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Sept. 20, 2012
TOPEKA The Kansas Department of Health and Environment is distributing rough-draft copies of the KanCare managed care companies’ provider manuals.
“We really need to get feedback on them from the field,” said Paul Endacott, director of strategic purchasing and initiatives at KDHE.
Endacott, addressing a meeting Thursday of the Kancare Provider Work Group, said he expected to have copies of the United Healthcare and Sunflower State Health Plan proposed manuals in group members’ hands by Friday.
About two-thirds of the group’s 21 members received their copies early Wednesday evening. The others did not, Endacott said, because the files were too large for the members’ email accounts.
“They’re pretty big,” Endacott said. “(UnitedHealthcare’s) is 21 megabytes.”
The manuals are expected to spell out the companies’ prior-authorization, billing and appeal procedures.
In recent weeks, providers — a group that includes hospitals, physicians, pharmacists, nursing homes, home health agencies and community mental health centers — have said they’re reluctant to enter contracts with the three managed care companies without first having access to the provider manuals.
The third company, Amergroup, is expected to have its its proposed provider manual to KDHE on Friday. Endcacott said he hoped it would be distributed early next week.
Plans also call for sharing copies of the manuals with the providers’ state trade associations.
Copies will not be posted on the KanCare website because they are rough drafts and are likely to be altered during the review process, KDHE officials said.
Earlier this week, KDHE’s director of health care finance, Kari Bruffett, said the limited distribution was intended to generate feedback while minimizing confusion.
After KDHE approves the provider manuals, she said, the finalized versions will be posted on the KanCare website sometime next week. The managed care companies will the sending them out as well.
KanCare is Gov. Sam Brownback’s plan for moving virtually all of the 380,000 Medicaid enrollees – children, pregnant women, and frail seniors, mostly – into the three companies’ managed care plans.
Kansas is expected to spend about $3.2 billion on Medicaid services in the coming year. Brownback officials say KanCare will save the state and federal governments $1 billion over five years while improving services to Medicaid beneficiaries.
The three companies’ state contracts call for them having 90 percent of their provider networks in place by Oct. 12; 100 percent by Nov. 16.
KanCare is scheduled to launch Jan. 1, pending the needed federal approvals.
Much of the meeting Thursday was spent listening to managed care company officials answer questions about the subcontractors they’ll be using to manage their pharmaceutical, dental, vision, and transportation benefit packages.
Each of the companies’ representatives predicted a smooth transition from the current state-run system to one that’s privatized.
Dwight Young, who runs the community mental health center in Great Bend, said he was having a hard time figuring out how KanCare would increase efficiency and lower costs.
“This comes with huge administrative costs for us,” Young said. “We’re going from having one contract with the state to contracting with three managed care companies. It triples everything, not to mention having to deal with subcontractors.”
Endacott said the current system – “doing things one way, a single way” – had essentially run its course and was no longer able to maximize efficiency.
“The landscape is changing,” he said. “The state’s been running the Medicaid program at less that 6 percent (administrative cost). That’s not enough of an investment to see the improvements we want.”
The work group meets again Oct. 18.
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