Kansas

In Kansas:
  • Medicaid services are delivered on a managed care basis, and KanCare (Kansas Medicaid) members are assigned to one of three managed care organizations (MCOs). Kansas operates KanCare through a Section 1115 Waiver, which was approved in 2012, and went into effect in January 2013. The KanCare MCOs provide most Medicaid services and are responsible for physical, behavioral and long-term care services. Some of the MCOs use subcontractors to provide certain services, such as a behavioral health, dental, and vision services.
  • Prior to the transition to KanCare there were a total of 354,664 beneficiaries enrolled in Kansas’s Medicaid program as of July 2011. Of these 310,036 were enrolled in managed care programs. According to a KanCare quarterly report, there were a total of 330,019 beneficiaries enrolled in KanCare MCOs as of December 31, 2013.
  • Kansas also delivers Home and Community Based Services (HCBS) through seven HCBS waivers including six that include children among the target population: autism, physical disability, intellectual/developmental disabilities (I/DD), technology assisted, traumatic brain injury, and serious emotional disturbance. In January 2014 Kansas received approval to incorporate the HCBS and targeted case management services for I/DD individuals into KanCare.
As of 2013, 280,343 individuals were eligible for KAN Be Healthy (KBH), Kansas’s Medicaid benefit for children and adolescents (also known at the Early and Periodic Screening, Diagnostic, and Treatment benefit, or EPSDT). According to CMS data from 2013, Kansas achieved an EPSDT screening ratio of 82% and a participation ratio of 58%. 119,617 children received dental services of any kind, with 112,350 receiving preventive dental services.
 

Last updated June 2014

 
Medical Necessity
The State of Kansas defines medical necessity as follows:
 
“Medical necessity means that a health intervention is an otherwise covered category of service, is not specifically excluded from coverage, and is medically necessary, according to all of the following criteria:
  • “Authority.” The health intervention is recommended by the treating physician and is determined to be necessary by the state or the state’s designee.
  • “Purpose.” The health intervention has the purpose of treating a medical condition.
  • “Scope.” The health intervention provides the most appropriate supply or level of service, considering potential benefits and harms to the patient.
  • “Evidence.” The health intervention is known to be effective in improving health outcomes. For new interventions, effectiveness shall be determined by scientific evidence as provided herein. For existing interventions, effectiveness shall be determined as provided in paragraph i.
  • “Value.” The health intervention is cost-effective for this condition compared to alternative interventions, including no intervention. “Cost-effective” shall not necessarily be construed to mean lowest price. An intervention may be medically indicated and yet not be a covered benefit or meet this regulation’s definition of medical necessity.” Interventions that do not meet this regulation’s definition of medical necessity may be covered at the choice of the state or the state’s designee. An intervention shall be considered cost effective if the benefits and harms relative to costs represent an economically efficient use of resources for patients with this condition. In the application of this criterion to an individual case, the characteristics of the individual patient shall be determinative.
 
Kansas statutes also add that KAN Be Healthy services (see pgs. 60-61) also include:
  • “Other necessary health care, diagnostic services, treatment and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the [KAN Be Healthy] screening services.
Initiatives to Improve Access
 
Reporting & Data Collection
KanCare, as part of its Section 1115 Waiver, has a significant quality measurement component. Additionally, each of the three KanCare health plans and their subcontractors are required to obtain accreditation by the National Committee for Quality Assurance.
 
In terms of Evaluation Design of its 1115 Waiver, Kansas incorporates different measures from the KanCare contracts related directly to the goals of the KanCare program. This includes quantitative measure such as: Healthcare Effectiveness Data and Information Set (HEDIS); mental health measures including Serious Emotional Disturbance (SED) Waiver reports and National Outcome Measures; Substance Use Disorder measures; and Case Record reviews. Kansas also includes a number of qualitative reports such as: Consumer Assessment of Health Plans Survey (CAHPS), Substance Abuse Disorder consumer surveys, Provider Surveys, and other reports/surveys.
 
KanCare also has a pay for performance (P4P) program that ties payment to six performance measures related to operations for the first year, and fifteen performance measures related to quality for the later years. Among the fifteen quality measures that Kansas will be tying to payment are: well-child visits in the first 15 months of life and preterm births.   
Behavioral Health
The three KanCare MCOs are required to cover behavioral health services; and some use subcontractors to provide these services. Kansas also has a HCBS waiver for individuals age 5 and over who meet thee definition of having a developmental disability or are eligible for care in an Intermediate Care Facility. As of January 2014 this waiver and the services provided are incorporated into KanCare. The services from this waiver that are now provided by KanCare include long-term services and supports services and targeted case management.
 
Kansas is also working on an Affordable Care Act Section 2703 Health Homes State Plan Amendment that will be used to provide comprehensive and intensive coordination of care to those with Serious Mental Illness and Chronic Conditions. Kansas anticipates launching its Health Homes effective July 1, 2014.    
Support to Providers and Families
Support to Providers
 
The KanCare website offers information to providers on how to become a KanCare Provider as well as information on each of the health plans.
 
Support to Families
 
Kansas Medicaid has developed a KAN Be Healthy Kontact Korner document, which provides information and links on topics such as physical and developmental growth, dental, nutrition, immunization, blood lead, hearing and vision. Kansas has also held a series of events for consumers to provide information related to the roll out of KanCare, the integration of I/DD services, and the Section 2703 Health Homes State Plan Amendment.
Care Coordination
KanCare expects that the health plans are actively engaged in care coordination for their members. One of the KanCare Contracting Principles, as identified in the Section 1115 Waiver that created KanCare, is that the health plans are required to perform a number of functions related to care coordination. This includes undertaking a health risk assessment to identify health and service needs in order to develop care coordination and integration plans for each member. Additionally, there are several measures among the quality measures that are tied to Kansas’ pay for performance program that are related to care coordination, or indicate that care coordination is occurring, including:
  • Annual monitoring for patients on persistent medications;
  • Follow-up after hospitalization for mental illness;
  • Decreased utilization of inpatient services; and
  • Increased integration of care.
Care coordination is also a central part of Kansas’s Section 2703 Health Homes State Plan Amendment. Kansas defines its health homes as: “A team of health professionals: May include a physician, nurse care coordinator, nutritionist, social worker, behavioral health professional (including mental health or substance use disorder providers), and can be free standing, virtual, hospital-based, community mental health centers, etc.”
Oral Health
Dental Screens are part of a KAN Be Healthy visit. The Health Plans, or their subcontractors, provide dental services to all children eligible for KAN Be Healthy, including more advanced dental services as deemed medically necessary.