Remaking Kansas Medicaid Proposals
On January 19, 2011 Governor Sam Brownback, Lt. Governor Jeff Coyler, M.D., Senate
President Steve Morris, and House Speaker Mike O’Neal held a joint press conference
to announce how they would work together to implement structural reform to state
government. Lt. Governor Colyer said that members of the sub-cabinet would begin
work on reforming the state’s Medicaid program and asked that stakeholders and
citizens submit pilot projects and reform ideas based on three criteria; improving quality
of care of Kansans receiving Medicaid, controlling the costs of the program, and longlasting reforms of health care that improve the quality of health and wellness of
Kansans. The call for proposals closed on February 28th with 64 citizens, stakeholders,
and organizations submitting proposals containing over 120 recommendations for
remaking the Medicaid program.
Expand Managed Care
KHPA received seven recommendations in this category including expanding managed
care to the aged, blind, and disabled populations as well as the dual eligibles;
expanding the PACE program to mid-size communities; comprehensive integrated
physical-behavioral health management for special populations including foster care,
SMI, ABD/LTC; and an ABD care management program SG county.
Care Coordination/Medical Home
KHPA received thirteen recommendations in this category including care coordination of
hospital transitions for the elderly and disabled; improve health literacy of consumers;
develop health coach programs; reinitiate ECM program; implement medical home
model; care coordination bridging physical and behavioral health services; enhanced
PCMH intervention using community health coaches matched to beneficiaries in cultural
and linguistic characteristics; CMHCs serving as health homes for adults with SPMI and
children with SED; and a pediatric medical home for children with special needs.
Fraud Prevention & Recovery
KHPA received three recommendations in this category including strengthening estate
recovery processes; and using data analytics and predictive modeling to identify fraud
and abuse potential incidents.
Utilization Management
KHPA received ten recommendations in this category including evaluation of increased
use of institutional care; examination of denial of behavioral health services to
beneficiaries with dual diagnoses; examination of hospice abuse risks; utilize natural
occurring opportunities to educate beneficiaries on appropriate utilization of services; to
evaluate hospitalization trends of beneficiaries on SED waiver; and introduction of price
transparency to drive market-based consumer decisions
Consulting Services
KHPA received seven recommendations in this category including assistance flagging
claims for presumptive disability applicants who become eligible for SSI; using health
care data analytics to identify cost-savings opportunities; analysis of beneficiary risk,
provider practice patterns, and implementation of a virtual medical home; and a
population based analytic tool identifying individual care deviation from evidencedbased standards of best practice for behavioral health.
Pharmacy
KHPA received eleven recommendations in this category including PDL for
antidepressants; expansion of step therapy; systematic review of the pharmacy benefit;
medication therapy management; coverage of electronic medication compliance
management devices; implementation of the Kansas behavioral health pharmacy
management program; increase generic usage; prescriber education initiatives;
mandate only Kansas retail pharmacies dispense medications to Kansas beneficiaries;
utilize medication management programs reimbursing Kansas pharmacists for
professional consultation services; and behavioral health pharmacy management.
Targeted Interventions
KHPA received seven recommendations in this category including instituting a wellness
program in long term care facilities; chronic disease self-management program for the
elderly; competitive employment opportunities for people with disabilities; diabetic
management for beneficiaries with disabilities; and targeted interventions for high risk
beneficiaries for smoking cessation and weight loss.
Eligibility
KHPA received sixteen recommendations in this category including changing
procedures related to assessment and plan of care for admission into long term care
facilities; adding MediKan beneficiaries as an optional Medicaid group; expanding the
HCBS waiver for select populations; service flexibility for HCBS-FE beneficiaries, review
of presumptive disability determination process and criteria; reevaluation of waiver
beneficiaries’ assessment scores; expanding Working Healthy and WORK; amend the
SPA to adopt Community First Choice option; connect eligibility notification to income
tax standard: to expand the Autism waiver capacity; and integrating Medicaid into the
private insurance market.
Cost Sharing
KHPA received three recommendations in this category including tiered pharmacy
copayments; and to levy copayments and premiums for Title 19 beneficiaries
Payment Reform
KHPA received twelve recommendations in this category including integration of the
SCHIP population for behavioral health services; integration of Medicaid and Medicare
for seniors; recalibrate inpatient and outpatient payments; eliminate payment for never
events; examine reimbursement rates for mental health case management services; KS
Newborn screening program sustained fee impact on Medicaid funding; mental health
services consolidated spending; and an alternative revenue enhancements through
HMO privilege fee.
Delivery System Restructuring
KHPA received seven recommendations in this category including formation of a
primary care ACO; downsize the nursing home capacity and substitute a
comprehensive set of long term services and supports in sparsely populated areas; to
integrate services for the frail elderly including HUD housing, PACE, mobile clinic, and
telehealth; and introducing consumer-directed plans in Medicaid.
Technological Integration
KHPA received six recommendations in this category including telemonitoring for
targeted populations; connecting rural health providers to each other and to
beneficiaries through use of secure messaging and initiating e-visits; and increase use
of assistive technology in homes.
Benefit Changes
KHPA received seventeen recommendations in this category including coverage of
medical nutrition therapy by registered dietitians; coverage of bariatric surgery as a
treatment for weight loss for the chronically obese; adding community based services
for target populations; coverage of weight reduction assistance in conjunction with
bariatric surgery; full dental benefits for all Medicaid beneficiaries; broaden benefit
package to include social support benefits; provide rehabilitation services in additional
settings; provide coverage of habilitation services; and eliminate coverage of
circumcision; and increasing benefit flexibility within Medicaid.
Administrative Reorganization
KHPA received two recommendations in this category including creating the Office of
Integrated Community Services to administrate all HCBS services; and an agency
modification.
Remaking Medicaid Call for Proposals Respondents
AARP Kansas
Action Pact Development LLC
Allergan, Inc.
Association of CMHCs of Kansas, Inc.
Capper Foundation
Care Management Technologies
Centpatico
Cerebral Palsy Research Foundation of Kansas, Inc.
Cerner Corporation
Children’s Mercy Family Health Partners
Crossroads Hospice of Kansas
Disability Rights Center of Kansas
Kansas Area Agencies on Aging Association
Kansas Association of Homes and Services for the Aging
Kansas Citizens
Kansas Dietetic Association
Kansas Health Care Association/Kansas Center for Assisted Living
Kansas Health Consumer Coalition
Kansas Health Solutions
Kansas Independent Pharmacy Service Corporation
Kansas Legal Services
March of Dimes Greater Kansas City Chapter
Medical Society of Sedgwick County
National Alliance on Mental Illness
National Organization of Circumcision Information Resource Centers
North Central-Flint Hills Area Agency on Aging
Northrop Grumman
Nueterra Health Alliance
Oral Health Kansas
PBA Health
Policy Studies, Inc.
Providers
Remote Medication Management Systems
Resource Center for Independent Living, Inc.
Southeast Kansas Area Agency on Aging, Inc.
State Employees
Statewide Independent Living Councils of Kansas
Twin Valley Developmental Services, Inc.
UniCare
United Healthcare Community & State
University of Kansas Department of Family Medicine
University of Kansas Medical Center Department of Preventive Medicine
University of Kansas Research and Training Center on Independent Living
Value Options, Inc.
Vivius
Windsor Place At-Home Care