KHI News Service

KanCare provider manuals still not finalized

Many providers hold off on signing network contracts

By Dave Ranney | October 03, 2012

State approval of the KanCare managed care companies’ provider manuals is taking longer than initially expected, which means many Medicaid service providers are still holding off on signing KanCare network contracts in the face of looming deadlines.

“We know that providers are eager to have the final versions,” of the manuals said Miranda Steele, a spokesperson for the Kansas Department of Health and Environment. “We're just trying to make sure that the final versions are in agreement with the contracts we have in place with the plans.”

Steele said KHDE officials were working on a “communications update” meant to let providers “know where everything is” with respect to the manuals. The memo should be distributed this week or early next week, she said.

"They (manuals) should be out very soon. But they're thick documents and it's a stringent process," she said.

Cindy Luxem, executive director at the Kansas Health Care Association.

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In recent weeks, many providers — a group that includes hospitals, physicians, pharmacists, nursing homes, home health agencies and community mental health centers — have said they were reluctant to enter contracts with the three managed care companies without first having access to the provider manuals.

“Our legal counsel keeps pointing to places in the contracts that refer to such-and-such page in the provider manual,” said Cindy Luxem, executive director at the Kansas Health Care Association, an organization that represents the state's for-profit nursing homes. “But it’s pretty hard to know what’s on that page when you don’t know what the final version is going to be.”

The manuals are expected to spell out the companies’ prior-authorization, billing and appeal procedures.

KDHE officials last month said that they expected to have the manuals approved and ready for review by last week.

The delay in issuing the manuals is significant because the managed care companies’ contracts with the state call for them to have 90 percent of their provider networks in place by Oct. 12 and complete by Nov. 16 so that KanCare will be ready for its scheduled launch on Jan. 1, pending needed federal approvals of the KanCare plan.

Luxem said that about half of her group's members have signed contracts with the managed care companies.

“The other half hasn’t,” she said. “I’ve got people saying they don’t really have a choice so they went ahead and signed, and I’ve got people who are saying ‘Wait a minute, these are for-profit insurance companies that are coming in to save the state money. I have to be careful.’ For them, trust is an issue.”

Steele said the final versions of the provider manuals are not expected to be much different from the rough-draft versions that were sent to several state associations and to members of KanCare Provider Work Group last month.

She said the only changes to the draft versions of the manuals would "be those required by the state and even then the state has commitments from the plans to revisit with providers who have signed contracts and have concerns about changes to the final versions of the manuals."

Any future revisions to the manuals by the managed care companies also would require state approval, Steele said.

Once the manuals are approved by state officials, she said, the managed care companies would post copies on their respective websites. Copies also will be posted on the state's KanCare website.

KanCare is Gov. Sam Brownback’s plan for moving virtually all of the state’s 380,000 Medicaid enrollees into managed care plans run by three for-profit insurance companies: United Healthcare, Amerigroup, and Sunflower State Health Plan, a subsidiary of Centene.

State officials plan to auto-assign Medicaid enrollees — children, pregnant women, frail elders and the disabled — to one of the three companies later this month or in early November.

Enrollees then could switch plans prior to KanCare’s launch or within 45 days after it is up and running.

State officials also have been conducting readiness reviews of the KanCare companies and have said they will decide by Oct. 19 whether the firms are ready to launch on Jan. 1.

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