Summary of Medicaid proposals provided by the governor's office
Remaking Kansas Medicaid Proposals
On January 19, 2011 Governor Sam Brownback, Lt. Governor Jeff Coyler, M.D., Senate President Steve Morris, and House Speaker Mike O’Neal held a joint press conference to announce how they would work together to implement structural reform to state government. Lt. Governor Colyer said that members of the sub-cabinet would begin work on reforming the state’s Medicaid program and asked that stakeholders and citizens submit pilot projects and reform ideas based on three criteria; improving quality of care of Kansans receiving Medicaid, controlling the costs of the program, and long-lasting reforms of health care that improve the quality of health and wellness of Kansans. The call for proposals closed on February 28th with 64 citizens, stakeholders, and organizations submittingproposals containing over 120 recommendations for remaking the Medicaid program.
Expand Managed Care
KHPA received seven recommendations in this category including expanding managed care to the aged, blind, and disabled populations as well as the dual eligibles; expanding the PACE program to mid-size communities; comprehensive integrated physical-behavioral health management for special populations including foster care, SMI, ABD/LTC;and an ABD care management program SG county.
Care Coordination/Medical Home
KHPA received thirteen recommendations in this category including care coordination of hospital transitions for the elderly and disabled; improve health literacy of consumers; develop health coach programs; reinitiate ECM program; implement medical home model; care coordination bridging physical and behavioral health services; enhanced PCMH intervention using community health coaches matched to beneficiaries in cultural and linguistic characteristics; CMHCs serving as health homes for adults with SPMI and children with SED; and a pediatric medical home for children with special needs.
Fraud Prevention & Recovery
KHPA received three recommendations in this category including strengthening estate recovery processes; and using data analytics and predictive modeling to identify fraud and abuse potential incidents.
Utilization Management
KHPA received ten recommendations in this category including evaluation of increased use of institutional care; examination of denial of behavioral health services to beneficiaries with dual diagnoses; examination of hospice abuse risks; utilize natural occurring opportunities to educate beneficiaries on appropriate utilization of services; to evaluate hospitalization trends of beneficiaries on SED waiver; and introduction of price transparency to drive market-based consumer decisions
Consulting Services
KHPA received seven recommendations in this category including assistance flagging claims for presumptive disability applicants who become eligible for SSI; using health care data analytics to identify cost-savings opportunities; analysis of beneficiary risk, provider practice patterns, and implementation of a virtual medical home; and a population based analytic tool identifying individual care deviation from evidenced-based standards of best practice for behavioral health.
Pharmacy
KHPA received eleven recommendations in this category including PDL for antidepressants; expansion of step therapy; systematic review of the pharmacy benefit; medication therapy management; coverage of electronic medication compliance management devices; implementation of the Kansas behavioral health pharmacy management program; increase generic usage; prescriber education initiatives; mandate only Kansas retail pharmacies dispense medications to Kansas beneficiaries; utilize medication management programs reimbursing Kansas pharmacists for professional consultation services; and behavioral health pharmacy management.
Targeted Interventions
KHPA received seven recommendations in this category including instituting a wellness program in long term care facilities; chronic disease self-management program for the elderly; competitive employment opportunities for people with disabilities; diabetic management for beneficiaries with disabilities; and targeted interventions for high risk beneficiaries for smoking cessation and weight loss.
Eligibility
KHPA received sixteen recommendations in this category including changing procedures related to assessment and plan of care for admission into long term care facilities; adding MediKan beneficiaries as an optional Medicaid group; expanding the HCBS waiver for select populations; service flexibility for HCBS-FE beneficiaries, review of presumptive disability determination process and criteria; reevaluation of waiver beneficiaries’ assessment scores; expanding Working Healthy and WORK; amend the SPA to adopt Community First Choice option; connect eligibility notification to income tax standard: to expand the Autism waiver capacity; and integrating Medicaid into the private insurance market.
Cost Sharing
KHPA received three recommendations in this category including tiered pharmacy copayments; and to levy copayments and premiums for Title 19 beneficiaries
Payment Reform
KHPA received twelve recommendations in this category including integration of the SCHIP population for behavioral health services; integration of Medicaid and Medicare for seniors; recalibrate inpatient and outpatient payments; eliminate payment for never events; examine reimbursement rates for mental health case management services; KS Newborn screening program sustained fee impact on Medicaid funding; mental health services consolidated spending; and an alternative revenue enhancements through HMO privilege fee.
Delivery System Restructuring
KHPA received seven recommendations in this category including formation of a primary care ACO; downsize the nursing home capacity and substitute a comprehensive set of long term services and supports in sparsely populated areas; to integrate services for the frail elderly including HUD housing, PACE, mobile clinic, and telehealth; and introducing consumer-directed plans in Medicaid.
Technological Integration
KHPA received six recommendations in this category including telemonitoring for targeted populations; connecting rural health providers to each other and to beneficiaries through use of secure messaging and initiating e-visits; and increase use of assistive technology in homes.
Benefit Changes
KHPA received seventeen recommendations in this category including coverage of medical nutrition therapy by registered dietitians; coverage of bariatric surgery as a treatment for weight loss for the chronically obese; adding community based services for target populations; coverage of weight reduction assistance in conjunction with bariatric surgery; full dental benefits for all Medicaid beneficiaries; broaden benefit package to include social support benefits; provide rehabilitation services in additional settings; provide coverage of habilitation services; and eliminate coverage of circumcision; and increasing benefit flexibility within Medicaid.
Administrative Reorganization
KHPA received two recommendations in this category including creating the Office of Integrated Community Services to administrate all HCBS services; and an agency modification.
Remaking Medicaid Call for Proposals Respondents
AARP Kansas
Action Pact Development LLC
Allergan, Inc.
Association of CMHCs of Kansas, Inc.
Capper Foundation
Care Management Technologies
Centpatico
Cerebral Palsy Research Foundation of Kansas, Inc.
Cerner Corporation
Children’s Mercy Family Health Partners
Crossroads Hospice of Kansas
Disability Rights Center of Kansas
Kansas Area Agencies on Aging Association
Kansas Association of Homes and Services for the Aging
Kansas Citizens
Kansas Dietetic Association
Kansas Health Care Association/Kansas Center for Assisted Living
Kansas Health Consumer Coalition
Kansas Health Solutions
Kansas Independent Pharmacy Service Corporation
Kansas Legal Services
March of Dimes Greater Kansas City Chapter
Medical Society of Sedgwick County
National Alliance on Mental Illness
National Organization of Circumcision Information Resource Centers
North Central-Flint Hills Area Agency on Aging
Northrop Grumman
Nueterra Health Alliance
Oral Health Kansas
PBA Health
Policy Studies, Inc.
Providers
Remote Medication Management Systems
Resource Center for Independent Living, Inc.
Southeast Kansas Area Agency on Aging, Inc.
State Employees
Statewide Independent Living Councils of Kansas
Twin Valley Developmental Services, Inc.
UniCare
United Healthcare Community & State
University of Kansas Department of Family Medicine
University of Kansas Medical Center Department of Preventive Medicine
University of Kansas Research and Training Center on Independent Living
Value Options, Inc.
Vivius
Windsor Place At-Home Care
This story was originally published April 7, 2011 at 12:00 AM with the headline "Summary of Medicaid proposals provided by the governor's office."