not?  Will health departments be able to sign contracts with MCOs?
Yes, absolutely.  Public health departments bring a great number of resources to bear such as health education, health literacy, disease prevention, health promotion, etc. They will be an important part of the KanCare MCO networks. If you are a health department and have not been contacted by an MCO for contracting, you should contact them and ask to sign up.

9.  To provide services will a LHD have to have electronic health records?
No, although we encourage all providers to move toward that goal.

10.  We are a small health department that only provides immunization services and HCBS services; do we need to contract with each MCO?
Yes.  Since you will not be controlling who your clients sign up with, it is better to sign up with all three MCOs

11.  What role will the LHD play in the new KanCare?  What services will we be able to provide?
Local health departments are valued providers and can continue to provide all services they currently provide, as well as all they are eligible to provide.

12.  What will be required for local health departments in terms of credentials?
The MCOs can explain what you need.  They have worked to standardize credentialing as much as possible to make it easier for providers.  Please contact them for specifics.

13.  Where do health departments fit in “medical home” model as far as still being able to provide/bill for immunizations, physicals, Kan Be healthy?
A health department could certainly function as a health home for a person, if the health department meets at the standards that are yet to be developed and can provide the following:  coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

14.  Will health departments still be able to provide services to members without having the member’s primary or home provider?
Yes

15.  Will the health department sign up for all three health plans?
We have to engage public health, primary care, and clinical services all as one.  So the hope is that the health departments all get engaged in this process.  We know that not all of the departments do direct patient care but they are experts in health promotion, disease prevention, and health literacy.  To continue in this role for all Medicaid patients, they would need to sign up with all three health plans.

16.  Will the health department be reimbursed by KanCare for these services at the same rate as the doctor’s office?  Will we be back to having to have referrals from the doctor’s office in order for the health department to provide services?
All rates paid by the MCOs will be at least what is paid in fee for service today.  Referrals will not be needed.

17.  Will the public health departments be part of the providers?  Vaccinations and family planning?

As part of the RFP, we encouraged the MCOs to work with all of our providers, this includes public health departments.  So yes, public health departments can contract with MCOs.

Referrals

1.  Referrals needed if a patient does not see the assigned PCP?
A member should call their MCO and request another PCP be assigned to their care.

2.  Will a specialist who is not a PCP need to get a referral?
No. 

3.  Are referrals needed from ER to specialty follow-ups?
No, but you must stay in your MCO’s network of providers.

4.  Are referrals needed if a patient does not see the assigned PCP?
Referrals are not necessary.  If you want to change your PCP, you need to contact the MCO.                                              

5.  Do the MCOs require paper referrals to specialists?
No

6.  Where do the MCOs require paper referrals to specialists?
No referrals are required to specialists.

7.  Will a specialist who is not a PCP need to get a referral?
No

Reimbursement/Billing/Claims

1.  What is your definition of “clean” claim?
Clean claim means one that can be processed without obtaining additional information from the provider of the service or from a third party.  It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity

2.  Will Medicaid rates continue to change quarterly based on the CMI? If so, will the MCOs change their reimbursement rate to providers to correspond with each Medicaid quarterly rate?
Yes and Yes

3.  Are there plans to reduce provider rates before November 9, 2012?
No

4.  Since the MCOs cannot reduce provider rates, can providers expect procedure time caps?
Procedures will be covered as they are today.

5.  Will all MCOs have option to manually enter single claims?
Yes.  This is one of the protections included in the provider agreements. 

6.  Are the reimbursements based on a fee for service?
Yes. The KMAP Fee for Service schedule was provided to all the Plans

7.  Are there going to be any workshops for how to bill hospital providers or providers in general?
Each MCO is planning on individual training for providers as well as provider training overall.  KDHE, the Kansas Hospital Association, and other associations will also be working as forms of education.

8.  Bill for rural health clinic: Do we submit claims on UB format, HEFA format?
The state will work with the MCOs on billing uniformity. 

9.  Can we still submit claims online and check eligibility on KMAP?
Yes.  We are working on a billing model that will allow providers to bill using their preferred method.   

10.  Currently use Gateway for claim submission, will the MCOs be contacting such organizations to facilitate current claim submission vs. the MCOs website?
MCOs will be working with clearinghouses for electronic claim submissions. Providers have the option to bill through an established commercial clearinghouse, through the State's single billing interface (MMIS) or to send their claims directly to the MCOs.

11.  Does billing go through each plan or through KMAP billing?
Providers have the option to bill through an established commercial clearinghouse, through the State's single billing interface (MMIS) or to send their claims directly to the MCOs.

12.  For billers, will there be a central billing place or will we have to bill to each MCO separately? Will there be billers meetings and training?
Providers have the option to bill through an established commercial clearinghouse, through the State's single billing interface (MMIS) or to send their claims directly to the MCOs.  Each MCO will conduct training for their network providers on how to submit claims and the billing process.

13.  For claim submission and checking benefits/eligibility, will it be necessary to go through the specific MCO?
The KMAP site can continue to be referenced regarding claim submission and eligibility. The MCO website will have to be referenced regarding benefits.

14.  Has the state defined what is considered a “clean claim” when measuring the quality measure?
Yes. We use a federal definition. Processes will be in place to monitor the adherence to the RFP requirements for clean claims processing.

15.   How long do we have to bill 2012 claims online?
Current timely filing guidelines will apply to all fee for service claims

16.  How many days do you give to file claims?
The state has set an expectation that the minimum amount of time would be 90 days, with 30 additional days for good cause.  Also for instances of retroactive eligibility and  where you may be a provider who bills Medicare or another primary payer first, that the clock on the timely claims filing does not start until you get the adjudication from that primary care payer (where Medicaid is secondary).  But we also do not restrict any of the plans from offering more extended periods for timely claims submission up to twelve months.

17.  How will KanCare affect billing when one person is served by multiple providers?
As you do today, each provider will bill for that separate service.  However, that would all go through the MCOS.

18.  How will this effect billing when one person is served by multiple providers?
As you do today, each provider will bill for that separate service.  However, that would all go through the MCOS.

19.  If MMIS is used for billing, will their audit of claims be included in the 30 day payment period for clean claims?
Claims submitted through the front end billing process will be subjected to the 20 day clean claim processing requirement.

20.  If provider uses MMIS, can MMIS accept crossover claims from Medicare and disperse to plans?
Yes.

21.  Our reimbursement payments are currently direct deposit into our bank accounts, will the MCOs continue to do this?
Yes.

22.  We use the PES program to submit LTC claims, will we still be able to use this program to submit?
PES can still be used to submit claims for processing and MCOs will support different billing options.

23.  What is expected timely filing?
The state has set an expectation that the minimum amount of time would be 90 days, with 30 additional days for good cause.  Also for instances of retroactive eligibility and  where you may be a provider who bills Medicare or another primary payer first, that the clock on the timely claims filing does not start until you get the adjudication from that primary care payer (where Medicaid is secondary).  But we also do not restrict any of the plans from offering more extended periods for timely claims submission up to twelve months.

24.  What will happen to outstanding claims from the 2012 year when KanCare takes over?
Current timely filing guidelines will apply to all fee for service claims.

25.  Which clearing house will all 3 MCOs be associated with?  Or will we need to determine this individually?
Each of the MCOs have established relationships with numerous clearinghouses, but they are willing to establish new relationships with clearinghouses that you may be using.

26.  Will all 3 plans use the same billing techniques?
Each plan has options for providers to submit their claims electronically, by batch or by paper.

27.  Will all MCOs accept paper or will it be electronic billing only?
Yes, either electronically, by paper, by fax, or by phone.

28.  Will all MCOs have option to manually enter single claims?
Yes. 

29.  Will benefits/reimbursement rates for outpatient (non-facility) physical/occupational therapy be changed?
All currently covered services will be covered at the FFS rate paid now.

30.  Will billing be done online as before?
Yes

31.  Will billing continue on KMAP website?
Yes.  Billing will continue on KMAP.

32.  Will billing in AuthentiCare change when KanCare starts?
No.  We will retain that program, AuthentiCare will continue.

33.  Will each MCO follow the same reimbursement level?
Each MCO must pay at least the current FFS Medicaid rate to any provider enrolled in their network.

34.  Will each plan have its own timely file or will KanCare mandate?
All three plans have a 90-day timely filing standard, with exceptions for retroactive Medicaid eligibility issues and cases where Medicaid is the secondary payer.

35.  Will hospice providers continue to bill room and board for patients in Medicaid nursing homes?
Yes

36.  Will nurse practitioner bill under supervising physician?
Yes

37.  Will the billing process for claims be one central location? Describe the billing process?
The single clearing house would be optional for providers. Providers can also submit claims directly to the MCOs, or use an established commercial clearinghouse.

38.  Will there be 1 clearing house for billing to the 3 MCOs?
Yes.  All providers will be able to bill a single State claims interface for all three plans.  Providers can also use an established commercial clearinghouse or submit claims directly to all three MCOs.

39.  Will there be a standardized billing system for all 3 MCOs?
Yes.  All providers will be able to bill a single State claims interface for all three plans.  Providers can also use an established commercial clearinghouse or submit claims directly to all three MCOs.

40.  Will we have provider reps that will meet with us regarding claim issues?
Yes. Each MCO does offer provider representatives to assist with billing inquiries.

41.  Will we still have up to a year to file claims and 2 years to make claim adjustments?
Each MCO has a 90-day timely filing standard, with exceptions for retroactive Medicaid eligibility issues and in case where Medicaid is the secondary payer.

42.  Will we still use the PES system to bill in claims or will each insurance company have their own billing system?
PES can still be used to submit claims for processing and MCOs will support different billing options.

43.  What education will you provide for billing staff?
The MCO will provide both individual and group training for billing staff. 

44.  Will there be further training as the time gets closer?
Yes

45.  What’s the turnaround time for payments?
Clean claims pay with 30 days, 99% of non-clean claims within 60 days and all claims including adjustments within 90 days

46.  What are the chances that in year two or three the MCOs will significantly reduce the payments? Who will help the providers if this turns out to be the case?
The health plans have agreed to offer 100% of fee-for-service rates to providers for the entire contract period.  They cannot reduce the rates in years 2 or 3, or in any optional contract year the State may exercise under the current KanCare contracts.

47.  Can we complete online 1500 claim forms?
Providers will have the option for online and electronic claims submission.

48.  CMS is giving a 7% payment increase for primary care.  Will Medicaid be doing the same

Yes. The enhanced reimbursement for primary care was included in the rate development for KanCare, so that will be included in contracts for MCOs

49.  Currently our Medicaid reimbursement is in the form of an electronic transaction to our bank account and we log onto Medicaid to print our remittance advices, will payments from the 3 MCOs be handled similarly?
Yes, the three MCOs are offering the option of receiving electronic payments and all three have web interfaces to manage your remittance documents. 

50.  Do providers get to negotiate their reimbursement rates, or do they get paid by the state reimbursement rates?
The state contracts with each of the MCOs requires them to pay all the existing providers at least at the current fee-for-service rate, 100%.  Since that is the floor, the providers then have the opportunity to negotiate rates.  Similarly, if the provider is interested in an agreement where they would be paid a capitated rate, then that would be allowed.  

51.  Given an out-of-network provider is paid 90 percent of the Kansas fee schedule, what constitutes a “reasonable” offer to be made by the MCO?
No less than the fee for service rate on November 9th 2012. 

52.  How will the DSH payment be affected?
DSH payments will not be affected

53.  How will these changes affect DMEPOS? Will they follow existing Kansas Medicaid guidelines or will each plan have their own guidelines? Will DMEPOS still be paid at 100 percent?
Existing services will continue under KanCare and providers will continue to be paid at least the rate in place November 9th. 

54.  I’m from a PRTF and outpatient behavior health that has 16 providers, each with different licensures. Under the current system, all of these providers are Medicaid eligible in that the services they provide are reimbursed by Medicaid. Having worked with private insurance companies, it is my understanding that the following licensures are not eligible for CAQH numbers: LPC, LMFT, LMSW. Does this mean that these individuals are no longer eligible for reimbursement for their services?
CAQH is only one method of credentialing providers.  The three MCOs and the State have agreed on a single credentialing form that can be used for non-traditional providers.  This credentialing form is available from the MCOs. 

55.  If a patient receives care at a hospital, who is not on the patient’s plan, how will the hospital be paid, especially if the care is emergent?
Out of network providers will receive 90% of fee for service rates; however, care that is determined as emergent will be reimbursed at 100% of FFS.

56.  If not listed as “PCP” on patient ID card, will provider still be paid?
If you are a provider in an MCO's network and you are providing a service to a patient in that network that they are eligible for, then the MCO would pay for that.  If there was a need for prior authorization, then prior authorization would be required before performing that service.

57.  MCO must pay at least the amount of the Kansas Medicaid fee schedule as of Nov. 2012.  How long before they can change to their own fee schedule?
Through the duration of the contract, the MCOs have the requirement that the providers get paid at the level of fee-for-service or above. The contract we have with the MCOs is a 3 year contract with two optional one year extensions that would make it a five year contract overall.

58.  The provider is only paid 90% if they don’t meet certain benchmarks, what if the benchmarks are not met due to non-compliance on the consumers?
It is not you as the provider that is being held accountable, it is the MCOs.  We want to help bring the resources to you and the patients that you serve to improve those health care outcomes.  They are still required to pay you at your current fee-for-service rate.

59.  What will the recourse/time frame be for non-collection?
MCOs must resolve provider complaints within 30 days of receipt.  See RFP Attachment D, Section 2.0 for details. 

60.  Will payment rates for health homes be negotiable or will they be the same across the state?
This has not been determined.  Health Homes are not scheduled to be operational until the end of 2013. 

61.  Will providers be paid on fee-for-services basis?
Providers will be paid FFS unless they negotiated another payment method that is approved by the State.

62.  Will the capitation be per member? 
It is per member, per month capitation rate.  There are different capitation rates for the various populations.  There are several cells that are based on the kind of services and eligibility categories for the individuals who receive this care.

63.  Will the withholding amounts that are affecting the contractors affect FQHC’s and their PPS/Payment rate?
The P4P withholds will not affect the PPS payment rate

64.  How will KanCare contractors handle retroactive eligibility? (i.e. services in January 2013 for someone not determined eligible until March 2013)
The MCOs will be responsible for three months of retroactive eligibility claims.

65.  Will there be a delay in payment if we submit claims through the MMIS system instead of directly submitting the claims to the MCOs?
There is no expected delay in payment due to the submission of claims through the front end billing.

66.  Can we set up electronic funds transfers (EFTs)?
Yes.

67.  Can we do inpatient crossovers like before on KMAP?
KMAP is merely a front end billing solution that will be used to forward claims onto the appropriate MCO. KMAP will no longer be processing and adjudicating claims for payment. That process will be handled through the MCO.

68.  Can we batch/bill on PES system thru KMAP?
Yes. PES will still be available for claims submission. The claims will then be forwarded on to the appropriate MCO for processing and adjudication.

69.  What are the differences planned for the claims submission single front-end provided by the State compared to the existing KMAP online, if any?
KMAP is merely a front end billing solution that will be used to forward claims onto the appropriate MCO. KMAP will no longer be processing and adjudicating claims for payment. That process will be handled through the MCO. Once you have entered your claim, you will receive notification that your claim has been forwarded to the appropriate MCO for processing and adjudication.

70.  Will DSW (PCA's) be paid with the same system now in place and who will be responsible for issuing payments?
The MCOs will be issuing claim payments to providers.

Rural Health Clinics (RHCs)

1.  We have 3 rural health clinics, each in a separate county with a different provider #.  Can the patients float between our clinics as needed for care?             
Yes

2.  How do MCOs plan on processing and reimbursing claims for rural health clinics?
MCOs are required to reimburse rural health clinics at the PPS rate. The State is considering updating the PPS base period for RHCs.

Savings

1.  Since the introduction of managed care (HMOs) hasn’t medical cost actually increased?
In general, health care costs have increased in the country and in Medicaid. Some of that increase is related to the aging of our population and to new services which generally cost more when they are first implemented; however, we know that people often don't get preventive services they need which can result in higher costs later to treat diseases and conditions that should have been detected earlier. The Medicaid population often has a difficult time getting coordinated care to help with preventive care, as well as management of existing conditions, like diabetes or high blood pressure. MCOs have many resources to help coordinate this care, along with the community supports and services some of our population needs.

2.  It is estimated that KanCare will save $1 billion. How will that be accomplished without cutting rates/services?
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. The plans are expected to coordinate the care that their members receive. This means they are responsible for making sure people get preventive care early, before the patient gets sick and needs more expensive care. Over time, this will lead to reduced costs.

3.  You are going to take $300 million out of the $3 billion as a managed care discount, i.e., savings, the MCOs are going to charge 15 to 20 percent in administrative costs. That means there is approximately 30 percent less for care, correct?
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. These rates include the plans' administrative costs and the managed care discount. There is also a risk sharing element in the contracts that ensures the health plans will not exceed a certain percentage in profit. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. Consumers must receive the same level and quality of services they are receiving now, or the health plans will face penalties.

4.  It is estimated that KanCare will save $1 billion. How will that be accomplished without cutting rates/services?
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. The plans are expected to coordinate the care that their members receive. This means they are responsible for making sure people get preventive care early, before the patient gets sick and needs more expensive care. Over time, this will lead to reduced costs.

SOBRA

1.  SOBRA Medicaid coverage will not change?
Correct. The SOBRA program will work as it does today, the eligibility will be the same and you will be paid accordingly. SOBRA coverage will not go into the MCOs.

2.  What will happen to SOBRA?
The SOBRA program is not changing.  Individuals receiving SOBRA coverage will not be included in KanCare.  SOBRA will continue to be a fee for service program.

3.  Will there be SOBRA services in Kansas after January 1, 2013?
Yes. SOBRA services will continue in the fee-for-service program.

Spenddown

1.  Will the members still have a spenddown?
Medicaid eligibility will not change.  If you had a spenddown before and your income has not changed, you will continue to have a spenddown.

2.  Will Medicaid recipients have a spenddown as they can have today?
Yes. The spenddown status of people who are over 65, and who are on disability, will not be changed.  They will still be assigned an MCO at the beginning, but that MCO will not pay the doctor bills until the spenddown has been met.  This will still work through the MMIS system as it works today.

Third Party Liability

1.  If I receive supplementary insurance would this work against my deductible?
You must take off co pays and deductibles for your primary insurance.  Insurance other than Medicaid may affect your spenddown for Medicaid since the premiums for the other insurance may be allowed as an expense to be applied against the Medicaid spenddown amount. 

2.  Talk about how TPL will work after KanCare starts?
No change from current process for the provider with the exception they will send their updates to the plans and will bill the MCO instead of KMAP.  Medicaid (KanCare) will continue to be the payer of last resort if there is primary insurance.

3.  How will the changes from fee for service Medicaid to the MCOs be coordinated/communicated to the COB Administrator for Medicare crossover claims?
If the question is referring to COBA then the claims will continue to be submitted as they are currently. No changes would be necessary.

4.  Will there be a period initially that our Medicare co-insurance claims will go to KMAP instead of the MCO?
With Front End Billing the claims will continue to come to HPES first.

5.  Will we still have to process COB if Medicare is primary insurer?
Yes.

Training

1.  Will there be more detailed training sessions on more billing specifics, such as precertification requirements, etc?
Yes. Each health plan will offer additional training sessions for providers. Check their websites or call the plan for more information.

2.  How much training will the providers receive from the MCO's?
Each MCO will communicate with contracted providers about training opportunities. This will differ for each plan, so you should reach out to the plans directly if you have specific training needs or questions.

Transportation

1.  How will non-emergency medical transportation change with KanCare or will it still be billed through MTM?
Each of the KanCare MCOs will be required to cover non-emergency medical transportation as part of their contract.  The current program that is provided through MTM in Kansas now go away and transportation services will be provided under KanCare by the three health plans.  If you are a provider you will need to contact all three of the health plans and get information about how to sign up with them to provide that services.  Each of the plans is using a transportation broker.  All of the benefits that are provided to Medicaid beneficiaries today will continue under KanCare. 

2.  If an approved transportation provider is unavailable, will you reimburse expenses of a non-approved transport?
Consumers can choose to ride with a friend or family member and receive gas mileage reimbursement in most cases.  The consumer should contact the health plan before their appointment to set up a trip request.  There will be a trip log and other information and paperwork to complete.

3.  Will the MCOs provide transportation when clients live in the long-term care facilities?
Non-emergency medical transportation is considered part of the per diem rate, so that will not change from how it is today. 

Value Added Services

1.  Are tax payers paying for incentives?
No, they are a value-added service at no additional cost to the state.

2.  Why is there such an incentive program to the member and not the providers? 
The MCOs will offer certain incentives to providers in exchange for improved quality and other outcomes.  Talk with the MCO representatives when you are discussing their contracts.

3.  Will a comparison summary of side-by-side MCOs benefits and value added services be available?
Yes, it will be in the enrollment packet.  It will also be on the KanCare website.

4.  Where do the funds come from for the incentives offered to the members?
All of the value-added services, as laid out in the contracts, are provided at no additional cost to the state.   They will be paid by the MCOs.

5.  Will any of the plans offer chiropractor services?
No, Kancare does not cover chiropractic services.

Vision

1.  As a specialty practice (ophthalmology) will a referral be needed for each visit as it is now with Unicare?
Each MCO may determine its own requirements. As a rule, referrals will generally not be needed.

2.  For each KanCare provider what network will be used for Eyewear/glasses for their enrolled patients?
VSP for United Health
Opticare for Sunflower
Ocular Benefits for Amerigroup

3.  What are the specifics of vision portion?
No changes to the current program, but all three plans will be offering value-added benefits that may also include additional vision services.  We recommend reviewing those benefits with each of the plans

4.  What changes are going to be implemented for vision care or eye health care--vision exams? glasses? contact lenses?
No changes to the current program, but all three plans will be offering value-added benefits that may also include vision.  We recommend reviewing those benefits with each of the plans

5.  Who will provide vision coverage with UHC? How will claims be filed?
Vision Service Plan (VSP). The manner in which claims will be filed will need to be addressed by the MCO.

6.  Will optical (frames, lenses) process the same or will there be different provider to process these claims (as is now with Unicare who uses VSP)?
Each MCO will be responsible for vision services. The MCOs will be using the following vision subcontractors:
VSP for United Health
Opticare for Sunflower
Ocular Benefits for Amerigroup

7.  Will the vision benefits stay the same as well as hardware benefit?
No changes to the current program, but all three plans will be offering value-added benefits that may also include vision.  We recommend reviewing those benefits with each of the plans

8.  Will there be any changes to eye care?
No changes to the current program, but all three plans will be offering value-added benefits that may also include vision.  We recommend reviewing those benefits with each of the plans

9.  With the medical home concept, will vision (or dental perhaps) need a referral from the primary care physician? 
No.

10.  Will vision (eyes) be covered? 
The scope of services will remain the same, but some or all the plans may be providing some additional vision benefits.

Working Healthy/WORK

1.  Will DDP and working healthy/work assessments be paid through MCOs?
Work assessments will not be paid by the MCOs.

2.  I am an existing provider (providing case mgmt services) for individuals on the Working Healthy Program-Will I be allowed to contract with the MCO’s, or are my job duties being absorbed by the MCO Care Coordinators?
Details are still being worked out related to the provision of Independent Living Counseling. The WORK Program Manager will keep WORK ILCs informed as details are finalized.