KanCare: Process and Timeline

Topeka, Kansas • November 13, 2012Kansas Association of Counties

KanCare: Process and Timeline

Topeka, Kansas • November 13, 2012Kansas Association of Counties

Scott C. Brunner

Senior Analyst

Kansas Health Institute

Who’s included in KanCare?Who’s included in KanCare?

All Medicaid eligible people Infants and children (Medicaid and CHIP) Pregnant women Low income adults Persons with disabilities

Dual eligible Medicare and Medicaid elderly, foster children and special needs children included through a “waiver”

Who’s included in KanCare? (continued)

Who’s included in KanCare? (continued)

January 1, 2013, all beneficiaries will be assigned to 1 of 3 MCOs.

Assignment provides each MCO a fair distribution of age, health needs and location in Kansas

45 day choice period (with CMS approval)

12 month assignment lock

What services are covered?What services are covered?

All medically necessary services available through the Medicaid State Plan or HCBS waivers.

Must be in an “amount, duration and scope” no less than required by Medicaid.

Rates paid must be no less than 100% of the Medicaid rate.

Impact on CDDOsImpact on CDDOs

CDDOs maintain statutory role in gate keeping and case management

CDDOs must also practice conflict free case management.

The contracts include safeguards for provider reimbursement and quality, and provisions aimed at minimizing conflicts across assessment, case management, and service provision.

What services are covered? (continued)

What services are covered? (continued)

Community Mental Health Centers (CMHCs) must have a role in providing specialized services, including Targeted Case Management, for adults and children with severe and persistent mental illness.

What services are covered? (continued)

What services are covered? (continued)

“2.2.4.1The CONTRACTOR(S) shall: not CONTRACT for services with any provider who also provides either case management or functional eligibility assessments, in order to achieve conflict-free case management for LTC and HCBS services.”

.

What is changing…What is changing…

What services are covered? (continued)

What services are covered? (continued)

Case management for the FE, PD, and TBI waiver will be assumed by the MCOs.

Aging and Disability Resource Center (ADRC) will assume responsibility for screening and eligibility for HCBS from Centers for Independent Living (CIL) and Area Agencies on Aging (AAA).

Medicaid/CHIP Population and Spending

Medicaid/CHIP Population and Spending

Average Monthly Beneficiaries Expenditures (in Millions)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$16,810.0 $139.7 $40,027.0

$610.7 $60,969.0

$1,207.4

$268,038.0

$683.5

Kansas Medicaid and CHIP Population and Spending by Type of Beneficiary

Children and FamiliesPeople with DisabilitiesElderlyOther

FY 2012 Medical Assistance Report

Medicaid and CHIPManaged Care

Medicaid and CHIPManaged Care

Enrollment Expenditures0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$282,051

$697,483,323

43,542

$2,125,669,463

Fee for ServiceManaged Care

163,882 people are currently in comprehensive managed care

Amerigroup Centene/Sunflower State Health Plan United HealthCare

• Debit card based incentive to purchase health items.

• Smoking Cessation• Free cell phone and minutes • Preteen fitness programs• Vouchers for Weight Management

Programs• Transportation for caregivers to medical

appointments• Transportation to community locations• Over the counter Drugs provided

through the mail• Free Allergy preventative bedding• Free home pest control• Free Career Development training • Free professional clothing• GED preparation assistance• Additional respite care for families of

people with Developmental disabilities, severe emotional disturbance, or frail elderly.

• Adult Teeth Whitening• Relationship counseling• Entertainment discount coupons• Adult preventive dental• Bariatric Surgery

• CentAccount Debit card based incentive plan

• Connections Plus free , preprogrammed cell phones

• In home telemonitoring• Appointment escorts for persons with

mental illness or developmental disabilities

• Home visits for new mothers. • Baby Showers-group classes for new

mothers • Start Smart birthday-quarterly education

session for children• Smoking cessation workbook• Adopt a school programs• Incentive for followup behavioral health

appointments• Adult preventive dental• Bariatric surgery

• Prepaid debit card based incentive• Infant care books and online reminders

for appointments• Membership in 4H, YMCA, or Boys or

Girls Club• Coverage for sports physicals• Weight watchers and $50 reward for

workout gear• $50 gift card for completing pediatric

obesity program• Micro grants for schools that implement

obesity programs• Mobile applications for health tracking• Free cell phones for high risk members• Community services searchable database• Enhanced vision benefits with different

frame selection and contact lens substitution

• Additional podiatry benefits• Sesame Street programs for asthma,

healthy habits, and nutrition• Mental health education for peers and

family members• Empower Kansas employment support

for people with disabilities• Adult preventive dental• Bariatric surgery

Section 1115 WaiversSection 1115 Waivers

States request that CMS waive provisions of the Social Security Act and Medicaid requirements

Demonstration projects must promote Medicaid program objectives.

1115 waivers are approved at the discretion of the HHS Secretary through negotiations between a state and CMS.

Section 1115 Waivers (continued)

Section 1115 Waivers (continued)

Must be budget neutral to the federal government.

Waiver approval establishes a per person cap on federal outlay over the life of the waiver.

Cost Neutrality/Cost SavingsCost Neutrality/Cost Savings

$1.1 billion in savings over the 5 years of the proposed waiver. $440 million from the Long Term Care population

• (Skilled Nursing Facility and ICFMR)

$152 million from Non Dual SSI $131 million from Wavier populations

Savings are from all services provided to the population

2013 2014 2015 2016 2017 2018 -

200.0

400.0

600.0

800.0

1,000.0

1,200.0

1,400.0

Annual Costs for Medicaid Populations Groups Before and After KanCare

Children and FamiliesChildren and Families-KanCareElderlyElderly-KanCarePeople with DisabilitiesPeople with Disabilities-KanCareOther Other-KanCare

Expe

nditu

res

(in M

illio

ns)

Key DatesKey Dates

October 5, 2012—Earliest CMS approval

October 12, 2012—90% of provider network in place.

October 19, 2012 – Go/No Go on Assignment

October 24, 2012—Initial beneficiary assignment to MCO.

Key Dates (continued)Key Dates (continued)

Early November—Initial assignment letters to beneficiaries.

November 16, 2012—100% of provider network in place.

End of November—Pre-enrollment meetings.

January 1, 2013—Start of MCO contract.

• Subject to CMS approval of the 1115 waiver• Subject to CMS approval of the contracts

Information for policy makers. Health for Kansans.Information for policy makers. Health for Kansans.

Kansas Health InstituteKansas Health Institute