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Originally published July 26, 2012 at 5:13 p.m., updated July 29, 2012 at 10:43 a.m.
TOPEKA CLARIFICATION APPENDED:
State health officials say they’re close to completing their review of contract forms that managed care companies will use to enroll providers in KanCare, Gov. Sam Brownback’s plan for reforming the state’s $2.8 billion Medicaid program.
Officials also said they were close to approving a credentialing form for Medicaid providers, a draft of which should be finished today, said Kim Brown, assistant director for Medicaid and management operations at the Kansas Department for Aging and Disability Services.
KanCare calls for letting three managed care companies – Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene – run the state’s Medicaid programs for the poor, disabled and frail elderly.
Addressing a Thursday meeting of the Provider External Implementation Workgroup, Brown said she hoped to have the credentialing form approved and returned to the managed care companies by Aug. 3.
The form, which is being assembled by the managed care companies, is meant to streamline the credentialing processes.
The companies would add the form to their network enrollment packets, which should be made available within a few days to hundreds of providers, including physicians, hospitals, nursing homes, pharmacists, mental health centers, home health agencies and centers for independent living.
The companies’ contracts with the state require them to have 90 percent of their respective provider networks in place by Oct. 12 and 100 percent in place by Nov. 16. State officials will review the networks to ensure their adequacy.
“We want there to be a huge network,” said Paul Endacott, the workgroup’s chair and director of strategic purchasing and initiatives at the Kansas Department of Health and Environment. “We want everyone we have now and everyone we don’t have now.”
It’s not yet known how many providers will join the companies’ networks because, so far, they’ve not been sent contracts to review and sign.
But Jerry Slaughter, executive director of the Kansas Medical Society, said he expected most of the state’s physicians would join.
“It’s hard to say, but my sense is that all three companies will be able to meet the network adequacy requirements because I think just about everybody who’s in the program now will continue. It’s part of what they see as a professional responsibility,” Slaughter told KHI News Service.
“But at the same time, I have to say there are some complicating factors,” he said. “We’re going from having to deal with two companies to three, so there will a little more complexity. And there’s so much uncertainty going on right now at the federal level, it’s hard to know what’s going to happen.”
Currently, HealthWave, the state’s health insurance program for children in low- and modest-income families, is administered by UniCare and Children's Mercy Family Health Partners.
Under KanCare, the UniCare and Family Health Partners contracts will expire, and the three managed care companies would take over HealthWave on Jan. 1, 2013, pending federal approval of the KanCare contracts and the Medicaid waiver sought by Kansas.
The workgroup also discussed whether, under KanCare, case management services for the physically disabled would be provided by the managed care companies or by the state’s centers for independent living and other public and private providers.
Brown said each of the managed care companies has the option of providing the services itself or subcontracting with other providers.
Kent Cerneka, a director with Sunflower State Health Plan, said the issue remained unresolved.
“Our organization, as well as the others, is working with the state on what the right solution is,” Cerneka said.
Deone Wilson, executive director at the Resource Center for Independent Living in Osage City, said the managed care companies’ takeover of case management would be a major change in state policy.
"If case management is turned over to the MCOs, it means we’ll be moving away from a culture of independence and a philosophy of choice, and we’ll be medicalizing everything," Wilson said. "We’ll be going to a system that’s coordinated by nurses and social workers, rather than one that’s been built on the concept of people with disabilities supporting one another and self-directing their care.”
CLARIFICATION: An earlier version of this story failed to distinguish between the contract and credentialing forms being reviewed by state officials.
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