The state Medicaid director has told the major doctor groups that the KanCare managed care companies will continue to deal with physicians and other Medicaid service providers as if they are already in the companies' service networks beyond KanCare's 90-day transition period, so long as the providers have contracts pending with the companies.
KanCare, which was launched Jan. 1, is Gov. Sam Brownback's initiative to move virtually all the state's 380,000 Medicaid enrollees into health plans run by three commercial insurance companies, Amerigroup, UnitedHealthcare and Sunflower State Health Plan, which is a subsidiary of Centene.
In order to meet expectations of federal Medicaid officials and to smooth implementation of KanCare, state officials required that the KanCare contractors allow previous plans of care for Medicaid patients to remain in place until April 2, an attempt to assure that services provided before the KanCare changeover would stay intact until the new system was fully established.
Also during the 90-day transition period, patients may see medical providers not signed with the managed care plans without the providers seeing reductions in their Medicaid payment rates.
Range of problems
Since KanCare was launched, the problems have ranged from billing errors and stalled payments to service providers to confusion about which doctors or other providers patients may visit for treatment and still be covered.
Last week, the Kansas Medical Society and the Kansas Medical Group Management Association, sent a letter to Dr. Susan Mosier at the Kansas Department of Health and Environment, asking her to consider extending beyond April 2 the so-called "continuity of care" conditions the state and the KanCare companies agreed to abide by during the KanCare transition. An addendum to the letter listed 26 ongoing problems with the new program.
Mosier responded tp the request in a letter dated Wednesday, saying the state would not extend the transition period but that it had "secured assurances" from the insurance companies that they would continue to treat providers as "in-network" after April 2, so long as the providers had contracts pending with the companies.
Medical groups' KanCare letter
State letter to KMS and KMGMA
2nd KMS letter to KDHE
Jerry Slaughter, executive director of the Kansas Medical Society, said the physician group was "pleased" with the state's response.
But it wasn't immediately clear if the answer would be as satisfying to members of the Kansas Medical Group Management Association, which includes among its members people who handle billing for doctors' offices and clinics.
Shirley Gamble, who oversees bill coding at hospital clinics in Sterling and Lyons, said she wasn't sure how the KanCare customer service representatives who deal with patients and providers would be able to stay on top of which providers have contracts pending versus those who do not.
Gamble is a member of the Kansas Medical Group Management Association and serves on two of its committees. She said the group would be meeting next week and that discussion of the group's request for an extended transition period for KanCare and the state's response were sure to be discussed by members then.
'It's a concern'
One of the problems in her area, she said, has been that some clinic patients received medical cards from the KanCare companies indicating they were assigned to new primary care providers they didn't know. Then when they called customer service they were told they couldn't see their customary doctors because the doctors were not in the company's network.
"They're not telling them to check with your doctor's office to see if they've (the doctors) signed a contract (that's pending)," she said. "It's kind of making the patients feel like they have to go with the doctor listed on their card. We've had several panicked calls from patients wondering what they're going to do. We're in a small town and it's a concern. If (the KanCare companies) could just give their customer service people access to an alphabetical list of providers with contracts pending and then they could say 'yes, it's been received,' that would be so much more comforting."
Gamble is among those who have dialed into the state's frequent KanCare troubleshooting teleconferences seeking solutions to problems they've encountered with the new system.
During today's call she asked the managers of each of the insurance companies where they were with respect to completing provider contracts and credentialing, one of the main concerns behind the doctor groups' request for an extended transition.
Each company official said there were backlogs of contracts still being worked through. And each said their companies were working to clear the backlogs fast as they could.
"We got 100s and 100s of contracts in December, some on the 31st," said Laura Hopkins of Amerigroup. "We're working them first-in, first-out. There's still many that need done."
"We are working as quickly as we can and want to have everything loaded before the continuity-of-care period ends," on April 2, said Nan Thayer Kartsonis, president of UnitedHealthcare's Kansas plan.
"As of Tuesday, we had 103 (contracts) in process," said Jean Rumbaugh of Sunflower. "We've been aggressively working those."
Medical society pleased
Slaughter told KHI News Service that the organization was satisfied with the state's assurances that providers with contracts pending would be treated as if they were already in a KanCare network beyond April 2.
"We are very pleased with their approach," he said. "It will allow the continuity of care period to continue while contracting and (provider) credentialing processes are finalized. That should be very helpful to both patients and providers."
He also said the medical society had been pleased by the responsiveness of the state and the MCOs.
"You'll always have some bumps in the road," he said. "We feel pretty good that these issues are going to be resolved."
He wrote a letter dated Thursday to Mosier saying the medical society was not trying to be critical of the KanCare program when it co-signed last week's letter noting the 26 ongoing problems.
"Our comments were not intended to be criticisms of either the KanCare program, the office of Medicaid Services, or the contracted MCOs, all of whom have been working very closely with the provider community to achieve an orderly transition to the new program," he wrote. "On the contrary, your staff and the MCOs (managed care organizations) have worked hard to be responsive to provider concerns throughout the KanCare implementation process."
State officials also have said they believe the transition has been going relatively smoothly given its complexity, a view shared by Tom Bell, president of the Kansas Hospital Association.
“There are going to be bumps in the road," he said. "But from our perspective, the state has done a tremendous job of being responsive to those bumps in the road so far.”
KHI News Service coverage of KanCare
→ Hutchinson Clinic's letter throws a curve to KanCare open enrollment (1/28/14)
→ National Disability Council again urges CMS to hold off on Kansas DD carve-in (1/14/14)
→ DD carve-in not approved for Jan. 1 launch (12/27/13)
→ National Council on Disability urges one-year delay of KanCare DD carve-in (12/13/13)
→ KDADS chief describes lessons learned with KanCare (12/5/13)
→ Other states watching Kansas as it implements ‘unprecedented’ Medicaid model (12/5/13)
→ KanCare reimbursement problems continue for providers (11/25/13)
→ Kansas dental program for children on hold because of KanCare MCO (11/11/13)
→ Kansas Medicaid providers complain to oversight committee (10/7/13)
→ Wichita hospital execs describe problems with KanCare (8/29/13)
→ KanCare to adopt “health home” model for treating mentally ill (7/22/13)
→ Kentucky’s rush into Medicaid managed care: A cautionary tale for other states (7/18/13)
→ DD groups largely reconciled to KanCare carve-in (7/15/13)
→ Advocates urge more government oversight of Medicaid managed care (7/8/13)
→ Independent pharmacists push for KanCare contract enforcement (7/1/13)
→ Payroll agents for the disabled on Medicaid say they are struggling under KanCare (6/3/13)
→ Personal Care Attendants: KanCare's unheralded workers (5/20/13)
→ House GOP leaders pen letter backing DD supports in KanCare (5/17/13)
→ More than 1,000 rally at Statehouse for DD carve-out (5/8/13)
→ Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
→ As KanCare continuity of care period ends, problems persist; legislators starting to hear about it (4/8/13)
→ Advocates raise concerns over possible reductions in KanCare services (3/28/13)
→ Conferees agree on KanCare oversight committee (3/28/13)
→ DD advocates push to extend KanCare "carve-out" (3/20/13)
→ Safety-net clinics struggling with KanCare (3/4/13)
→ Major medical provider groups ask for longer KanCare transition (2/13/13)
→ Lawmakers and providers assess KanCare transition (1/28/13)
→ Five-part series: "Lower cost and better care: Can KanCare deliver?" (1/14/13)
→ Independence of KanCare ombudsman questioned (1/7/13)
→ KanCare special terms and conditions spelled out by CMS in a document (12/28/12)
→ KanCare workforce shift hampering local agencies (12/10/12)
→ Governor announces KanCare approval by feds (12/7/12)
→ More KanCare implementation details outlined (12/3/12)
→ Federal officials say they hope to act soon on KanCare waiver request (11/28/12)
→ New KanCare info included on state website (11/20/12)
→ Groups call for KanCare delay (11/8/12)
→ Go/no-go date looms this week for KanCare (10/15/12)
→ KanCare benefit packages outlined (9/26/12)
→ Provider groups nervous about lack of KanCare details (9/13/12)
→ KanCare Confidential (9/10/12)
→ KanCare contracts awarded (6/27/12)
→ KanCare plan panned again at public hearing (6/20/12)
→ Wichita KanCare forum draws more than 200 (6/19/12)
→ Medicaid makeover: Can Kansas learn from Kentucky? (6/11/12)
→ Hundreds protest inclusion of disability services in KanCare (4/25/12)
→ Counties weighing in on KanCare (4/9/12)
→ Hospital administrator to chair KanCare Advisory Council (3/29/12)
→ Brownback Medicaid makeover an “ambitious” plan (3/28/12)
→ KanCare bidders heavily courting Medicaid providers (3/19/12)
→ Legislators push to delay KanCare start (3/7/12)
→ Brownback announces managed care for all in Medicaid (11/8/11)
→ Kansas Medicaid makeover in the works (3/7/11)
→ Full Medicaid and KanCare coverage
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