Overview of Implementation Plans for KanCare Payment Reductions July 19th, 2016

KanCare Agenda Overview – KDHE State Budget Reductions Impact on KDHE Summary of Payment Reductions Implementation Plans MCO Timelines and Contacts Amerigroup Sunflower Health Plan UnitedHealthcare Question and Answer Session

Provider Payment Reductions Effective with Dates of Service on and After July 1, 2016, all Payments Issued by the Kansas Medical Assistance Program will be Reduced by 4% with the Following Exceptions: Critical Access Hospitals (I/P and O/P Services Only) Rural, Densely-Settled Rural and Frontier Hospitals as Defined by the US Census Bureau (I/P and O/P Services Only) Rural Health Clinics (RHCs) Encounter Rate Federally Qualified Health Centers (FQHCs) Encounter Rate Out-of-State Hospitals (Except for Children’s Mercy Missouri) State Hospitals (Kansas Neurological Institute, Larned, Parsons and Osawatomie) Indian Health Services (IHS) Home and Community-Based Services (HCBS) Electronic Health Record (EHR) Payments Fee-for-Service Pharmacy Claims Hospice Services All Other Out-of-State Providers WORK Program MFP Services

Provider Payment Reductions In Addition to the 4% Payment Reduction, the Following Reductions are also Effective for Dates of Service on and After July 1, 2016: Non-Claims Payment Reductions Medicaid Disproportionate Share Hospital (DSH) Payments Will be Reduced by 4% Medicaid Graduate Medical Education (GME) Payments Will be Reduced by 4% Claims Payment Reductions Health Care Access Improvement Program (HCAIP) Enhanced Payment Rate for Inpatient Claims Will be Reduced from 25.8% to 23.1% (Applies to ALL Hospitals) Inpatient DRG Outlier Payments Will be Reduced from 75% to 55% (Applies to All Hospitals)

Provider Payment Reductions Claim Examples Inpatient Hospital Claim Hospital Exempt from 4% Payment Reduction: Subject to the I/P HCAIP Reduction Subject to the Outlier Payment Reduction, if Applicable Inpatient Hospital Claim Hospital Not Exempt from 4% Payment Reduction: Subject to the I/P HCAIP Reduction Subject to the 4% Reduction Subject to Outlier Payment Reduction (if Applicable) Subject to GME Reduction, if Applicable

Provider Payment Reductions Inpatient Hospital Claim Example

Provider Payment Reductions Claim Examples Outpatient Hospital Claim Hospital Exempt from 4% Payment Reduction: No Impact Outpatient Hospital Claim Hospital Not Exempt from 4% Payment Reduction: Subject to the 4% Reduction Calculation: Published Fee Schedule Reimbursement x 25.8% (HCAIP Outpatient Payment Enhancement) x .96%

Provider Payment Reductions Effective with Dates of Service on and After July 1, 2016, There Will be a 4% Payment Reduction for Other Hospital Services: Skilled Nursing Nursing Home RHC and FQHC (Services Other Than the Encounter Rate) Home Health Ambulance Physician Services Certified Registered Nurse Anesthetist (CRNA)

MCO Implementation Schedules Amerigroup Sunflower UnitedHealthcare

Question and Answer Session Questions: Question and Answer Session