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

2. 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

4. 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

5. 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)

6. 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

7. Provider Payment Reductions
Inpatient Hospital Claim Example

8. 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%

9. 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)

10. MCO Implementation Schedules
Amerigroup
Sunflower
UnitedHealthcare

11. Question and Answer Session
Questions:
Question and Answer Session