TOPEKA — Only one of the three KanCare managed care companies has completed its provider manual, state officials said today during a meeting with representatives of the state's doctors, hospitals and other Medicaid providers.

Sunflower State Health Plan, a subsidiary of Centene, completed its main provider manual on Wednesday, Kim Brown of the Kansas Department of Health and Environment told members of the work group, which is one of four formed in June to help state officials make the transition to KanCare.

KanCare is Gov. Sam Brownback's plan to reform the state's $3.2 billion Medicaid program by assigning and dividing most of its day-to-day management among three insurance companies, commonly referred to as MCOs.

Revisions expected Friday

Brown said the other two companies, United Healthcare and Amerigroup, were expected to submit their revised provider manuals to KDHE by Friday. She said once they were approved by state officials they would be made widely available to Medicaid providers through the companies' respective websites.

Draft versions of all the companies' manuals already have been given to providers. But many providers have held off signing contracts with the managed care companies because the agreements reference the provider manuals for details of how the contract terms would apply and the providers are reluctant to sign without seeing the final documents.

"A lot of folks are waiting to see what's in the contracts and the provider manuals," said Mike Larkin, a representative on the work group for the Kansas Pharmacists Association.

"The deadlines are ahead of the information," Mike Malone, who represents the Kansas Optometric Association, told KHI News Service after the meeting. "Maybe it will all come out in the wash."

But Malone said he and many other optometrists were waiting to sign contracts until they had seen the finalized plan books.

Network adequacy?

Meanwhile, the MCOs face state deadlines for demonstrating they have signed on enough providers to their respective networks to make KanCare work.

"I have no idea what percentage" of doctors has signed contracts, Ruth Cornwall of the Kansas Medical Society told fellow workgroup members. "I know some are feeling rushed by the MCOs."

A deadline for the MCOs to demonstrate 90 percent "network adequacy" passed last Friday. State officials haven't said yet if the companies met that threshold, though Brown and Paul Endacott, also of KDHE, were asked about it repeatedly during today's meeting. State officials are expected to issue an update on the status of the networks and other developments sometime tomorrow.

Meanwhile, top state health officials met today with federal officials in Baltimore to review the state's so-called Section 1115 waiver request, which needs approval from U.S. Secretary of Health and Human Services Kathleen Sebelius, if KanCare is to proceed on schedule in the form initially proposed by the Brownback administration. Kansas officials say they intend to launch KanCare on Jan. 1 - or as much of it as federal regulations would allow - in the event the waiver request is rejected or not fully approved.

'A handful of things'

"Even if we get nothing with the 1115, there are parts we could implement," Endacott told the work group members. "It would be a lot of actuary work to implement a smaller program. If they (federal officials) didn't want anything to do with us, they wouldn't have been meeting with us weekly. We are down to a handful of things on the 1115."

Brown told the work group members that the provider network adequacy question probably was among the matters discussed today at the Baltimore meeting. She said she "didn't have a sense" for whether the 90 percent mark had been met by the companies last week.

Kansas officials at the Baltimore meeting were not available for comment.

Brownback officials also have said they will decide tomorrow whether they will begin mailing enrollment assignments to the state's Medicaid beneficiaries later this month telling them which managed care plan they have been put in.

Officials have said that the enrollees would have at least until mid February 2013 to choose another plan, if they are not content with the one picked for them by Hewlett-Packard using software algorithms that will aim to keep family members on the same plan and in plans that have contracts with providers the enrollees already use. Hewlett-Packard is the company the state contracts with to manage its Medicaid claims data and billing.

Centene leaving Kentucky

In related news this week, Centene's stock price jumped Wednesday after the company announced that its Kentucky Spirit Health Plan subsidiary intended to bail out a year early on its three-year managed care contract with the state of Kentucky. A Centene official told Bloomberg Businessweek News that the company did "not believe there is a viable path to a sustainable managed care program in Kentucky."

Centene is one of three MCOs under contract with Kentucky. The company said it would end its contract there July 5 and had filed a "formal dispute" with Kentucky officials seeking damages incurred under the contract. Bloomberg reported the company expected to lose $60 million to $70 million in its third quarter due to its Kentucky operations.