1. Division of Health Care Finance
Michael Randol, Director

2. Discussion Topics KanCare Overview Features and Benefits
Partnerships- KDHE, KDADS, MCO
KanCare Going Forward

3. KanCare - Current KanCare 1115 Waiver Project
In year 4 of a 5 year demonstration
95% of populations and services included
Break down silos of care
Improve quality/outcomes while bending cost curve down
Provide integrated, coordinated care
Increased emphasis on health, wellness, prevention, early detection and early intervention

4. KanCare Composition

5. KanCare Populations
*HCBS Services includes Autism, Severe Emotional Disturbance, Technology Assisted, and Traumatic Brain Injury
**Long Term Care includes Nursing Facilities, Money Follows the Person Frail Elderly and Physically Disabled, and the Physically Disabled and Frail Elderly Waivers

6. Key Features of KanCare
Coordinating care for the whole person
Clear accountability
Improving health outcomes
Consolidation of financing

7. Whole Person-Centered Care Coordination
No reduction in current levels of Medicaid services and eligibility
New services include:
Heart and lung transplants for adults
Weight-loss surgery
Valued-added services
In lieu of services
Options counseling

8. Improving Outcomes
Through the contracts with the managed care organizations (MCOs), we are focused on:
Lessening reliance on institutional care
Decreasing re-hospitalizations
Managing chronic conditions
Improving access to health services

9. Financing Consolidation
Move almost the entirety of Medicaid into a capitated risk-based managed care system
KanCare contractors will be rewarded for paying for preventive care that keeps people healthy

10. KanCare Benefits for Kansas
Added new services and benefits (Bariatric surgery, heart and lung transplants and Value Added Services)
2013 through 2015
Total members getting value added services
Total units of value added services provided
Total value of value added services provided
Combined three KanCare MCOs
520,515
1,722,637
$14,634,532

11. KanCare - Utilization Comparison

12. KanCare Cost Comparison

13. KDHE
MCOs
KDADS

14. KDHE Single State Medicaid Agency. Responsible to CMS for all
Medicaid programs, policy and implementation decisions
Manages FFS and Medical programs (non-Medicaid)
Works collaboratively with KDADs
Provides oversight of MCOs

15. KDADS
Manages community based programs policy and eligibility (such as HCBS, Mental Health, and SUD)
Licensing and credentialing for community programs
Nursing facilities, and PACE
Senior care act, Medicare programs
Oversees state hospitals (OSH, Larned, Parsons and KNI)

16. MCOs
Contracts with providers to ensure services are delivered to our members
Manage provider network to ensure service provision (contracting and Credentialing)
Coordinate care in community and transitions between in-patient services
Provide health literacy and preventive services
Assist in identifying and supporting members with special health care needs (complex health needs, disabilities, mental health or substance use treatment needs)

17. KanCare Renewal - Process
Conduct Renewal Stakeholder Forums
May 2016
Develop Draft Renewal Application
June-July 2016
Post Application for Review and Tribal Consultation
Aug.-Sept. 2016
Renewal Application Submitted to CMS
November 2016
CMS Public Notice & Consultation With State
Throughout 2017
CMS Decision & Special Terms and Conditions Issued By

18. KanCare – Potential Changes
Continued improvement in coordination and integration of care
Payment based on outcomes and value
Waiver Integration

19. KanCare Website