MDNews - Greater Kansas

++++++++++++++++ LEGAL RX +++ +++ ++++++++++++++++ + + KanCare — Medicaid Reform in Kansas By Ryan Hellmer K ANSAS IS IN the midst of a comprehensive overhaul of the state's Medicaid program — to be known as "KanCare." Undoubtedly, these changes will impact enrollees, but the impacts will be much further reaching than that. Specifics of the reform effort are emerging every day, but at the core of the reform is the movement toward private managed care contracts for the coordination of care and reimbursement for all Medicaid recipients in Kansas. With the expansion of eligibility criteria under federal health care reform (the Affordable Care Act) and continued cost growth at the state level, Kansas is one of a plurality of states seek- ing overhauls to their Medicaid plans. At the core of Kansas' reform is the shift away from government administration. The plan is presented as a simultaneous two-track endeavor. Under the first track, the state will make four immediate reforms: (1) move all Medicaid popula- tions into managed care; (2) cover all Medicaid services, including long-term services and supports (LTSS), through managed care; (3) establish safety-net care pools to reimburse uncompensated hospital costs and to provide payments to critical-access and other essential hospitals; and (4) create and support alternatives to Medicaid. The second track is a fundamental redesign of the Medicaid program to administer the state plan under a block grant via outcomes- based criteria. This second track would operate under a "global waiver" from federal Medicaid requirements. Kansas intends to have the first-track reforms in operation January 1, 2013. The state has already issued a request for proposal (RFP) and received bids from a number of companies to provide man- aged care under three separate statewide contracts. Additional reforms will be dependent on the receipt of a waiver from the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS). While Gov. Sam Brownback assures that these reforms will not jeopardize the availability or quality of care and will not bring cuts to physician reimbursement, KanCare is not without controversy. Opponents of the managed-care model are concerned over the impact to the availability of services, particularly for those with chronic diseases and the developmentally disabled. One of the latest critiques of the reform effort (as of this writing) was an attack on the financial stability of companies bidding on the statewide managed-care contracts. The Brownback administration makes a compelling fiscal argument for the necessity of Medicaid reform (as do the other 25 states seeking significant reforms). The financial impact of govern- ment health care programs is enormous and growing. The increase in the number of eligible participants (in both Medicare and Medicaid) as well as increased costs place unprecedented budgetary pressure on states and the federal government. One crucial piece of the KanCare reforms is yet to be decided — the federal waivers. Without the receipt of waivers from certain federal Medicaid conditions of participation, the KanCare reform could be short-lived. This is a critical time for providers under the state Medicaid plan. These reforms are being pushed through at a blinding pace. Even if there were no other changes in eligibility or services, the move from fee for service to managed care will require significant adjustment. If you provide services to Medicaid patients in Kansas, keep an eye on KanCare. ■

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