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KanCare HCBSAll MCO Training
Fall 2017
1
WELCOME
Welcome Housekeeping items Introductions Amerigroup Sunflower Health Plan UnitedHealthcare
◦ Kansas Department of Health and Environment◦ Kansas Department of Aging and Disability
Services
2
AGENDA
◦ Policy Updates◦ General Administration ◦ Claim Management ◦ Appeal and Grievance Procedures ◦ Adverse Incident Reporting ◦ Value Added Benefits and Services ◦ Lt. Governor Workshop Update ◦ KDADS◦ Q&A
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NEW POLICIES AND UPDATES
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Effective with claims processed on/after 5.1.17: Reconsideration: Request by a provider for an MCO to review the denial, in whole or in part, of payment
for a service.
Provider has the right to submit either a reconsideration request or an appeal request following receipt of the remittance, explanation of payment, or notice of action.
Reconsideration process is optional.
Provider may submit a request for a reconsideration with the MCO within 120 calendar days from the date of the receipt of remittance, explanation payment or notice of action, plus three (3) calendar days if the notice is mailed.
Provider’s right to appeal is preserved throughout the reconsideration process.
Provider may terminate the reconsideration process and submit an appeal request.
Appeal: Request for an MCO to review an action.
Provider may submit an appeal request to the MCO within 60 calendar days from the receipt of remittance, explanation payment or notice of action, plus three (3) calendar days if the notice is mailed.
Provider also may submit an appeal request to the MCO following receipt of the reconsideration resolution notice within 60 calendar days of the receipt of remittance, explanation payment or notice of action; plus three (3) calendar days if the notice is mailed
Provider must complete the MCO’s appeal process before requesting a state fair hearing
State Fair Hearing: An administrative hearing involving the presentation of evidence and argument before a presiding officer concerning an action.
Provider has the right to submit a request for a state fair hearing following receipt of an appeal resolution notice.
Provider may submit a request for hearing 30 calendar days from the date of the appeal resolution notice, plus three (3) calendar days if the notice is mailed.
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Provider Payment Dispute Resolution
IDD Assessment and Tier Rate Functional Assessment: Initial assessment must be completed by the CDDO
upon IDD eligibility determination and/or upon the individual attaining the age of five years and acknowledging a willingness to accept services upon receiving an offer of services.
◦ The assessment shall be initiated within 5 calendar days and completed within 30 calendar days from the date of IDD eligibility determination.
◦ CDDO shall enter the data from the assessment and reassessment into the KDADS’ system of record (currently KAMIS) within 7 calendar days from the date of completing the assessment and utilize the information system for collecting and updating data.
Reassessment: CDDOs are required by State policy to reevaluate annually, within 365 days of the last assessment. Reassessments shall include individuals not on the waiting list who are state-funded and/or received a previous assessment of Tier 0.
◦ An annual reassessment is not required for individuals placed on the waiting list.
◦ Any tier change resulting from a reassessment shall become effective the first day of the month following the completion of the reassessment.
Providers may access the tier score by contacting the CDDO
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Background Check Requirements
Effective with the issuance of Informational Memorandum of January 24, 2017, HCBS providers to maintain a clear background as evidenced through background checks of : Kansas Bureau of Investigation, Adult Protective Services, Child Protective Services, Nurse Aid Registry, Kansas State Board of Nursing, Office of Inspector General and Motor Vehicle screen.◦ Note: For a KBI criminal history record information (CHRI) check,
HCBS providers shall submit employee information through KDADS Health Occupational Credentialing Division (HOC)
To be a qualified HCBS provider of services that involve, or may involve one-on-one contact with HCBS service recipient, individuals and entities shall meet provider qualifications, including passing a background check.
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Background Check Implementation
Prospective Employees: Background checks shall be conducted on all prospective employees.Current employees with employment of 3 years or more: Background check shall be conducted during the anniversary month of their date of employment. Subsequent checks shall be required every two years.
12 months after date of memorandum (January 24, 2018)Prospective and current employees with a period of employment of less than 3 years: Background checks shall be conducted during the anniversary month of their date of employment. Subsequent checks shall be required every two years.
Refer to KDADS Background Check Informational memo (1/24/17) and Attachment A (3/23/17)
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EXISTING POLICY UPDATES
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IDD/Extraordinary Funding (EF)
Eligibility is determined by the results of the uniform Extraordinary Funding Tool. The tool and associated worksheets can be found on the KDADS Provider Forms page under “IDD Extraordinary Funding”. Policy M2016-044 is located in on the KDADS Final Policy page.
All requests for Extraordinary Funding must be submitted by the day or residential provider to the participant’s MCO.
When reviewing the request, the MCOs will consider other community resources, third party sources and/or Medicaid-covered benefits available to the participant. Additional documentation may be requested to complete the review process. This documentation must be provided to the MCO within 10 business days of the date the request was made.
MCOs will complete all new extraordinary funding determinations within 30 days of receiving all required documentation.
Persons transferring to a new provider, a new MCO or are moving to a new location with the same provider: the provider is required to submit a new request to the MCO within 60 days of transition. The MCO will complete a review to assess the need for continued extraordinary funding in the new location. MCO will continue extraordinary funding until there has been sufficient time for a decision.
Requests that do not contain the documentation required by the State EF Policy, or that are not submitted within the required time frame, may be administratively denied.
Annual requests for renewal of Extraordinary Funding must be submitted at least 60 days prior to the expiration of the current extraordinary funding authorization.
State policy requires a financial audit to cost of both Individualized rate the super tier rate.
If a provider disagrees with the denial or termination of extraordinary funding, the provider may appeal with the participant’s MCO following the process outlined within the administrative denial letter issued by the MCO. If the MCO denies extraordinary funding through the appeal, the community service provider can request an administrative reconsideration from KDADS within 10 days of the MCO’s appeal decision. 10
Residential Billing
The definition of a residential habilitation service includes “activities of daily living such as personal grooming and cleanliness, bed making and household chores, food preparation, and the social and adaptive skills necessary to enable the beneficiary to reside in a non-institutional setting.”
The staff member must have physically provided one of the defined services and “assistance, acquisition, retention and/or improvement skills” to the participant.
The participant does not have to be present for all of the residential services provided.
Residential habilitation cannot be billed if the participant is absent from service for the entire 24-hour period (in the hospital, home visiting family, etc.).
Participant Presence Requirement tables are located in the KMAP IDD Provider Manual (refer to pages 8-22)
◦ Table 1 Purpose of Support vs. Presence Requirements
◦ Table 2 Type of Support vs. Presence Requirements
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PENDING POLICY UPDATES
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Final Rules: Overview
The Final Rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade.
The Final Rule aligns key rules with those of other health insurance coverage programs and strengthens both the consumer experience and key consumer protections.
The Final Rule addresses several sections of Medicaid law, under which states may use federal Medicaid funds to pay for home- and community-based services (HCBS).
The rule supports enhanced quality in HCBS programs and adds protections for individuals receiving services.
This rule also reflects the Centers for Medicare & Medicaid Services’ (CMS’) intent to help ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting.
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Final Settings: Status Update
KDADS is working through their plan with CMS related to the Final Settings rule◦ States now have until March 17, 2022 to demonstrate compliance
with the final rule. For more information, please visit: http://www.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html
◦ State link: http://www.kdads.ks.gov/commissions/home-community-based-services-(hcbs)/hcbs-waivers
MCOs have been utilizing Person Centered Planning with all waivers for about 1.5 years
KDADS is working with all Kansas Stakeholders to make sure their PCISPs meet all of the CMS Final Rule Requirements for Person Centered Support Planning
We anticipate that additional Final Rule requirements will be included as part of the upcoming RFP
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MFP Update(Money Follows the Person)
The current demonstration grant as funded by CMS is coming to an end in all 43 participating states. The end date in Kansas for transitions to the community is June 30, 2017. Consumers who transition by that date will still receive the supports of the MFP program for 365 days and a seamless transition onto the appropriate waiver without going on a waiting list.
Given the experiences with the MFP Grant, Kansas will continue to prioritize home- and community based-services for meeting the needs of individuals who would otherwise live in institutional settings. Kansas has chosen to prioritize the support of individuals to live in the least restrictive setting possible that meets their needs.
Currently details of the new plan are being codified. We hope to announce them soon. Each individual’s assigned KanCare MCO will be the primary means of supporting their ability to live in the least restrictive environment of their choice. This includes helping to transition individuals out of institutional settings. It is our belief that sustainability of the goals and objectives of the MFP program must be an integral component of the Medicaid healthcare delivery system.
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MFP Update(Money Follows the Person) An integral component of KanCare is and will be on-going identification and support to
transition individuals residing in institutional settings into community settings. In light of this any Medicaid participant who wishes to transition to a community-based environment should contact their MCO care coordinator and indicate their desire to live in the community. When details for the new sustainability program are established and eligibility criteria are announced, these individuals will be among the first able to enroll in the new plan
Further information is pending a KDAD publication of a transition plan and formal policy
Reference: KDADS MFP and The Sustainability Program (dated June 20,2017)
For questions please contact:Larry D. Kelley
[email protected] Program Manager
Kansas Department for Aging and Disability Services785-296-7744
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GENERAL ADMINISTRATION
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KMAP ID & Revalidation
Services attached to KMAP ID
If provider is not contracted with KMAP for a specific waiver service, they should not be providing it
To update KMAP Profile – Providers are required to fill out the KMAP Application and Disclosure of Ownership form if adding a service/waiver type
To Update MCOs - Ensure your contracts with each MCO are updated to reflect those additional services. Contact your provider representative for questions.
Revalidating with the State of Kansas
The revalidation date is five years from the last KMAP enrollment date.
A letter is mailed to the provider 60 days in advance of their upcoming revalidation date with KMAP.
KMAP needs 30 days to process the revalidation application. During that timeframe KMAP may request that the provider submit any updates, corrections, or additional documentation as needed to process revalidation.
To ensure that KMAP services will continue without interruption, the revalidation application must be completed, submitted, and approved prior to the inactivation date on the letter.
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KMAP ID & Revalidation contd.
If the revalidation is not submitted and approved by the inactivation date, the KMAP ID associated with the application will be inactivated.
If inactivated, the provider will have KMAP access for an additional 30 days to submit the revalidation application or to perform any prior claims maintenance.
Claims will be denied for dates of service after the inactivation date until the revalidation is approved.
Once approved, as long as all enrollment requirements are met, the provider will be reinstated with no lapse in enrollment and claims may be resubmitted.
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Upcoming changes to Enrollment and Credentialing May 2017: The updated Kansas Organizational Credentialing and Recredentialing
Application is now available as a fillable form on KMAP and MCO websites
October 2017: The new KMAP provider website will go live on October 16, 2017, and will contain new functionalities
January 2018: Effective January 1, 2018, all new provider enrollments and recredentialed providers must enroll with KMAP in order to be enrolled/credentialed with an MCO
July 2018: All providers in one of the MCO networks must have an active KMAP provider ID number in order to remain in the MCO networko If a provider is in an MCO network and does not have an active KMAP provider ID number, it is
strongly recommended that providers submit an enrollment application to KMAP as quickly as
possible to ensure compliance well before the due date.
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Recredentialing
MCOs are required by CMS and the State of Kansas to recredential providers every 3 years. It is critical that you return the recredentialing packets with all documents included, for example:
Credentialing application
Disclosure of Ownership Statement
Licensures, Insurance and other required documents
If this information is not returned timely we are required to terminate the provider contract, resulting in a non par status and reduction or denial of payment. If this occurs, the only option to re-join the MCO’s network will require new credentialing and agreements.
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Client Obligation
What is the HCBS client obligation? The HCBS client obligation is the payment amount the KanCare Clearinghouse determines HCBS recipients must contribute toward payment for their HCBS services. HCBS recipients pay their client obligation each month directly to the care provider assigned the client obligation – typically the provider who delivers the majority of HCBS services to the recipient. The client obligation is deducted from the provider’s claims payment each month and the provider is responsible for collecting the client obligation from the HCBS recipient.
Where can I verify client obligation amounts? Providers can view obligation amounts for KanCare members by logging onto the Kansas Medical Assistance Program’s secure website at kmap-state-ks.us.
Check with MCO provider representative if you have questions on how providers are notified of the client obligation by each MCO
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Care CoordinationIntegrated Service Plan (ISP): plan that details the approved services and community/natural supports a participant needs in order to remain healthy and safe, and to meet and achieve their Person-Centered Plan goals. The Integrated Service Plan is developed with the member, their support team and Care Coordinator.
Care coordinator completes a functional needs assessment and initial ISP within 7 business days from 834 eligibility file notification. Service authorization will occur on or before business day 14 to initiate services.
Person-Centered Plan (PCISP): A support plan with goals that is developed based upon the lifestyle preferences of the member. The Person-Center process details the supports a participant needs and wants including formal and informal supports for achieving goals, addressing barriers, and ensuring choice, independence, integration, and a person-centered focus in the service planning process. The Person-Centered Plan is preferably led by the member, anddeveloped with the member, his/her support team and Care Coordinator.
Care coordinator & member develop the person centered service plan (PCISP)
All HCBS services require prior authorization. Authorization must be obtained before starting services.
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TBI Authorization/Precertification Process Amerigroup
Link to AGP Precertification Request Form https://providers.amerigroup.com/ProviderDocuments/KSKS_PrecertRequest.pdf
Providers will need to email the Precertification Request form to [email protected] in order to obtain authorization for occupational therapy, physical therapy, speech therapy, cognitive therapy, behavioral therapy and transitional living skill services for members who are on the Traumatic Brain Injury (TBI) waiver.
Supporting documents must be sent into the TBI mailbox at the time of the request. This includes precertification request forms, any current therapy evaluations, and service recommendation forms. For ongoing therapies, in addition to the previously listed documentation, the six most current clinical notes for the member are required to support medical necessity for ongoing therapies.
This change aligns the waiver process with utilization management protocols and ensures the availability of staff to respond to your request in the event that the designated contact is unavailable.
Providers will still receive acknowledgement of authorizations. If you have not received confirmation within 10 days, call the Long-Term Services and Supports department at 1-877-434-7579, ext. 50103 or email [email protected].
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CLAIM MANAGEMENT
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Claims Timely Filing
Each MCO is allowed to set timely filing requirements as part of each individual contract with providers. Review individual provider contracts for timely filing requirements. New day claims◦ Generally, the timely filing requirement for new day claims is 180 days* from
the date of service
Corrected claims◦ Generally, the timely filing requirement is 365 days* from the paid date
Claims impacted by Retro-eligibility ◦ Timely filing requirements begin on the date the member was deemed
eligible by the state. A provider has 180 days* from the date the member was determined eligible by the State to file an their initial claim
*Providers must check their individual contract for each MCO for provider specific timely filing requirements.
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Claims Outcome & Payment Information Provider Remittance Advices (PRA), also known as Explanation of
Payment (EOP) is the primary source for providers to see how a claim was processed.
Claims submitted to KMAP for routing to the MCO’s will get Front End Billing EOP’s if KMAP was unable to pass the claim along to the MCO for processing.
It is critical that providers review and post payments and denials noted on PRA’s/EOP timely in order to ensure corrected claims or reconsiderations are submitted within required timelines. Additionally it allows you to quickly resolve any outstanding items and remove dollars from outstanding Accounts receivable reports.
All 3 MCO’s have self service tools on their Websites, Provider Services Call Centers, and Provider Relations staff to assist you with any question regarding how a claim was processed.
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What if I need help with a claim?
All 3 MCO’s have self service tools on their Websites, Provider Services Call Centers, and Provider Relations staff to assist you with any question regarding how a claim was processed. When reaching out for assistance please make sure you have the following information: The MCO claim number The members Medicaid ID # The date of service on the claim Total billed charges The Tax ID # or NPI for the provider Provider Contact Information
If working with one of our call centers or Provider Relations staff, please make sure you note in your file the name of the person you spoke with and the date and time of the call.
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How do I submit a corrected claim?
A corrected claim would be needed if the provider determines there was an error on the original claim either by their on internal review or based on how the MCO processed their claim.
Indicate a 7 to replace the claim or 8 to void the claim in its entirety as under the frequency code on the 1500 claim form.
Include the original MCO claim number in the ICN field on the claim.
Submit the corrected claim within 365 days of the original paid date, although we strongly recommend submitting corrected claims as quickly as possible.
Check with the MCO to learn what options are available for submitting corrected claims, i.e. Electronically, paper, etc.
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How do I submit a claim reconsideration?
Claim reconsiderations can be submitted by a provider when they believe a claim was processed incorrectly by one of the MCOs. Effective with claims processed on/after 5/1/17, reconsiderations must be submitted within 120 calendar days of the claim adjudication date.
• This also applies to claim processing where there is a recoupment due to overpayment
• Submit the reconsideration to the MCO making note of the specific error made on the claim
• Explain what the correct outcome should be on the claim
• Provide any documentation or additional supporting information for the desired outcome for the claim
• Provide all data elements required on the MCO form or electronic request
• Providers are strongly encouraged to submit a reconsideration as soon as they determine the claim needs to be reviewed by the MCO
• Allow 30 days for the MCO to review the reconsideration and provide a response
• Providers will receive a notice of reconsideration determination either through a provider remittance advice or a notification letter.
• Providers may submit a request for an appeal based on the reconsideration determination notice.
Note: Providers are not required to file a reconsideration prior to an appeal.
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How Do I Submit a Claim Reconsideration?
AmerigroupVerbal submissions may be submitted by calling Provider Services at 1-800-454-3730. Note- You cannot file an Appeal verbally only a reconsideration.
Amerigroup can receive reconsiderations via the Payment Appeal Tool located at www.availity.com. Instructions for utilizing the functionality can be found by accessing the following link: https://providers.amerigroup.com/ProviderDocuments/KSKS_CAID_HowtoSubmitAppealonAvaility.pdfProviders may mail their written Reconsideration Requests to :
Payment Appeal Unit Amerigroup Kansas, Inc. P.O. Box 61599 Virginia Beach, VA 23466-1599
Note: Corrected Claims are not considered a reconsideration. 31
How do I submit a claim reconsideration?
Sunflower Reconsiderations may be submitted via:
Phone – 1-877-644-4623
Secure Email via the provider portal:
Log into the secure web portal and click “Create Message”
In the subject line drop down box choose “Reconsideration”.
In the note section describe the reasoning for the Reconsideration request and the appropriate claim number.
Then click Send
Sunflower Health Plan
P.O. Box 4070
Farmington, MO 63640-3833
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How do I submit a claim reconsideration?
UHCProviders have 3 options for submitting a reconsideration:
Electronically: UnitedHealthcare portal (uhconline.com) using the Link: claimsLink Application. Follow steps outlined in the Link: claimsLink Quick Reference
Phone – Providers can call our Provider Services Call Center at
1-877-542-9235
Mail – Providers can submit a UHC Reconsideration form and submit via mail. Use the Claim Reconsideration Request Form (available on uhccommunityplan.com) sending request to
UnitedHealthcare Community Plan
PO Box 31350
Salt Lake City, UT 84131-0350
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APPEAL & GRIEVANCES
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How Do I File an MCO Appeal?
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Appeal: Request for an MCO to review an action. Provider may submit an appeal request to the MCO within 60
calendar days from the date of remittance, explanation of payment or notice of action, plus three (3) calendar days if the notice is mailed.
Provider also may submit an appeal request to the MCO following receipt of the reconsideration resolution notice within 60 calendar days of the date of remittance, explanation of payment or the notice of action, plus three (3) calendar days if the notice is mailed
Provider must complete the MCO’s appeal process before requesting a state fair hearing
How Do I File an MCO Appeal?
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Amerigroup All appeals must be filed in writing. Providers may mail appeals to the below address:
Payment Appeal Unit Amerigroup Kansas, Inc. P.O. Box 61599 Virginia Beach, VA 23466-1599
The following link will take you to the AGP Appeals form which can be utilized in your written communication. https://providers.amerigroup.com/ProviderDocuments/KSKS_ClaimPaymentAppealForm.pdf
ORAmerigroup can receive appeals via the Payment Appeal Tool located at www.availity.com. Instructions for utilizing the functionality can be found by accessing the following link: https://providers.amerigroup.com/ProviderDocuments/KSKS_CAID_HowtoSubmitAppealonAvaility.pdf
Note- If the provider files the appeal online and would like to bypass the reconsideration process, the provider must indicate in the notes section of the appeal, “I would like to bypass the reconsideration”.
How Do I File an MCO Appeal?
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SunflowerProviders may only file an appeal in writing and must include the Provider
Reconsideration & Appeal Form and send it to:
Sunflower Health Plan
P.O. Box 4070
Farmington, MO 63640-3833
If the request does not specifically indicate an appeal is being requested, it will
process as a reconsideration.
How Do I File an MCO Appeal?
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UHCAll appeals must be submitted in writing and mailed to UHC at the following address:
UnitedHealthcareAttention: Formal Grievances and Claim AppealsPO Box 31364Salt Lake City, UT 84131-0364
If the request does not specifically indicate an appeal is being requested, it will process as a reconsideration.
How Do I File for a State Fair Hearing?
All providers have the right to request an Administrative Fair Hearing, also known as a State Fair Hearing, following receipt of the negative outcome of their claims appeal or clinical appeal To request a state fair hearing, the provider must send a written
request to:Office of Administrative Hearings1020 South Kansas AvenueTopeka, KS 66612-1327
The request must specifically request a fair hearing. The request should describe the decision appealed and the specific reasons for the appeal.
The request must be received by that office within 30 calendar days of the date of the negative action. Providers are given 3 additional calendar days to allow for mailing the state fair hearing request
Provider must complete the MCO appeals process prior to filing for a state fair hearing
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SAFETY MANAGEMENT
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Safety Tips & Reminders
The MCO Care Coordinators were recently asked for feedback on what they are seeing and messaging they want us to share.
As caregivers and care coordinators it is our responsibility to take steps to identify safety issues for our members and take steps to prevent and/or otherwise minimize the risks.
Our partnership and good communication is key to ensuring safety issues are identified and managed appropriately.
You are our eyes and ears – SEE SOMETHING; SAY SOMETHING
◦ Please notify the Care Coordinator if there are any concerns relative to member’s well-being
◦ Make sure there is compliance with back-up plans and if there are any issues notify the Care Coordinator
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Safety Touch Points Know your surroundings and always have an exit plan Keep your cell phone available and charged >>> for emergency
calls Be aware of unclean areas If animals live in the house:◦ There needs to be a scheduled cleaning◦ Review with member flea/tick protection measures
Check member for bug bites on body◦ If bug bites found are of concern let Care Coordinator and PCP
know Electrical outlets should be free from multiple plug-ins which can
cause fire Food Poisoning Risk: Make sure food is not outdated, old or moldy.
Remove as necessary Evacuation Plan for various risks (fire, tornado, flood)◦ Is there an evacuation plan?◦ Is Caregiver aware of plan?
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Safety Touch Points Ambulation/Fall Risk:◦ Does member need DME for ambulation?◦ Are they falling frequently or at risk for falls Do their shoes fit properly? Does the member hold onto furniture? Are there clear paths for ambulation?
◦ Bathroom safety – Does the member need a shower chair, toilet riser, hand held commode?
Medication Management◦ Check to see if member knows medications◦ Monitor for noncompliance◦ Problem Identification – multiple meds and hoarding; how many MD’s is
member getting meds from◦ Family Involvement: are member’s meds coming up short?◦ NOTE: Care Coordinators should be contacted if there is a need for a
Medication review from HHA nurse
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Safety Touch Points Abuse◦ Remember Care Coordinators are not there and cannot see,◦ Notify Care Coordinator if there are concerns
Scam Exposure◦ Be alert to any scam activity such as sweepstakes and “bill collectors”
Electrical Outages:◦ Plan for electrical outage◦ If member is on O2 – should have portable O2 tanks and caregiver should
know where this is located
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ADVERSE INCIDENT MANAGEMENT
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Adverse Incident Management
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What is a critical or adverse incident?Adverse incidents shall be defined as, events or incidents that bring harm, or create the potential for harm, to a KDADS program participant. See KDADS 2.6.17 Informational Memo re: Adverse Incident Reporting (AIR) for the list and definitions of adverse incidents.
When is it appropriate to report and incident? KDADS service providers shall report all adverse incidents and serious occurrences involving
individuals receiving services from the following KDADS programs: Home and Community Based Services (HCBS) Waivers, Money Follows the Person (MFP), Mental Health, Substance Abuse, Aging and Disability Resources Centers (ADRC), Senior Care Act and Older Americans Act.
Adverse Incidents shall be reported no later than 24 hours after the occurrence of an adverse incident.
See KDADS 2.6.17 Informational Memo re: Adverse Incident Reporting (AIR) for the list and definitions of adverse incidents which shall be reported.
Why are incidents reported? The adverse incident reporting and review process is designed to facilitate ongoing quality
improvement to ensure the health and safety of individuals receiving services by agencies licensed or funded by KDADS. It is intended to provide information to improve policies, procedures, and practices.
All reportable adverse incidents shall be documented and analyzed as part of the provider’s quality assurance and improvement program.
Adverse Incident Management
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How is an incident reported? All adverse incidents shall be reported using the KDADS Adverse Incident Reporting
System located on the KDADS website homepage in the Quick Links section. This reporting page is secure but does not require a login. See Adverse Incident Report Form.
Follow steps outlined on the Quick Reference for Submitting AIR Reports and AIR Instructions for Providers to create, submit, print and close the report.
Incidents regarding both child and adult abuse, neglect and exploitation shall be reported to both the Department of Children and Families (DCF) at 800.922.5330 and KDADS via the AIR System.
What happens after the incident report is submitted? At the time of submission an email notification is sent to the designated KDADS program
personnel. MCO is verified by KDADS personnel and an email notification is sent to MCO
personnel (if it involves an enrolled Medicaid member). Each MCO will only have access to incident reports involving consumers enrolled with a particular MCO at the time the incident occurred.
Information and documentation shall be readily available, shared and exchanged between KDADS and MCOs.
All communications, findings, notes, other supporting documentation, etc., will be documented in the AIR database as it is collected. Communication and collaboration between both parties will be ongoing until both parties are satisfied and can conclude the investigation.
Note: Select “Adverse Incident Management” on KDADS Provider Section
When to ReportA report should be made to DCF when: The adult is unable to protect his/her own interest and is in a harmful
situation or is in danger of being harmed OR A specific incident or pattern suggests abuse, neglect, exploitation or
fiduciary abuse is occurring OR The adult is unable to provide or obtain the services necessary to ensure
safety and well-being and to avoid physical and mental harm or illness.
Where and How to Report Call the Protection Report Center at 1-800-922-5330 or call local
law enforcement if a child or adult is in imminent danger.
Link to AIR Manualhttp://kdads.ks.gov/docs/default-source/General-Provider-Pages/manuals/AIR/air-instructions-for-providers-v2.pdf?sfvrsn=6
Adult Abuse Awareness
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VALUE ADDED SERVICES
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Value Added Benefits are additional benefits that each of the MCOs offer members beyond the KanCare covered benefits.
These benefits are designed to help aid and encourage members on various health matters.
Each of the MCOs disseminate information to members related to the Value Added Benefits at enrollment .
The Care Coordinators at each of the MCOs also assist with identification of members who could benefit from one or more of these benefits.
As providers it is important that you are aware of these benefits and can assist members. Your Provider Advocate or a Care Coordinator are happy to assist or answer any questions.
Value Added Benefits
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Value Added Benefits – Amerigrouphttps://www.myamerigroup.com/Documents/KSKS_CAID_ValueaddedBenefits_ENG.pdf
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Value Added Benefits - Amerigroup
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Value Added Benefits - Sunflower
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Value Added Benefits - Sunflower
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Value Added Benefits - Sunflower
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Value Added Benefits - UHC
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LT. GOV. WORKGROUPKANCARE 2.0
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Lt. Gov. Workgroup
Convened earlier this year for the purpose of improving the provider experience
Key area of focus:◦ Claims/Billing/Prior Authorization
◦ Grievances and Appeals
◦ Client/Member Experience
◦ Data Transparency
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KDADS HCBS Access Guide
Please note KDADS has recently published a new HCBS Access Guide
Link: http://www.kdads.ks.gov/commissions/home-community-based-services-(hcbs)
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KanCare Ombudsman Liaison TrainingStrengthening Services to Kansans
Ombudsman Liaisons educate and assist Kansas Medicaid members within their current workplace during their regular hours of operation.
The Ombudsman Liaison Training is designed to help these community organization staff members to acquire a better understanding of:
Basic KanCare Programs (including Home and Community Based Services)
How to Assist with Medicaid Applications
Where to go for Medicaid related resources, ongoing education and support.
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Questions?
