Safety Net Care Pool. Provide updates on any activities or planning related to payment reform initiatives or delivery system reforms impacting demonstration population and/or undertaken in relation to the SNCP. As per STC 69, include projected or actual changes in SNCP payments and expenditures within the quarterly report. Please note that the annual report must also include SNCP reporting as required by STC 69. Demonstration Evaluation Discuss progress of evaluation design and planning. Enclosures/Attachments Identify by title any attachments along with a brief description of what information the document contains. State Contact(s) Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. ATTACHMENT A Quarterly Report Content and Format Date Submitted to CMS ATTACHMENT B Historical Budget Neutrality Data SFY07 SFY08 SFY09 SFY10 SFY11 5-YEARS Medicaid Pop 1 ABD/SD Dual TOTAL EXPENDITURES $ 44,236,459 $ 43,025,422 $42,691,201 $40,506,394 $40,532,103 $210,991,580 Eligible Member Months 208,752 202,688 198,906 200,134 210,200 PMPM COST $ 211.91 $212.27 $214.63 $202.40 $192.83 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE -2.74% -0.78% -5.12% 0.06% -2.16% ELIGIBLE MEMBER MONTHS -2.90% -1.87% 0.62% 5.03% 0.17% PMPM COST 0.17% 1.11% -5.70% -4.73% -2.33% Medicaid Pop 2 ABD/SD Non Dual TOTAL EXPENDITURES $262,996,600 $287,521,460 $302,718,060 $318,094,717 $353,270,763 $1,524,601,599 ELIGIBLE DELIVERIES 277,577 287,295 303,044 325,477 345,539 PMPM COST $947.47 $1,000.79 $998.92 $ 977.32 $1,022.38 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 9.33% 3.50% 5.63% 5.29% 5.48% -0.19% 5.08% 7.40% -2.16% 11.06% 6.16% 4.61% 7.66% 5.63% 1.92% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 3 Adults TOTAL EXPENDITURES $145,696,984 $178,511,453 $ 182,736,445 $192,965,697 $215,135,856 $915,046,435 Eligible Member Months 341,481 302,194 297,411 327,511 383,991 PMPM COST $426.66 $590.72 $614.42 $589.19 $560.26 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 22.52% -11.51% 38.45% 2.37% -1.58% 4.01% 5.60% 10.12% -4.11% 11.49% 17.25% -4.91% 10.23% 2.98% 7.05% Medicaid Pop 4 Children TOTAL EXPENDITURES $339,146,737 $391,345,646 $395,809,865 $395,188,873 $469,903,838 $1,991,394,959 Eligible Member Months 1,842,324 1,807,933 1,862,831 2,088,632 2,297,347 PMPM COST $184.09 $216.46 $212.48 $189.21 $204.54 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 15.39% 1.14% -0.16% 18.91% 8.49% ELIGIBLE MEMBER MONTHS -1.87% 3.04% 12.12% 9.99% 5.67% PMPM COST 17.59% -1.84% -10.95% 8.10% 2.67% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 5 DD Waiver TOTAL EXPENDITURES $317,272,274 $333,079,826 $352,328,338 $361,930,538 $378,141,817 $1,742,752,793 Eligible Member Months 88,021 92,716 94,654 98,443 100,367 PMPM COST $3,604.51 $3,592.47 $3,722.28 $3,676.54 $3,767.57 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 4.98% 5.33% -0.33% 5.78% 2.09% 3.61% 2.73% 4.00% -1.23% 4.48% 1.95% 2.48% 4.49% 3.34% 1.11% Medicaid Pop 6 LTC TOTAL EXPENDITURES $714,587,999 $764,736,723 $837,320,779 $802,268,440 $893,612,115 $4,012,526,055 Eligible Member Months 278,125 285,098 295,461 288,224 284,917 PMPM COST $2,569.30 $2,682.36 $2,833.94 $2,783.49 $3,136.39 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 7.02% 9.49% -4.19% 11.39% 5.75% ELIGIBLE MEMBER MONTHS 2.51% 3.64% -2.45% -1.15% 0.60% PMPM COST 4.40% 5.65% -1.78% 12.68% 5.11% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 7 MN Dual TOTAL EXPENDITURES $37,210,534 $34,425,301 $28,602,622 $42,253,903 $34,382,233 $176,874,594 Eligible Member Months 35,739 31,269 28,620 30,996 27,711 PMPM COST $1,041.17 $1,100.96 $999.38 $1,363.19 $1,240.76 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST -7.49% -12.51% 5.74% -16.91% -8.47% -9.23% 47.73% 8.30% 36.40% -18.63% -10.60% -8.98% -1.96% -6.16% 4.48% Medicaid Pop 8 TOTAL EXPENDITURES Eligible Member Months PMPM COST MN Non Dual $24,500,245 21,421 $1,143.73 $28,139,319 26,080 $1,078.96 $30,191,137 21,895 $1,378.92 $28,559,359 19,534 $1,462.00 $31,471,604 19,602 $1,605.55 $142,861,664 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 14.85% 7.29% -5.40% 10.20% 6.46% ELIGIBLE MEMBER MONTHS 21.75% -16.05% -10.78% 0.34% -2.19% PMPM COST -5.66% 27.80% 6.02% 9.82% 8.85% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 9 Waiver TOTAL EXPENDITURES $61,320,583 $79,821,639 $118,700,459 $138,297,856 $149,625,842 $ 547,766,379 Eligible Member Months 34,936 42,109 53,790 61,202 64,235 PMPM COST $1,755.22 $1,895.60 $2,206.74 $2,259.68 $2,329.36 TREND RATES 5-YEAR ANNUAL CHANGE AVERAGE TOTAL EXPENDITURE 30.17% 48.71% 16.51% 8.19% 24.98% ELIGIBLE MEMBER MONTHS 20.53% 27.74% 13.78% 4.95% 16.45% PMPM COST 8.00% 16.41% 2.40% 3.08% 7.33% ATTACHMENT C HCAIP Hospitals Hospital Name City County Blue Valley Hospital Inc. Overland Park Johnson Xxx Xxxxxx Memorial Hospital Xxxxxxx Xxxxx Children's Mercy Hospital South Overland Park Johnson Xxxxxx County Hospital Burlington Xxxxxx Coffeyville Regional Medical Center Coffeyville Xxxxxxxxxx Xxxxxxx Memorial Hospital Leavenworth Leavenworth Doctors Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Heart Hospital Xxxxxxx Xxxxxxxx Xxxxx Community Hospital Junction City Xxxxx Great Bend Regional Hospital, LLC Great Bend Xxxxxx Xxxx Medical Center Xxxx Xxxxx Heartland Spine & Specialty Hospital Overland Park Xxxxxxx Kansas City Orthopaedic Institute Leawood Xxxxxxx Kansas Heart Hospital Xxxxxxx Xxxxxxxx Kansas Medical Center Andover Xxxxxx Kansas Rehabilitation Hospital Topeka Shawnee Kansas Spine Hospital Wichita Sedgwick Kansas Surgery & Recovery Center Xxxxxxx Xxxxxxxx Labette County Medical Center Xxxxxxx Xxxxxxx Xxxxxxxx Memorial Hospital Xxxxxxxx Xxxxxxx LTAC Hospital of Xxxxxxx Xxxxxxx Xxxxxxxx Manhattan Surgical Hospital Manhattan Xxxxx XxXxxxxxx Memorial Hospital XxXxxxxxx XxXxxxxxx Meadowbrook Hospital Xxxxxxx Xxxxxxx Menorah Medical Center Overland Park Xxxxxxx Xxxxx Health Center - Fort Xxxxx Fort Xxxxx Xxxxxxx Mercy Health Center - Independence Independence Xxxxxxxxxx Xxxxx Hospital - Moundridge Moundridge XxXxxxxxx Xxxxx Regional Health Center Manhattan Xxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Miami County Medical Center Paola Miami Mid-America Rehabilitation Hospital Overland Xxxx Xxxxxxx Xxxxxx County Health System Xxxxxxx Xxxxxx Mount Carmel Regional Medical Center Pittsburg Xxxxxxxx Xxxxxx Regional Health Emporia Xxxx Xxxxxx Medical Center Xxxxxx Xxxxxx Olathe Medical Center Xxxxxx Xxxxxxx Overland Park Regional Medical Center Overland Park Johnson Xxxxx Regional Medical Center Pratt Pratt Promise Regional Medical Center Xxxxxxxxxx Xxxx Providence Medical Center Kansas City Wyandotte Xxxxxx Memorial Hospital Ottawa Franklin Saint Xxxxxxxxx Hospital Garden City Xxxxxx Saint Xxxxxxx Health Center Topeka Shawnee Saint Xxxx Hospital Leavenworth Leavenworth Saint Luke's South Hospital Overland Park Xxxxxxx Xxxxxx Regional Health Center Salina Saline Salina Surgical Hospital Salina Saline Select Specialty Hospital Kansas City Overland Park Xxxxxxx Select Specialty Hospital Topeka Topeka Shawnee Select Specialty Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Xxxxxxx Mission Medical Center Overland Park Johnson South Central Kansas RMC Arkansas City Xxxxxx Southwest Medical Center Liberal Xxxxxx Specialty Hospital of Mid- America Overland Park Johnson Xxxxxxxx-Xxxx Regional Health Center Topeka Shawnee Summit Surgical, LLC Xxxxxxxxxx Xxxx Xxxxxx Regional Medical Center Wellington Xxxxxx Xxxxx X. Xxxxx Memorial Hospital El Dorado Xxxxxx Via Xxxxxxx Hospital St. Xxxxxx Wichita Xxxxxxxx Via Christi Regional Medical Center Xxxxxxx Xxxxxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Via Christi Rehabilitation Center Xxxxxxx Xxxxxxxx Xxxxxx Medical Center Xxxxxxx Xxxxxxxx Xxxxxx Rehabilitation Hospital Xxxxxxx Xxxxxxxx Western Plains Medical Complex Dodge City Ford ATTACHMENT D LPTH/BCCH Hospitals Hospital Name City County Large Public Teaching Hospital The University of Kansas Hospital Kansas City, KS Wyandotte Border City Children's Hospital Children's Mercy Hospital Kansas City, XX Xxxxxxx ATTACHMENT E UC Payment Application Template [PLACEHOLDER: Following CMS review and approval, the UC Payment Application Template (see STC 68) will be placed in this attachment] ATTACHMENT F DSRIP Planning Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Planning Protocol (see STC 69) will be placed in this attachment] ATTACHMENT G DSRIP Funding and Mechanics Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Funding and Mechanics Protocol (see STC 69) will be placed in this attachment] ATTACHMENT H Ombudsman Plan The following report was submitted by the state of Kansas on November 26, 2012, as a part of CMS’ KanCare review. This report describes the qualified independent, conflict-free entity which will assist KanCare enrollees in the resolution of problems and conflicts between the MCOs and participants regarding services, coverage, access and rights. The Ombudsman should help participants understand the fair hearing, grievance, and appeal rights and processes at each MCO and proactively assist them through the process if needed. Ombudsman activities are available to all demonstration eligible populations, but specific focus and outreach activities will be directed towards KanCare enrollees utilizing LTSS (institutional, residential and community based). (see STC 41). [REMAINDER OF THIS PAGE INTENTIONALLY BLANK] ATTACHMENT H Ombudsman Plan Xxxxxx State Office Building 000 XX Xxxxxxx Street, Room 900-N Topeka, KS 66612 Phone: 000-000-0000 Fax: 000-000-0000 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxxx Xxxxxxxx, Director Xxx Xxxxxxxxx, Governor KanCare Implementation Activity: KanCare Consumer Ombudsman Date Updated: Dec. 5, 2012 Purpose: The ombudsman will help Kansas consumers enrolled in a KanCare plan, with a primary focus on individuals participating in the HCBS waiver program or receiving other long term care services through KanCare. The ombudsman will assist KanCare consumers with access, service and benefit problems. The ombudsman will provide information about the KanCare grievance and appeal process that is available through the KanCare plans and the State fair hearing process, and assist KanCare consumers seek resolution to complaints or concerns regarding their fair treatment and interaction with their KanCare plan. The ombudsman will: Help consumers to resolve service-related problems when resolution is not available directly through a provider or health plan. Help consumers understand and resolve billing issues, or notices of non-coverage. Assist consumers learn and navigate the grievance and appeal process at the KanCare plan, and the State fair hearing process, and help them as needed. Assist consumers to seek remedies when they feel their rights have been violated. Assist consumers understand their KanCare plan and how to interact with the programs benefits. Serve as a point of contact and resource for legislative and other inquiries into the provision of LTSS in managed care. Organization:
Appears in 1 contract
Samples: www.kancare.ks.gov
Safety Net Care Pool. Provide updates on any activities or planning related to payment reform initiatives or delivery system reforms impacting demonstration population and/or undertaken in relation to the SNCP. As per STC 69, include projected or actual changes in SNCP payments and expenditures within the quarterly report. Please note that the annual report must also include SNCP reporting as required by STC 69. Demonstration Evaluation Discuss progress of evaluation design and planning. Enclosures/Attachments Identify by title any attachments along with a brief description of what information the document contains. State Contact(s) Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. ATTACHMENT A Quarterly Report Content and Format Date Submitted to CMS ATTACHMENT B Historical Budget Neutrality Data SFY07 SFY08 SFY09 SFY10 SFY11 5-YEARS Medicaid Pop 1 ABD/SD Dual TOTAL EXPENDITURES $ 44,236,459 $ 43,025,422 $42,691,201 $40,506,394 $40,532,103 $210,991,580 Eligible Member Months 208,752 202,688 198,906 200,134 210,200 PMPM COST $ 211.91 $212.27 $214.63 $202.40 $192.83 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE -2.74% -0.78% -5.12% 0.06% -2.16% ELIGIBLE MEMBER MONTHS -2.90% -1.87% 0.62% 5.03% 0.17% PMPM COST 0.17% 1.11% -5.70% -4.73% -2.33% Medicaid Pop 2 ABD/SD Non Dual TOTAL EXPENDITURES $262,996,600 $287,521,460 $302,718,060 $318,094,717 $353,270,763 $1,524,601,599 ELIGIBLE DELIVERIES 277,577 287,295 303,044 325,477 345,539 PMPM COST $947.47 $1,000.79 $998.92 $ 977.32 $1,022.38 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 9.33% 3.50% 5.63% 5.29% 5.48% -0.19% 5.08% 7.40% -2.16% 11.06% 6.16% 4.61% 7.66% 5.63% 1.92% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 3 Adults TOTAL EXPENDITURES $145,696,984 $178,511,453 $ 182,736,445 $192,965,697 $215,135,856 $915,046,435 Eligible Member Months 341,481 302,194 297,411 327,511 383,991 PMPM COST $426.66 $590.72 $614.42 $589.19 $560.26 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 22.52% -11.51% 38.45% 2.37% -1.58% 4.01% 5.60% 10.12% -4.11% 11.49% 17.25% -4.91% 10.23% 2.98% 7.05% Medicaid Pop 4 Children TOTAL EXPENDITURES $339,146,737 $391,345,646 $395,809,865 $395,188,873 $469,903,838 $1,991,394,959 Eligible Member Months 1,842,324 1,807,933 1,862,831 2,088,632 2,297,347 PMPM COST $184.09 $216.46 $212.48 $189.21 $204.54 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 15.39% 1.14% -0.16% 18.91% 8.49% ELIGIBLE MEMBER MONTHS -1.87% 3.04% 12.12% 9.99% 5.67% PMPM COST 17.59% -1.84% -10.95% 8.10% 2.67% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 5 DD Waiver TOTAL EXPENDITURES $317,272,274 $333,079,826 $352,328,338 $361,930,538 $378,141,817 $1,742,752,793 Eligible Member Months 88,021 92,716 94,654 98,443 100,367 PMPM COST $3,604.51 $3,592.47 $3,722.28 $3,676.54 $3,767.57 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 4.98% 5.33% -0.33% 5.78% 2.09% 3.61% 2.73% 4.00% -1.23% 4.48% 1.95% 2.48% 4.49% 3.34% 1.11% Medicaid Pop 6 LTC TOTAL EXPENDITURES $714,587,999 $764,736,723 $837,320,779 $802,268,440 $893,612,115 $4,012,526,055 Eligible Member Months 278,125 285,098 295,461 288,224 284,917 PMPM COST $2,569.30 $2,682.36 $2,833.94 $2,783.49 $3,136.39 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 7.02% 9.49% -4.19% 11.39% 5.75% ELIGIBLE MEMBER MONTHS 2.51% 3.64% -2.45% -1.15% 0.60% PMPM COST 4.40% 5.65% -1.78% 12.68% 5.11% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 7 MN Dual TOTAL EXPENDITURES $37,210,534 $34,425,301 $28,602,622 $42,253,903 $34,382,233 $176,874,594 Eligible Member Months 35,739 31,269 28,620 30,996 27,711 PMPM COST $1,041.17 $1,100.96 $999.38 $1,363.19 $1,240.76 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST -7.49% -12.51% 5.74% -16.91% -8.47% -9.23% 47.73% 8.30% 36.40% -18.63% -10.60% -8.98% -1.96% -6.16% 4.48% Medicaid Pop 8 TOTAL EXPENDITURES Eligible Member Months PMPM COST MN Non Dual $24,500,245 21,421 $1,143.73 $28,139,319 26,080 $1,078.96 $30,191,137 21,895 $1,378.92 $28,559,359 19,534 $1,462.00 $31,471,604 19,602 $1,605.55 $142,861,664 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 14.85% 7.29% -5.40% 10.20% 6.46% ELIGIBLE MEMBER MONTHS 21.75% -16.05% -10.78% 0.34% -2.19% PMPM COST -5.66% 27.80% 6.02% 9.82% 8.85% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 9 Waiver TOTAL EXPENDITURES $61,320,583 $79,821,639 $118,700,459 $138,297,856 $149,625,842 $ 547,766,379 Eligible Member Months 34,936 42,109 53,790 61,202 64,235 PMPM COST $1,755.22 $1,895.60 $2,206.74 $2,259.68 $2,329.36 TREND RATES 5-YEAR ANNUAL CHANGE AVERAGE TOTAL EXPENDITURE 30.17% 48.71% 16.51% 8.19% 24.98% ELIGIBLE MEMBER MONTHS 20.53% 27.74% 13.78% 4.95% 16.45% PMPM COST 8.00% 16.41% 2.40% 3.08% 7.33% ATTACHMENT C HCAIP Hospitals Hospital Name City County Blue Valley Hospital Inc. Overland Park Johnson Xxx Xxxxxx Memorial Hospital Xxxxxxx Xxxxx Children's Mercy Hospital South Overland Park Johnson Xxxxxx County Hospital Burlington Xxxxxx Coffeyville Regional Medical Center Coffeyville Xxxxxxxxxx Xxxxxxx Memorial Hospital Leavenworth Leavenworth Doctors Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Heart Hospital Xxxxxxx Xxxxxxxx Xxxxx Community Hospital Junction City Xxxxx Great Bend Regional Hospital, LLC Great Bend Xxxxxx Xxxx Medical Center Xxxx Xxxxx Heartland Spine & Specialty Hospital Overland Park Xxxxxxx Kansas City Orthopaedic Institute Leawood Xxxxxxx Kansas Heart Hospital Xxxxxxx Xxxxxxxx Kansas Medical Center Andover Xxxxxx Kansas Rehabilitation Hospital Topeka Shawnee Kansas Spine Hospital Wichita Sedgwick Kansas Surgery & Recovery Center Xxxxxxx Xxxxxxxx Labette County Medical Center Xxxxxxx Xxxxxxx Xxxxxxxx Memorial Hospital Xxxxxxxx Xxxxxxx LTAC Hospital of Xxxxxxx Xxxxxxx Xxxxxxxx Manhattan Surgical Hospital Manhattan Xxxxx XxXxxxxxx Memorial Hospital XxXxxxxxx XxXxxxxxx Meadowbrook Hospital Xxxxxxx Xxxxxxx Menorah Medical Center Overland Park Xxxxxxx Xxxxx Health Center - Fort Xxxxx Fort Xxxxx Xxxxxxx Mercy Health Center - Independence Independence Xxxxxxxxxx Xxxxx Hospital - Moundridge Moundridge XxXxxxxxx Xxxxx Regional Health Center Manhattan Xxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Miami County Medical Center Paola Miami Mid-America Rehabilitation Hospital Overland Xxxx Xxxxxxx Xxxxxx County Health System Xxxxxxx Xxxxxx Mount Carmel Regional Medical Center Pittsburg Xxxxxxxx Xxxxxx Regional Health Emporia Xxxx Xxxxxx Medical Center Xxxxxx Xxxxxx Olathe Medical Center Xxxxxx Xxxxxxx Overland Park Regional Medical Center Overland Park Johnson Xxxxx Regional Medical Center Pratt Pratt Promise Regional Medical Center Xxxxxxxxxx Xxxx Providence Medical Center Kansas City Wyandotte Xxxxxx Memorial Hospital Ottawa Franklin Saint Xxxxxxxxx Hospital Garden City Xxxxxx Saint Xxxxxxx Health Center Topeka Shawnee Saint Xxxx Hospital Leavenworth Leavenworth Saint Luke's South Hospital Overland Park Xxxxxxx Xxxxxx Regional Health Center Salina Saline Salina Surgical Hospital Salina Saline Select Specialty Hospital Kansas City Overland Park Xxxxxxx Select Specialty Hospital Topeka Topeka Shawnee Select Specialty Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Xxxxxxx Mission Medical Center Overland Park Johnson South Central Kansas RMC Arkansas City Xxxxxx Southwest Medical Center Liberal Xxxxxx Specialty Hospital of Mid- America Overland Park Johnson Xxxxxxxx-Xxxx Regional Health Center Topeka Shawnee Summit Surgical, LLC Xxxxxxxxxx Xxxx Xxxxxx Regional Medical Center Wellington Xxxxxx Xxxxx X. Xxxxx Memorial Hospital El Dorado Xxxxxx Via Xxxxxxx Hospital St. Xxxxxx Wichita Xxxxxxxx Via Christi Regional Medical Center Xxxxxxx Xxxxxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Via Christi Rehabilitation Center Xxxxxxx Xxxxxxxx Xxxxxx Medical Center Xxxxxxx Xxxxxxxx Xxxxxx Rehabilitation Hospital Xxxxxxx Xxxxxxxx Western Plains Medical Complex Dodge City Ford ATTACHMENT D LPTH/BCCH Hospitals Hospital Name City County Large Public Teaching Hospital The University of Kansas Hospital Kansas City, KS Wyandotte Border City Children's Hospital Children's Mercy Hospital Kansas City, XX Xxxxxxx ATTACHMENT E UC Payment Application Template [PLACEHOLDER: Following CMS review and approval, the UC Payment Application Template (see STC 68) will be placed in this attachment] ATTACHMENT F DSRIP Planning Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Planning Protocol (see STC 69) will be placed in this attachment] ATTACHMENT G DSRIP Funding and Mechanics Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Funding and Mechanics Protocol (see STC 69) will be placed in this attachment] ATTACHMENT H Ombudsman Plan The following report was submitted by the state of Kansas on November 26, 2012, as a part of CMS’ KanCare review. This report describes the qualified independent, conflict-free entity which will assist KanCare enrollees in the resolution of problems and conflicts between the MCOs and participants regarding services, coverage, access and rights. The Ombudsman should help participants understand the fair hearing, grievance, and appeal rights and processes at each MCO and proactively assist them through the process if needed. Ombudsman activities are available to all demonstration eligible populations, but specific focus and outreach activities will be directed towards KanCare enrollees utilizing LTSS (institutional, residential and community based). (see STC 41). [REMAINDER OF THIS PAGE INTENTIONALLY BLANK] ATTACHMENT H Ombudsman Plan Xxxxxx State Office Building 000 XX Xxxxxxx Street, Room 900-N Topeka, KS 66612 Phone: 000-000-0000 Fax: 000-000-0000 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxxx Xxxxxxxx, Director Xxx Xxxxxxxxx, Governor KanCare Implementation Activity: KanCare Consumer Ombudsman Date Updated: Dec. 5, 2012 Purpose: The ombudsman will help Kansas consumers enrolled in a KanCare plan, with a primary focus on individuals participating in the HCBS waiver program or receiving other long term care services through KanCare. The ombudsman will assist KanCare consumers with access, service and benefit problems. The ombudsman will provide information about the KanCare grievance and appeal process that is available through the KanCare plans and the State fair hearing process, and assist KanCare consumers seek resolution to complaints or concerns regarding their fair treatment and interaction with their KanCare plan. The ombudsman will: • Help consumers to resolve service-related problems when resolution is not available directly through a provider or health plan. • Help consumers understand and resolve billing issues, or notices of non-coverage. • Assist consumers learn and navigate the grievance and appeal process at the KanCare plan, and the State fair hearing process, and help them as needed. • Assist consumers to seek remedies when they feel their rights have been violated. • Assist consumers understand their KanCare plan and how to interact with the programs benefits. • Serve as a point of contact and resource for legislative and other inquiries into the provision of LTSS in managed care. Organization:
Appears in 1 contract
Samples: kancare.ks.gov
Safety Net Care Pool. Provide updates on any activities or planning related to payment reform initiatives or delivery system reforms impacting demonstration population and/or undertaken in relation to the SNCP. As per STC 69, include projected or actual changes in SNCP payments and expenditures within the quarterly report. Please note that the annual report must also include SNCP reporting as required by STC 69. Demonstration Evaluation Discuss progress of evaluation design and planning. Enclosures/Attachments Identify by title any attachments along with a brief description of what information the document contains. State Contact(s) Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. ATTACHMENT A Quarterly Report Content and Format Date Submitted to CMS ATTACHMENT B Historical Budget Neutrality Data SFY07 SFY08 SFY09 SFY10 SFY11 5-YEARS Medicaid Pop 1 ABD/SD Dual TOTAL EXPENDITURES $ 44,236,459 $ 43,025,422 $42,691,201 $40,506,394 $40,532,103 $210,991,580 Eligible Member Months 208,752 202,688 198,906 200,134 210,200 PMPM COST $ 211.91 $212.27 $214.63 $202.40 $192.83 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE -2.74% -0.78% -5.12% 0.06% -2.16% ELIGIBLE MEMBER MONTHS -2.90% -1.87% 0.62% 5.03% 0.17% PMPM COST 0.17% 1.11% -5.70% -4.73% -2.33% Medicaid Pop 2 ABD/SD Non Dual TOTAL EXPENDITURES $262,996,600 $287,521,460 $302,718,060 $318,094,717 $353,270,763 $1,524,601,599 ELIGIBLE DELIVERIES 277,577 287,295 303,044 325,477 345,539 PMPM COST $947.47 $1,000.79 $998.92 $ 977.32 $1,022.38 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 9.33% 3.50% 5.63% 5.29% 5.48% -0.19% 5.08% 7.40% -2.16% 11.06% 6.16% 4.61% 7.66% 5.63% 1.92% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 3 Adults TOTAL EXPENDITURES $145,696,984 $178,511,453 $ 182,736,445 $192,965,697 $215,135,856 $915,046,435 Eligible Member Months 341,481 302,194 297,411 327,511 383,991 PMPM COST $426.66 $590.72 $614.42 $589.19 $560.26 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 22.52% -11.51% 38.45% 2.37% -1.58% 4.01% 5.60% 10.12% -4.11% 11.49% 17.25% -4.91% 10.23% 2.98% 7.05% Medicaid Pop 4 Children TOTAL EXPENDITURES $339,146,737 $391,345,646 $395,809,865 $395,188,873 $469,903,838 $1,991,394,959 Eligible Member Months 1,842,324 1,807,933 1,862,831 2,088,632 2,297,347 PMPM COST $184.09 $216.46 $212.48 $189.21 $204.54 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 15.39% 1.14% -0.16% 18.91% 8.49% ELIGIBLE MEMBER MONTHS -1.87% 3.04% 12.12% 9.99% 5.67% PMPM COST 17.59% -1.84% -10.95% 8.10% 2.67% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 5 DD Waiver TOTAL EXPENDITURES $317,272,274 $333,079,826 $352,328,338 $361,930,538 $378,141,817 $1,742,752,793 Eligible Member Months 88,021 92,716 94,654 98,443 100,367 PMPM COST $3,604.51 $3,592.47 $3,722.28 $3,676.54 $3,767.57 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST 4.98% 5.33% -0.33% 5.78% 2.09% 3.61% 2.73% 4.00% -1.23% 4.48% 1.95% 2.48% 4.49% 3.34% 1.11% Medicaid Pop 6 LTC TOTAL EXPENDITURES $714,587,999 $764,736,723 $837,320,779 $802,268,440 $893,612,115 $4,012,526,055 Eligible Member Months 278,125 285,098 295,461 288,224 284,917 PMPM COST $2,569.30 $2,682.36 $2,833.94 $2,783.49 $3,136.39 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 7.02% 9.49% -4.19% 11.39% 5.75% ELIGIBLE MEMBER MONTHS 2.51% 3.64% -2.45% -1.15% 0.60% PMPM COST 4.40% 5.65% -1.78% 12.68% 5.11% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 7 MN Dual TOTAL EXPENDITURES $37,210,534 $34,425,301 $28,602,622 $42,253,903 $34,382,233 $176,874,594 Eligible Member Months 35,739 31,269 28,620 30,996 27,711 PMPM COST $1,041.17 $1,100.96 $999.38 $1,363.19 $1,240.76 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE ELIGIBLE MEMBER MONTHS PMPM COST -7.49% -12.51% 5.74% -16.91% -8.47% -9.23% 47.73% 8.30% 36.40% -18.63% -10.60% -8.98% -1.96% -6.16% 4.48% Medicaid Pop 8 TOTAL EXPENDITURES Eligible Member Months PMPM COST MN Non Dual $24,500,245 21,421 $1,143.73 $28,139,319 26,080 $1,078.96 $30,191,137 21,895 $1,378.92 $28,559,359 19,534 $1,462.00 $31,471,604 19,602 $1,605.55 $142,861,664 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE 14.85% 7.29% -5.40% 10.20% 6.46% ELIGIBLE MEMBER MONTHS 21.75% -16.05% -10.78% 0.34% -2.19% PMPM COST -5.66% 27.80% 6.02% 9.82% 8.85% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 9 Waiver TOTAL EXPENDITURES $61,320,583 $79,821,639 $118,700,459 $138,297,856 $149,625,842 $ 547,766,379 Eligible Member Months 34,936 42,109 53,790 61,202 64,235 PMPM COST $1,755.22 $1,895.60 $2,206.74 $2,259.68 $2,329.36 TREND RATES 5-YEAR ANNUAL CHANGE AVERAGE TOTAL EXPENDITURE 30.17% 48.71% 16.51% 8.19% 24.98% ELIGIBLE MEMBER MONTHS 20.53% 27.74% 13.78% 4.95% 16.45% PMPM COST 8.00% 16.41% 2.40% 3.08% 7.33% ATTACHMENT C HCAIP Hospitals Hospital Name City County Blue Valley Hospital Inc. Overland Park Johnson Xxx Xxxxxx Memorial Hospital Xxxxxxx Xxxxx Children's Mercy Hospital South Overland Park Johnson Xxxxxx County Hospital Burlington Xxxxxx Coffeyville Regional Medical Center Coffeyville Xxxxxxxxxx Xxxxxxx Memorial Hospital Leavenworth Leavenworth Doctors Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Heart Hospital Xxxxxxx Xxxxxxxx Xxxxx Community Hospital Junction City Xxxxx Great Bend Regional Hospital, LLC Great Bend Xxxxxx Xxxx Medical Center Xxxx Xxxxx Heartland Spine & Specialty Hospital Overland Park Xxxxxxx Kansas City Orthopaedic Orthopedic Institute Leawood Xxxxxxx Kansas Heart Hospital Xxxxxxx Xxxxxxxx Kansas Medical Center Andover Xxxxxx Kansas Rehabilitation Hospital Topeka Shawnee Kansas Spine Hospital Wichita Sedgwick Kansas Surgery & Recovery Center Xxxxxxx Xxxxxxxx Labette County Medical Center Xxxxxxx Xxxxxxx Xxxxxxxx Memorial Hospital Xxxxxxxx Xxxxxxx LTAC Hospital of Xxxxxxx Xxxxxxx Xxxxxxxx Manhattan Surgical Hospital Manhattan Xxxxx XxXxxxxxx Memorial Hospital XxXxxxxxx XxXxxxxxx Meadowbrook Hospital Xxxxxxx Xxxxxxx Menorah Medical Center Overland Park Xxxxxxx Xxxxx Health Center - Fort Xxxxx Fort Xxxxx Xxxxxxx Mercy Health Center - Independence Independence Xxxxxxxxxx Xxxxx Hospital - Moundridge Moundridge XxXxxxxxx Xxxxx Regional Health Center Manhattan Xxxxx Miami County Medical Center Paola Miami ATTACHMENT C HCAIP Hospitals Hospital Name City County Miami County Medical Center Paola Miami Mid-America Rehabilitation Hospital Overland Xxxx Xxxxxxx Xxxxxx County Health System Xxxxxxx Xxxxxx Mount Carmel Regional Medical Center Pittsburg Xxxxxxxx Xxxxxx Regional Health Emporia Xxxx Xxxxxx Medical Center Xxxxxx Xxxxxx Olathe Medical Center Xxxxxx Xxxxxxx Overland Park Regional Medical Center Overland Park Johnson Xxxxx Regional Medical Center Pratt Pratt Promise Regional Medical Center Xxxxxxxxxx Xxxx Providence Medical Center Kansas City Wyandotte Xxxxxx Memorial Hospital Ottawa Franklin Saint Xxxxxxxxx Hospital Garden City Xxxxxx Saint Xxxxxxx Health Center Topeka Shawnee Saint Xxxx Hospital Leavenworth Leavenworth Saint Luke's South Hospital Overland Park Xxxxxxx Xxxxxx Regional Health Center Salina Saline Salina Surgical Hospital Salina Saline Select Specialty Hospital Kansas City Overland Park Xxxxxxx Select Specialty Hospital Topeka Topeka Shawnee Select Specialty Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Xxxxxxx Mission Medical Center Overland Park Johnson South Central Kansas RMC Arkansas City Xxxxxx Southwest Medical Center Liberal Xxxxxx Specialty Hospital of Mid- America Overland Park Johnson Xxxxxxxx-Xxxx Regional Health Center Topeka Shawnee Summit Surgical, LLC Xxxxxxxxxx Xxxx Xxxxxx Regional Medical Center Wellington Xxxxxx Xxxxx X. Xxxxx Memorial Hospital El Dorado Xxxxxx Via Xxxxxxx Hospital St. Xxxxxx Wichita Xxxxxxxx Via Christi Regional Medical Center Xxxxxxx Xxxxxxxx Via Christi Rehabilitation Xxxxxxx Xxxxxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Via Christi Rehabilitation Center Xxxxxxx Xxxxxxxx Xxxxxx Medical Center Xxxxxxx Xxxxxxxx Xxxxxx Rehabilitation Hospital Xxxxxxx Xxxxxxxx Western Plains Medical Complex Dodge City Ford Marillac Center Inc Overland Park Xxxxxxx Prairie View Hospital Xxxxxx Xxxxxx ATTACHMENT D LPTH/BCCH Hospitals Hospital Name City County Large Public Teaching Hospital The University of Kansas Hospital Kansas City, KS Wyandotte Border City Children's Hospital Children's Mercy Hospital Kansas City, XX Xxxxxxx ATTACHMENT E UC Payment Application Template [PLACEHOLDER: Following CMS review and approval, the UC Payment Application Template (see STC 68) will be placed in this attachment] ATTACHMENT F DSRIP Planning Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Planning Protocol (see STC 69) will be placed in this attachment] ATTACHMENT G DSRIP Funding and Mechanics Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Funding and Mechanics Protocol (see STC 69) will be placed in this attachment] ATTACHMENT H Ombudsman Plan This attachment excluding the report from Kansas referenced below has been moved to STC 42 , which modified and supersedes this attachment.. The following report was submitted by the state of Kansas on November 26, 2012, as a part of CMS’ KanCare review. This report describes the qualified independent, conflict-free entity which will assist KanCare enrollees in the resolution of problems and conflicts between the MCOs and participants regarding services, coverage, access and rights. The Ombudsman should help participants understand the fair hearing, grievance, and appeal rights and processes at each MCO and proactively assist them through the process if needed. Ombudsman activities are available to all demonstration eligible populations, but specific focus and outreach activities will be directed towards KanCare enrollees utilizing LTSS (institutional, residential and community based). (see STC 41). [REMAINDER OF THIS PAGE INTENTIONALLY BLANK] ATTACHMENT H Ombudsman Plan Xxxxxx State Office Building Phone: 000-000-0000 000 XX Xxxxxxx Street, Room 900-N Topeka, KS 66612 Phone: 000-000-0000 Fax: 000-000-0000 Topeka, KS 66612 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxx Xxxxxxxxx, Governor Xxxx Xxxxxxxx, Director Xxx Xxxxxxxxx, Governor KanCare Implementation Activity: :KanCare Consumer Ombudsman Date Updated: Dec. 5, 2012 Purpose: The ombudsman will help Kansas consumers enrolled in a KanCare plan, with a primary focus on individuals participating in the HCBS waiver program or receiving other long term care services through KanCare. The ombudsman will assist KanCare consumers with access, service and benefit problems. The ombudsman will provide information about the KanCare grievance and appeal process that is available through the KanCare plans and the State fair hearing process, and assist KanCare consumers seek resolution to complaints or concerns regarding their fair treatment and interaction with their KanCare plan. The ombudsman will: Help consumers to resolve service-related problems when resolution is not available directly through a provider or health plan. Help consumers understand and resolve billing issues, or notices of non-coverage. Assist consumers learn and navigate the grievance and appeal process at the KanCare plan, and the State fair hearing process, and help them as needed. Assist consumers to seek remedies when they feel their rights have been violated. Assist consumers understand their KanCare plan and how to interact with the programs benefits. Serve as a point of contact and resource for legislative and other inquiries into the provision of LTSS in managed care. Organization:: The KanCare Ombudsman will be located in the Kansas Department for Aging and Disability Services (KDADS). The Ombudsman will be organizationally independent from other KDADS commissions which set and direct Medicaid program, and reimbursement policy. The Ombudsman will receive administrative and legal support from the Office of the Secretary division of KDADS.
Appears in 1 contract
Samples: clpc.ucsf.edu
Safety Net Care Pool. Provide updates on any activities or planning related to payment reform initiatives or delivery system reforms impacting demonstration population and/or undertaken in relation to the SNCP. As per STC 69, include projected or actual changes in SNCP payments and expenditures within the quarterly report. Please note that the annual report must also include SNCP reporting as required by STC 69. Demonstration Evaluation Discuss progress of evaluation design and planning. Enclosures/Attachments Identify by title any attachments along with a brief description of what information the document contains. State Contact(s) Identify individuals by name, title, phone, fax, and address that CMS may contact should any questions arise. ATTACHMENT A Quarterly Report Content and Format Date Submitted to CMS ATTACHMENT B Historical Budget Neutrality Data SFY07 SFY08 SFY09 SFY10 SFY11 5-YEARS Medicaid Pop 1 ABD/SD Dual TOTAL EXPENDITURES $ 44,236,459 $ 43,025,422 $42,691,201 $40,506,394 $40,532,103 $210,991,580 Eligible Member Months 208,752 202,688 198,906 200,134 210,200 PMPM COST $ 211.91 $212.27 $214.63 $202.40 $192.83 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE TOTAL EXPENDITURE -2.74% -0.78% -5.12% 0.06% -2.16% ELIGIBLE MEMBER MONTHS -2.90% -1.87% 0.62% 5.03% 0.17% PMPM COST 0.17% 1.11% -5.70% -4.73% -2.33% Medicaid Pop 2 ABD/SD Non Dual TOTAL EXPENDITURES $262,996,600 $287,521,460 $302,718,060 $318,094,717 $353,270,763 $1,524,601,599 ELIGIBLE DELIVERIES 277,577 287,295 303,044 325,477 345,539 PMPM COST $947.47 $1,000.79 $998.92 $ 977.32 $1,022.38 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 9.33% 5.29% 5.08% 11.06% 7.66% ELIGIBLE MEMBER MONTHS PMPM COST 9.333.50% 3.505.48% 7.40% 6.16% 5.63% 5.29% 5.48PMPM COST 5.63% -0.19% 5.08% 7.40% -2.16% 11.06% 6.16% 4.61% 7.66% 5.63% 1.92% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 3 Adults TOTAL EXPENDITURES $145,696,984 $178,511,453 $ 182,736,445 $192,965,697 $215,135,856 $915,046,435 Eligible Member Months 341,481 302,194 297,411 327,511 383,991 PMPM COST $426.66 $590.72 $614.42 $589.19 $560.26 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 22.52% 2.37% 5.60% 11.49% 10.23% ELIGIBLE MEMBER MONTHS PMPM COST 22.52% -11.51% 38.45% 2.37% -1.58% 10.12% 17.25% 2.98% PMPM COST 38.45% 4.01% 5.60% 10.12% -4.11% 11.49% 17.25% -4.91% 10.23% 2.98% 7.05% Medicaid Pop 4 Children TOTAL EXPENDITURES $339,146,737 $391,345,646 $395,809,865 $395,188,873 $469,903,838 $1,991,394,959 Eligible Member Months 1,842,324 1,807,933 1,862,831 2,088,632 2,297,347 PMPM COST $184.09 $216.46 $212.48 $189.21 $204.54 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 15.39% 1.14% -0.16% 18.91% 8.49% ELIGIBLE MEMBER MONTHS -1.87% 3.04% 12.12% 9.99% 5.67% PMPM COST 17.59% -1.84% -10.95% 8.10% 2.67% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 5 DD Waiver TOTAL EXPENDITURES $317,272,274 $333,079,826 $352,328,338 $361,930,538 $378,141,817 $1,742,752,793 Eligible Member Months 88,021 92,716 94,654 98,443 100,367 PMPM COST $3,604.51 $3,592.47 $3,722.28 $3,676.54 $3,767.57 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 4.98% 5.78% 2.73% 4.48% 4.49% ELIGIBLE MEMBER MONTHS PMPM COST 4.98% 5.33% -0.33% 5.78% 2.09% 4.00% 1.95% 3.34% PMPM COST -0.33% 3.61% 2.73% 4.00% -1.23% 4.48% 1.95% 2.48% 4.49% 3.34% 1.11% Medicaid Pop 6 LTC TOTAL EXPENDITURES $714,587,999 $764,736,723 $837,320,779 $802,268,440 $893,612,115 $4,012,526,055 Eligible Member Months 278,125 285,098 295,461 288,224 284,917 PMPM COST $2,569.30 $2,682.36 $2,833.94 $2,783.49 $3,136.39 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 7.02% 9.49% -4.19% 11.39% 5.75% ELIGIBLE MEMBER MONTHS 2.51% 3.64% -2.45% -1.15% 0.60% PMPM COST 4.40% 5.65% -1.78% 12.68% 5.11% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 7 MN Dual TOTAL EXPENDITURES $37,210,534 $34,425,301 $28,602,622 $42,253,903 $34,382,233 $176,874,594 Eligible Member Months 35,739 31,269 28,620 30,996 27,711 PMPM COST $1,041.17 $1,100.96 $999.38 $1,363.19 $1,240.76 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE -7.49% -16.91% 47.73% -18.63% -1.96% ELIGIBLE MEMBER MONTHS PMPM COST -7.49% -12.51% 5.74% -16.91% -8.47% 8.30% -10.60% -6.16% PMPM COST 5.74% -9.23% 47.73% 8.30% 36.40% -18.63% -10.60% -8.98% -1.96% -6.16% 4.48% Medicaid Pop 8 MN Non Dual TOTAL EXPENDITURES $24,500,245 $28,139,319 $30,191,137 $28,559,359 $31,471,604 $142,861,664 Eligible Member Months 21,421 26,080 21,895 19,534 19,602 PMPM COST MN Non Dual $24,500,245 21,421 $1,143.73 $28,139,319 26,080 $1,078.96 $30,191,137 21,895 $1,378.92 $28,559,359 19,534 $1,462.00 $31,471,604 19,602 $1,605.55 $142,861,664 TREND RATES ANNUAL CHANGE 5-YEAR AVERAGE ANNUAL CHANGE TOTAL EXPENDITURE 14.85% 7.29% -5.40% 10.20% 6.46% ELIGIBLE MEMBER MONTHS 21.75% -16.05% -10.78% 0.34% -2.19% PMPM COST -5.66% 27.80% 6.02% 9.82% 8.85% ATTACHMENT B Historical Budget Neutrality Data Medicaid Pop 9 Waiver TOTAL EXPENDITURES $61,320,583 $79,821,639 $118,700,459 $138,297,856 $149,625,842 $ 547,766,379 Eligible Member Months 34,936 42,109 53,790 61,202 64,235 PMPM COST $1,755.22 $1,895.60 $2,206.74 $2,259.68 $2,329.36 TREND RATES 5-YEAR AVERAGE ANNUAL CHANGE AVERAGE TOTAL EXPENDITURE 30.17% 48.71% 16.51% 8.19% 24.98% ELIGIBLE MEMBER MONTHS 20.53% 27.74% 13.78% 4.95% 16.45% PMPM COST 8.00% 16.41% 2.40% 3.08% 7.33% ATTACHMENT C HCAIP Hospitals Hospital Name City County Blue Valley Hospital Inc. Overland Park Johnson Xxx Xxxxxx Memorial Hospital Xxxxxxx Xxxxx Children's Mercy Hospital South Overland Park Johnson Xxxxxx County Hospital Burlington Xxxxxx Coffeyville Regional Medical Center Coffeyville Xxxxxxxxxx Xxxxxxx Memorial Hospital Leavenworth Leavenworth Doctors Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Heart Hospital Xxxxxxx Xxxxxxxx Xxxxx Community Hospital Junction City Xxxxx Great Bend Regional Hospital, LLC Great Bend Xxxxxx Xxxx Medical Center Xxxx Xxxxx Heartland Spine & Specialty Hospital Overland Park Xxxxxxx Kansas City Orthopaedic Institute Leawood Xxxxxxx Kansas Heart Hospital Xxxxxxx Xxxxxxxx Kansas Medical Center Andover Xxxxxx Kansas Rehabilitation Hospital Topeka Shawnee Kansas Spine Hospital Wichita Sedgwick Kansas Surgery & Recovery Center Xxxxxxx Xxxxxxxx Labette County Medical Center Xxxxxxx Xxxxxxx Xxxxxxxx Memorial Hospital Xxxxxxxx Xxxxxxx LTAC Hospital of Xxxxxxx Xxxxxxx Xxxxxxxx Manhattan Surgical Hospital Manhattan Xxxxx XxXxxxxxx Memorial Hospital XxXxxxxxx XxXxxxxxx Meadowbrook Hospital Xxxxxxx Xxxxxxx Menorah Medical Center Overland Park Xxxxxxx Xxxxx Health Center - Fort Xxxxx Fort Xxxxx Xxxxxxx Mercy Health Center - Independence Independence Xxxxxxxxxx Xxxxx Hospital - Moundridge Moundridge XxXxxxxxx Xxxxx Regional Health Center Manhattan Xxxxx Miami County Medical Center Paola Miami ATTACHMENT C HCAIP Hospitals Hospital Name City County Miami County Medical Center Paola Miami Mid-America Rehabilitation Hospital Overland Xxxx Xxxxxxx Xxxxxx County Health System Xxxxxxx Xxxxxx Mount Carmel Regional Medical Center Pittsburg Xxxxxxxx Xxxxxx Regional Health Emporia Xxxx Xxxxxx Medical Center Xxxxxx Xxxxxx Olathe Medical Center Xxxxxx Xxxxxxx Overland Park Regional Medical Center Overland Park Johnson Xxxxx Regional Medical Center Pratt Pratt Promise Regional Medical Center Xxxxxxxxxx Xxxx Providence Medical Center Kansas City Wyandotte Xxxxxx Memorial Hospital Ottawa Franklin Saint Xxxxxxxxx Hospital Garden City Xxxxxx Saint Xxxxxxx Health Center Topeka Shawnee Saint Xxxx Hospital Leavenworth Leavenworth Saint Luke's South Hospital Overland Park Xxxxxxx Xxxxxx Regional Health Center Salina Saline Salina Surgical Hospital Salina Saline Select Specialty Hospital Kansas City Overland Park Xxxxxxx Select Specialty Hospital Topeka Topeka Shawnee Select Specialty Hospital Xxxxxxx Xxxxxxx Xxxxxxxx Xxxxxxx Mission Medical Center Overland Park Johnson South Central Kansas RMC Arkansas City Xxxxxx Southwest Medical Center Liberal Xxxxxx Specialty Hospital of Mid- America Overland Park Johnson Xxxxxxxx-Xxxx Regional Health Center Topeka Shawnee Summit Surgical, LLC Xxxxxxxxxx Xxxx Xxxxxx Regional Medical Center Wellington Xxxxxx Xxxxx X. Xxxxx Memorial Hospital El Dorado Xxxxxx Via Xxxxxxx Hospital St. Xxxxxx Wichita Xxxxxxxx Via Christi Regional Medical Center Xxxxxxx Xxxxxxxx Via Christi Rehabilitation Xxxxxxx Xxxxxxxx ATTACHMENT C HCAIP Hospitals Hospital Name City County Via Christi Rehabilitation Center Xxxxxxx Xxxxxxxx Xxxxxx Medical Center Xxxxxxx Xxxxxxxx Xxxxxx Rehabilitation Hospital Xxxxxxx Xxxxxxxx Western Plains Medical Complex Dodge City Ford ATTACHMENT D LPTH/BCCH Hospitals Hospital Name City County Large Public Teaching Hospital The University of Kansas Hospital Kansas City, KS Wyandotte Border City Children's Hospital Children's Mercy Hospital Kansas City, XX Xxxxxxx ATTACHMENT E UC Payment Application Template [PLACEHOLDER: Following CMS review and approval, the UC Payment Application Template (see STC 68) will be placed in this attachment] ATTACHMENT F DSRIP Planning Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Planning Protocol (see STC 69) will be placed in this attachment] ATTACHMENT G DSRIP Funding and Mechanics Protocol [PLACEHOLDER: Following CMS review and approval, the DSRIP Funding and Mechanics Protocol (see STC 69) will be placed in this attachment] ATTACHMENT H Ombudsman Plan The following report was submitted by the state of Kansas on November 26, 2012, as a part of CMS’ KanCare review. This report describes the qualified independent, conflict-free entity which will assist KanCare enrollees in the resolution of problems and conflicts between the MCOs and participants regarding services, coverage, access and rights. The Ombudsman should help participants understand the fair hearing, grievance, and appeal rights and processes at each MCO and proactively assist them through the process if needed. Ombudsman activities are available to all demonstration eligible populations, but specific focus and outreach activities will be directed towards KanCare enrollees utilizing LTSS (institutional, residential and community based). (see STC 41). [REMAINDER OF THIS PAGE INTENTIONALLY BLANK] ATTACHMENT H Ombudsman Plan Xxxxxx State Office Building 000 XX Xxxxxxx Street, Room 900000-N TopekaX Xxxxxx, KS 66612 XX 00000 Xxxxxx Xxxxx, MD, Secretary Xxxx Xxxxxxxx, Director Phone: 000-000-0000 Fax: 000-000-0000 xxx.xxxxxx.xxx/xxx/ Xxxxxx Xxxxx, MD, Secretary Xxxx Xxxxxxxx, Director Xxx Xxxxxxxxx, Governor KanCare Implementation Activity: KanCare Consumer Ombudsman Date Updated: Dec. 5, 2012 Purpose: The ombudsman will help Kansas consumers enrolled in a KanCare plan, with a primary focus on individuals participating in the HCBS waiver program or receiving other long term care services through KanCare. The ombudsman will assist KanCare consumers with access, service and benefit problems. The ombudsman will provide information about the KanCare grievance and appeal process that is available through the KanCare plans and the State fair hearing process, and assist KanCare consumers seek resolution to complaints or concerns regarding their fair treatment and interaction with their KanCare plan. The ombudsman will: • Help consumers to resolve service-related problems when resolution is not available directly through a provider or health plan. • Help consumers understand and resolve billing issues, or notices of non-coverage. • Assist consumers learn and navigate the grievance and appeal process at the KanCare plan, and the State fair hearing process, and help them as needed. • Assist consumers to seek remedies when they feel their rights have been violated. • Assist consumers understand their KanCare plan and how to interact with the programs benefits. • Serve as a point of contact and resource for legislative and other inquiries into the provision of LTSS in managed care. Organization:
Appears in 1 contract
Samples: www.medicaid.gov
