KanCare: Process and Timeline Topeka, Kansas • November 13, 2012 Kansas Association of Counties

1. KanCare: Process and TimelineTopeka, Kansas • November 13, 2012Kansas Association of Counties Scott C. Brunner Senior Analyst Kansas Health Institute

2. 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”

3. 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

4. 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.

5. Impact 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.

6. 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.

7. 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.” .

8. What is changing…

9. 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).

10. Medicaid/CHIP Population and Spending

11. Medicaid and CHIPManaged Care 163,882 people are currently in comprehensive managed care

16. Section 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.

17. 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.

18. Cost 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

20. Key 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.

21. 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

22. Kansas Health Institute Information for policy makers. Health for Kansans.