Kansas to Launch Health Homes Initiative
July 16, 2014 10:47 AM
Kansas officials plan to launch a Medicaid health homes initiative in the state, with beneficiaries expected to receive services beginning August 1. Kansas has not yet received formal approval of its proposed state plan amendments to enact the initiative, but local officials expect such approval. If approved, the federal government will pay for 90 percent of the costs in the first two years. KanCare’s three managed care organizations (MCOs) will manage the program. The health homes initiative would represent a merging of both the Affordable Care Act, which calls for the implementation of such health homes, and KanCare, which is Kansas’ recent transition from fee-for-service Medicaid to managed care.
The population eligible for enrollment in Kansas’ health homes will be limited to those Medicaid enrollees diagnosed with serious mental illness (SMI), estimated at about 36,000 people. Eventually, eligibility will expand to those who have asthma or diabetes, and are at risk of developing another chronic condition; these criteria are expected to expand eligibility by another 38,000 people. Eligible participants will be notified by mail that they will be included in the initiative unless they choose to opt out. Officials predict that 75 percent, or around 55,000, of eligible participants will stay in the health home initiative, while the rest will opt out (and remain in Medicaid).
State plan amendments have been submitted to the federal government for both the SMI and the chronic conditions populations.
Services provided by the health homes include: care coordination and health promotion; comprehensive care management; comprehensive transitional care, including follow-up, from impatient to other settings; patient and family/authorized representative support; referral to community and social support services, when applicable; and use of health information technology to integrate services, where applicable and feasible.
In its proposed SPA, Kansas requested its health home model take the form of a “team of health professionals” and includes “health home partners” such as home health agencies. Centers for independent living, community developmental disability organizations, community mental health centers, and physician groups have expressed interest in joining the health homes, and are doing so via renegotiating existing contracts with the three KanCare MCOs.
Praise and Skepticism
Kansas officials expect the health homes initiative to reduce costs to the Medicaid program. They previously predicted that the state would save $7 million from reduced medical expenses, and $24 million in general fund expenditures due to federal support, in the first two years.
However, the health home initiative has been delayed, likely effecting those predictions. The whole initiative had originally been slated to launch January 1 of this year. However, sending notices to the expanded asthma and diabetes population has been pushed from this month to at least January 1 of next year due to an inadequate provider network. At the time of this writing, notices to the SMI population were scheduled to be released on July 2 of this year.
Kansas will pay the MCOs a per member per month (PMPM) rate for each enrollee. The MCOs will in turn negotiate payment rates with the health home providers. While the latter will likely be a PMPM arrangement, the parties can negotiate alternative payment structures. Such alternative payment structures must be approved by the state. For details, click here.
To see more details of Kansas’ health homes, click here, here, and here. To see a recent Council brief on health homes, click here.
While home care agencies are included as possible providers in Kansas’ health homes, the Council has yet to find evidence of home health agencies in Kansas expressing such an interest. Jane Kelly, Executive Director of the Kansas Home Care Association (KHCA), stated “Many of our home health agencies felt there wasn’t much of an incentive for them to apply to be a participating provider.”
States should nonetheless continue to monitor health home developments, especially in the five states where in the states where home care companies explicitly included in the health home design, as is the case currently with Idaho, Iowa, Maine, New York, and Washington State.