The Robert G. (Bob) Bethell Committee on Home and Community Based Services and KanCare Oversight conducted two days of hearings Thursday, November 17th and Friday, November 18, 2016. LeadingAge Kansas provided testimony on both days concerning the future direction of KanCare, the 4.47% cut to nursing home Medicaid rates and the continuing backlog in Medicaid applications. We also submitted testimony as part of a Medicaid health care provider coalition, outlining improvements we believe must happen with the KanCare system going forward.
The Oversight Committee also completed its annual charge of making recommendations to their fellow legislators to address some of the concerns relayed by stakeholders. The recommendations can be found below in the excellent summary created by the Kansas Hospital Association:
- The Secretary of the Kansas Department of Health and Environment shall develop standards to be utilized uniformly by each managed care organization serving the State of Kansas pursuant to a contract with the Kansas Medical Assistance Program for each of the following:
- Documentation to be provided to a health care provider by any MCO when it denies a claim for reimbursement submitted by such provider. Denial reason codes must be HIPAA compliant, and MCOs must consistency apply denial reason codes in the same manner to ensure accurate reporting to the State.
- Documentation to be provided to a health care provider by any MCO when recoupments are made pursuant to a post-pay audit of such provider to include transparency of methodology used in the audit and a specific explanation of the reason for recoupment. MCOs may not arbitrarily remove codes (ICD-10, CPT, DRG, etc.) submitted by the provider or change the level of care provided to reduce payment without using the proper appeal protections in place.
- The Secretary of the Kansas Department of Health and Environment shall complete a quarterly review of claims, denials and appeals to determine:
- If a high percentage of denials are overturned on appeal; and if so, address the issue with the MCO(s).
- If a certain procedure or codes are denied more often than others, whether or not those denials were appropriate and address the issue with the MCO(s).
- Eligibility – Long term care applications more than 45 days of age will be sent to a team formed exclusively to get applications processed. The goal is to have 75 percent of LTC applications cleared within the first 45 days after submission. Monthly reporting will be made to KanCare Oversight Committee.
- All MCOs should work together to develop one standardized credentialing application. MCOs must respond to all submissions within 15 working days. MCOs must use the Council for Affordable Quality Healthcare’s portal for claims processing.
- The 4 percent Medicaid reimbursement cuts and the policy-based cuts will be restored.
- Extend current 1115 waiver one year, and delay request for proposals until the State clearly understands federal changes to the Affordable Care Act and Medicaid.
- Kansas Eligibility and Enforcement System – do not expand Phase 3 until a clear demonstration of system functionality and operational integrity. All problems must be resolved. Submit a request to have Legislative Post Audit update their December 2015 IT audit on KEES and report satisfactory performance before Phase 3 expansion.
- Kansas Department for Aging and Disability Services shall investigate the newly published IMD policy and determine how to enhance the care to Kansas mental health patients.
- All uncompensated care numbers presented to the KanCare Oversight Committee will be based on 100 percent of the Medicare allowable.
- MCO’s report to KanCare Oversight committee on first pass denial rate.
- Duplicate notices must be sent to patients and providers regarding application denials to avoid long-term care issues.
