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An Introduction to KanCare

An Introduction to KanCare. Prepared for LeadingAge Kansas Members March 2012. What is KanCare?. KanCare is the new Medicaid* Managed Care program for the State of Kansas. I mplementation is set for January 2013. (There has been talk of a 6 month delay but this is unlikely.)

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An Introduction to KanCare

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  1. An Introduction to KanCare Prepared for LeadingAge Kansas Members March 2012

  2. What is KanCare? • KanCare is the new Medicaid* Managed Care program for the State of Kansas. • Implementation is set for January 2013. (There has been talk of a 6 month delay but this is unlikely.) (*Medicaid is the state health insurance plan for low income Kansans.)

  3. Why KanCare? • Medicaid is unsustainable as currently structured. • 7.4% annual increase in budget over the last 10 years. • Increasing enrollment due to economic downturn and projected aging of the population. • According to the Administration, KanCare will: • Decrease the growth of the Medicaid budget by $850 million over the next 5 years. • Improve health outcomes for Kansans whose care is paid for by Medicaid.

  4. How are goals to be achieved? • Better care coordination and multidisciplinary case management, especially for people with complex health conditions and needs, should lead to: • Decreased emergency room visits and decreased avoidable hospitalizations. • Decreased nursing home use and nursing home length of stay.

  5. Who’s involved: MCOs • Health plans/managed care organizations (MCOs) will assume responsibility for providing all Medicaid covered services to their respective members throughout the state. • 3 KanCare MCOs will be selected by the State in June. • 5 companies have submitted bids: • United Health Care, WellCare, Centene(aka Sunflower State Health Plan), Coventry (LTC subcontractor is Independent Living Systems), and Amerigroup.

  6. Who’s involved:KanCare Members • All 380,000 Kansas Medicaid beneficiaries (called “Members”) • Aged • Disabled • Children and families • Members will be auto-assigned late this year and have 90 days to change their MCO if they choose. • After that there will be an annual enrollment period.

  7. Who’s involved:Health Care Providers • Health care providers that accept Medicaid. • Includes Physicians, Hospitals, Nursing homes, Home and Community-Based Services, Behavioral Health, Substance Abuse, others who accept Medicaid. • Providers can choose to contract with 1-3 KanCare MCOs to provide services to MCOs’ respective members. • Providers that do not sign up to be in KanCare networks will be paid 90% of their typical reimbursement rate. • Nursing homes are guaranteed an offer from all MCOs for a 3 year contract.

  8. Who’s involved: The State • The State will: • Select 3 MCOs • Pay MCOs a capitated rate for which MCOs Maintain quality expectations and performance measures for the MCOs. • Institute monetary penalties for MCOs that fall short on specific quality and performance measures • Maintain control over basic rate setting for nursing homes

  9. This presentation was prepared for us by LeadingAge Kansas, the statewide association providing advocacy, education, information, networking opportunities and dollar-stretching programs for not-for-profit aging service providers. Our organization is a LeadingAge Kansas member. www.leadingagekansas.org Ph 1-800-264-5242

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