Medicaid Eligibility and MCO Payment Issues
LeadingAge Kansas has heard growing concerns from providers about delays in Medicaid eligibility determinations, particularly for HCBS participants. Challenges with the functional eligibility process through KDADS and subsequent financial eligibility reviews through KDHE can create significant delays before services are approved.
We have also received reports of payment denials, claim issues, and recoupments from managed care organizations, including Healthy Blue and Sunflower Health Plan. We want to hear from our members, especially HCBS providers, about what you are experiencing and how we can support you.
These concerns are especially timely as the HCBS Frail Elderly (FE) Waiver is expected to begin a waitlist around July 1. Because HCBS providers do not receive retroactive Medicaid eligibility payments, organizations may want to review their admission and financial policies to prepare for potential delays in eligibility and waiver access.
If your organization has experienced eligibility delays, payment issues, or recoupments, please let us know. Your feedback will help guide our advocacy efforts.
From KDADS: Follow Up to NF Administrators for RHTP Survey and Notice of Deadline Extension
On behalf of the Kansas Rural Health Transformation Program (RHTP) administered by the KDHE, the Kansas Health Institute and the Docking Institute of Public Affairs are collaborating to survey nursing facilities delivering services in rural areas across our state. The survey meets an essential commitment for Kansas and its RHTP funding, as findings will be used to support and adjust programming for Kansas nursing facilities.
If you have already completed the survey, thank you for your valuable insights. If you haven’t had a chance yet, the deadline has been extended to Monday, June 15, at 10 am. This online survey should take only 10 minutes and can be completed by smartphone or other computing device.
Note: This message was sent to 157 facilities identified as being in rural counties for the purposes of the Rural Health Transformation Program. Check KOTA and your email inbox to see if you received the message and have taken the survey.
Regulation of the Week: FMCSA & Resident Transportation Vehicles
Recently, LeadingAge Kansas received questions after providers were notified that certain vehicles may need a USDOT number. Many members believed transportation regulations only applied to vehicles carrying 16 or more passengers.
After discussions with the Kansas Corporation Commission (KCC), we confirmed that vehicles designed to transport 9–15 passengers may be subject to FMCSA requirements because resident transportation is considered indirect compensation. However, an important exemption applies for many providers.
What You Need to Know
- Check your vehicle’s Gross Vehicle Weight Rating (GVWR), typically located on the driver’s side door jamb or door post.
- Vehicles under 10,001 lbs. GVWR generally qualify for an exemption from USDOT registration requirements.
- Vehicles 10,001 lbs. GVWR or greater that transport 9–15 passengers may require USDOT registration and compliance with applicable federal and state motor carrier regulations.
Even if exempt from USDOT registration, providers must still comply with certain limited FMCSA requirements, including accident reporting and distracted driving regulations.
Resources
- KCC Transportation Guidance: https://www.kcc.ks.gov/transportation
- Free KCC Safety Seminars: https://www.kcc.ks.gov/transportation/safety-information
Important: This guidance does not address CDL requirements. CDL requirements generally apply when transporting 16 or more passengers (including the driver) or when operating vehicles meeting applicable CDL weight thresholds.
See the attached handout for additional details and regulatory references.
