KHI News Service

KanCare companies focus on building provider networks

About 225 people attended sessions held in Topeka on Thursday to describe the new program

By Mike Shields | August 23, 2012

Efforts have begun in earnest to enroll doctors, hospitals and others in the provider networks being built by the three insurance companies hired by Kansas officials to run the state's Medicaid program.

During an informational meeting held today in Topeka for Medicaid providers, spokesmen for each of the companies boasted of quick payments for services and their desire to enlist all of the state's current Medicaid providers in their respective plans.

"We're cognizant of the fact that a health plan is nothing without its provider network," said Carolan Wishall of United Healthcare of the Midwest, one of the three managed care companies hired to implement Gov. Sam Brownback's KanCare plan.

The companies are working against a relatively tight deadline to get networks in place, assuming KanCare is launched as scheduled on Jan. 1. The other two companies are Sunflower State Health Plan, a subsidiary of Centene, and Amerigroup.

Gary Haulmark, a deputy at the Kansas Department for Aging and Disability Services, announced at the meeting held in a Holiday Inn conference room that the state and the managed care companies have settled on a uniform credentialing application that can be used by providers. And the company spokesmen said they would be heavily focused the next 60 days on getting contracts with providers signed.

At least one company official acknowledged that the networks might not be fully in place by Jan. 1 and that there would be an indeterminate grace period during which out-of-network providers would be paid full rates for Medicaid services as part of the transition to the new program. Once the networks are complete, state officials said, Medicaid patients still would be able to see out-of-network providers who agree to accept them, but the providers would be paid less by the plans they don't join.

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State officials said they would assign each Medicaid beneficiary to one of three plans in November. The enrollees then would have until the end of February to opt for an alternate. According to the KanCare proposal, each of the companies would initially get about a third of the state's 380,000 Medicaid clients assigned to it.

KanCare still needs federal approval, but if that comes as Brownback officials predict, then virtually all of the state's Medicaid enrollees, including the elderly in nursing homes and the mentally ill, would be rolled into the fixed-cost, managed care plans.

Brownback officials say KanCare will save the state and federal governments $1 billion over five years without cuts to services for patients or reduced payments for doctors and other providers.

In both the morning and afternoon meeting sessions, state and company officials described additional services that would be available to some or all Medicaid patients depending upon the plan they are enrolled in and their medical conditions. Among the new, "value-added" services described by the company officials were basic dental services for adults, help for smokers who want to quit, weight-loss programs and basic assistance finding jobs.

The add-on services are expected to vary company to company, and the Medicaid enrollees who attended the afternoon meeting were advised to carefully examine each company's offerings when they receive enrollment packets in November.

Some Medicaid enrollees at the meeting said they were pleased to hear about new services.

"It sounds better," said Sheryl, a Topeka woman who declined to give her last name. "If we get dental and vision care that would be good."

She said the current program only allowed her one visit to an optometrist every four years. She said she also liked hearing that the plans would offer targeted case management for asthma, major depression and bipolar disorder, each of which was a problem in her family.

"We're glad they're continuing our services," said Kathryn Gibbon, another Medicaid beneficiary from Topeka. "I'm looking forward to having good physical and mental health care."

But others at the meetings questioned how services could be improved, government costs reduced and profits still made by the insurance companies.

"Well, I just think the basic thing for them is the bottom line," said Laura Silverberg, a Topeka woman who said she had been receiving Medicaid services for 25 years. "I don't believe much of what they say until I see the proof of what they do. They're salespeople selling their companies. That's why they're here."

Silverberg said she wasn't sure how she would pick a plan but would seek advice from others.

"I don't see how you can get the same and more for less," said Rep. Jim Ward, a Wichita Democrat who attended the afternoon session, which had information tailored for Medicaid clients. "I don't buy that equation. It would be nice if Santa Claus came at Christmas, too, but I still buy presents in case he doesn't."

During the morning session, which was tailored for providers, Haulmark announced that each of the managed care companies was hiring and starting next week would hold job fairs in various cities across the state.

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