|Copyright:||(c) 2011 Targeted News Service|
|Source:||Targeted News Service|
In January, Governor
(See Deloitte summary report (http://www.kdheks.gov/hcf/medicaid_reform_forum/download/KS_Public_Input_and_Stakeholder_Consult.pdf).)
The vision statement outlined at the beginning of the process remains and was confirmed by the participation of Kansans from every corner of the state:
To serve Kansans in need with a transformed, fiscally sustainable
Historic Medicaid Growth, without expansion
Yet the cost drivers in
Projected sources of growth in
Through the reform process, the Administration quickly concluded that no short-term solutions - provider rate cuts, tweaks of eligibility requirements - could address the scale of the issue over time. Without intervention, projected
The Crowd-Out Effect, Expenses as Percentage of
FY 12-16 projected; illustrates impact on other programs if
The fiscal picture for
Just as important, Kansas Medicaid historically has not been outcomes-oriented. Focusing only on costs, to the exclusion of quality and outcomes, would be counterproductive. The public input and stakeholder consultation process validated the need for increased accountability in the services the state provides, and for a new level of investment in prevention, care coordination, and evidence-based practice.
The Kansas Solution
* Integrated, whole-person care
* Preserving or creating a path to independence
* Alternative access models and an emphasis on home and community based services.
Person-Centered Care Coordination: The clear message of the reform process has been to align the financial incentives for the payers, providers and consumers to best serve the needs of the whole person and the taxpayer, without adding to the administrative burden of the program. That message, combined with the themes that emerged from the process, led the
* The state will leverage private sector innovation to achieve public goals by issuing a Request for Proposal (RFP) targeting three statewide KanCare contracts.
* Population-specific and statewide outcomes measures will be integral to the contracts and will be paired with meaningful financial incentives.
* The reforms explicitly call for creation of health homes, with an initial focus on individuals with a mental illness, diabetes, or both.
* The KanCare RFP encourages contractors to use established community partners, including hospitals, physicians, community mental health centers (CMHCs), primary care and safety net clinics, centers for independent living (CILs), area agencies on aging (AAAs), and community developmental disability organizations (CDDOs).
* Safeguards for provider reimbursement and quality are included.
* The state will create a contractual obligation to maintain existing services and beneficiary protections.
* Services for individuals residing in state ICF-MR facilities will continue to be provided outside these contracts.
Off-ramps: Reforms include transition to private insurance coverage for Kansans currently on
* Reducing disincentives to work by enhancing Working Healthy and WORK program.
* Creating a disability preference for state employment.
* Leveraging state purchasing and incentive policies to encourage contractors to hire people with disabilities.
* Establishing cash incentives for businesses that hire people with disabilities who are currently receiving state services.
* Increasing awareness of the Use Law.
Collaboration: The solution encourages providers to practice at the highest level of their licensed training, while reducing isolated, narrowly focused care provision. An example is engaging pharmacists to actively collaborate in managing patient education, compliance and self-management, particularly for patients with medications from multiple prescribers.
Inclusiveness: Services for Kansans with developmental disabilities will continue to utilize the statutory role of CDDOs, but their inclusion in KanCare means the benefits of care coordination will be available to them. Contractors will be accountable for functional as well as physical and behavioral health outcomes. Providing Kansans with developmental disabilities enhanced care coordination will improve access to health services and continue to reduce disparities in life expectancy while preserving services that improve quality of life.
Consumer Voice: Because these reforms were driven by Kansans, the Administration also proposes to form an advisory group of persons with disabilities, seniors, advocates, providers and other interested Kansans to provide ongoing counsel on implementation of KanCare. Additionally, managed care organizations will be required to create member advisory committee to receive regular feedback, include stakeholders on the required
Realign State Agencies: Public interaction with the
Savings: Based on a conservative baseline of 6.6% growth in
Select Policy Highlights
* Ensure statewide services by each KanCare contractor so that every eligible Kansan on
* Expand provider-based systems such as PACE and PACE-like programs as a dual enrollment option.
* Require the completion of a health risk appraisal to identify health and service needs in order to develop care coordination and integration plans for each member.
* Require the provision of health homes to members with complex needs, starting with members who have a mental illness or diabetes, or both.
* Require efforts to improve members' health literacy in order to make effective use of services and to share responsibility for their health.
* Request value-added services, at no additional cost to the state, to incentivize members to lose weight, quit smoking, participate in chronic condition management programs, and other health and wellness initiatives.
* Promote continuity by establishing one-year enrollment lock after the choice period for individuals in plans.
* Require contractors to create member Advisory Committees to receive regular feedback and to have Member Advocates to help members who have complaints and grievances.
* Establish contractual obligation to maintain existing services and beneficiary protections.
* Require contractors to work with existing and additional provider networks and stakeholders.
* CDDOs maintain statutory role; CMHCs continue key role for SED and SPMI.
* Establish significant monetary incentives and penalties linked to quality and performance:
* 3-5% of total payments will be used as performance incentives to motivate continuous quality improvement.
* Additional penalties are associated with low quality and insufficient reporting.
* Measures include prevention, health and social outcomes.
* Minimize conflicts across assessment, case management and service provision.
* Utilize Aging and
* Solicit innovative solutions to incentivize healthy behavior - including obesity prevention, smoking cessation, and benefits for annual health screenings.
* Implement Medication Therapy Management to engage pharmacists in a bridging and collaborative role in patient education, compliance and self-management.
* Develop and implement evidence-based guidelines for pharmaceuticals, including behavioral health medications; enhance academic detailing and retrospective reviews.
* Strengthen anti-fraud efforts - including implementation of the Kansas Eligibility Enforcement System (KEES).
* Use uniform provider credentialing form and timeline to reduce administrative burdens on providers.
* Set provider reimbursement floor at 100% of fee for service rates inclusive of options for quality and outcomes incentive payments.
* The state reserves the right to set rates for nursing facilities.
* Preserve the benefit of existing add-on payments such as the hospital and nursing home provider assessment,
* Enforce prompt payment requirements.
* Establish tiered functional eligibility system for the Frail and Elderly that restricts access to the highest cost institutional settings only to those with the highest level of need in order to utilize appropriate alternative home and community based settings.
* Incentivize nursing facilities through a focused shared savings programs to diversify and build alternative HCBS capacity.
* Ensure access to mid-levels such as physician assistants and advanced practice nurses through integrated care model.
* Align financial incentives for integrated care systems through blended rates to re-balance and prevent premature nursing facility placement.
* Integrated care systems will be expected to effectively integrate
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