KanCare OmbudsmanVolunteer Training Program

Day 3 – Online Training

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Outline of Training – Day 3

• Brief review of Day 1 and Day 2• Medicaid in Other States• KanCare Waivers• Waiver Waiting Lists• Targeted Case Management• PACE, Program of All-Inclusive Care for the

Elderly• Money Follows the Person

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Outline of Training – Day 3

• Health Homes• Other Agencies Involved in KanCare• Appeal Process• Grievance Process• State Fair Hearing Process• Alternatives to Medicaid

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Review of Day 1

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Review Day 1

• Introduced KanCare– KanCare = Medicaid in Kansas

• Introduced the KanCare Ombudsman– Kerrie Bacon who assists people in finding answers to

their questions and concerns about KanCare. • Introduction to Medicaid– Medicaid was established by federal law. It is

administered and managed by Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services (HHS). Medicaid is a joint project between the federal government and states in the US.

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Review Day 1

• Introduction to Medicaid, continued:– Medicaid is a health care program for people with

very low income who also meet other eligibility criteria:• Age, child or elder• Condition, pregnancy• Disability

– States don’t have to participate but all now do.• The Medicaid Timeline at kff.org:–http://

kaiserfamilyfoundation.files.wordpress.com/2008/04/5-02-13-medicaid-timeline.pdf

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Review Day 1• Medicaid definition

– Medicaid provides health coverage to nearly 60 million children, families, pregnant women, the elderly, and people with disabilities.

– Medicaid Is available in every state.– A U.S. government program, financed by federal, state, and

local funds, of hospitalization and medical insurance for persons of all ages within certain income limits.

• Federal Oversight of Medicaid– Centers for Medicare and Medicaid Services (CMS) which is a

part of the Department of Health and Human Services (HHS).• CMS administers the Medicaid Program at the federal level.

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Review Day 1

• Basic and Optional Medical Services of Medicaid

• Details of Medicaid in Kansas called KanCare– There are still some programs that are modeled

after the pre-2013 Medicaid called a fee-for-service program.

• Learned how to apply for KanCare Families with Children programs and the types of programs available.

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KanCare Groups• In Kansas you must meet the criteria for or belong to a “group” of

people to receive KanCare/Medicaid benefits. Those groups of people in Kansas include groups we discussed in Day 1 of training (bold)– Children under the age of 19– Pregnant women– Low income families– People age 65 and over– Persons determined blind or disabled by the Social Security

Administration• Reminder: In Kansas there are two types of Medicaid/KanCare

applications: – Medical Assistance for Families with Children– Medical Assistance for the Elderly and Disabled

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Review - Basic Medicaid Services• Inpatient hospital services• Outpatient hospital services• EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services • Nursing Facility Services• Home health services• Physician services• Rural health clinic services• Federally qualified health center services• Laboratory and X-ray services• Family planning services• Nurse Midwife services• Certified Pediatric and Family Nurse Practitioner services• Freestanding Birth Center services (when licensed or otherwise recognized by

the state)• Transportation to medical care• Tobacco cessation counseling for pregnant women

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Review - Optional Medicaid Services •Prescription Drugs•Clinic services•Physical therapy• Occupational therapy• Speech, hearing and language disorder services• Respiratory care services• Other diagnostic, screening, preventive and rehabilitative services• Podiatry services• Optometry services• Dental Services• Dentures• Prosthetics• Eyeglasses• Chiropractic services

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Review - Optional Medicaid Services• Other practitioner services• Private duty nursing services• Personal Care• Hospice• Case management• Services for Individuals Age 65 or Older in an Institution for Mental Disease

(IMD)• Services in an intermediate care facility for the mentally retarded (ICF-MR)

**Please note the term mentally retarded is obsolete. Someone who has a disability of this nature is referred to as having an intellectual or developmental disability (I/DD)**

• State Plan Home and Community Based Services- 1915(i)• Self-Directed Personal Assistance Services- 1915(j)• Community First Choice Option- 1915(k)• TB Related Services• Inpatient psychiatric services for individuals under age 21• Other services approved by the Secretary*• Health Homes for Enrollees with Chronic Conditions – Section 1945

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How to apply for KanCareFamilies with Children

• How to apply for KanCare– Medical Assistance for Families with Children

application• Call the KanCare Clearinghouse to request an application• Complete the application, attach supporting documentation

and mail to:KanCare ClearinghousePO Box 3599Topeka, KS 66601-9738KanCare Clearinghouse contact number: 1-800-792-4884KanCare Clearinghouse fax number: 1-800-498-1255

• Always keep copies of information you send to the KanCare Clearinghouse

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How to apply for KanCareFamilies with Children

• Apply Online!• https://cssp.kees.ks.gov/apspssp/– There is a quick screen for eligibility or– Apply for Medical Assistance

• Remember to keep a copy of what is sent to the KanCare Clearinghouse.

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KanCare Application

• Also please remember that there are two types of applications:– Medical Assistance for Families with Children– Medical Assistance for the Elderly and Disabled

• If the wrong version of the application is sent in to be processed, it will delay benefits.

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Review of Day 2

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Review – Day 2

• KanCare/Medicaid, Medical Assistance for the Elderly and Disabled

• Elderly and Disabled Application• Financial Eligibility and Requirements• Types of Assistance for Elderly and Disabled• Estate Recovery• Groups Excluded from KanCare

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Review – Day 2

• KanCare/Medicaid Application for Medical Assistance for the Elderly and Disabled

• Elderly and Disabled Application• Financial Eligibility and Requirements• Types of Assistance for Elderly and Disabled• Estate Recovery• Groups Excluded from KanCare

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KanCare Groups• In Kansas you must meet the criteria or belong to a “group” of

people to receive KanCare/Medicaid benefits. Those groups of people in Kansas included in Day 2 (in bold):– Children under the age of 19– Pregnant women– Low income families

– People age 65 and over– Persons determined blind or disabled by the Social Security

Administration• Reminder: In Kansas there are two types of KanCare/Medicaid

applications: – Medical Assistance for the Elderly & Disabled– Medical Assistance for Families with Children

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KanCare Application for Elderly and Disabled

• KanCare website: http://www.kancare.ks.gov• Multiple ways to apply– Request an application from the local DCF office or

print the application from the above website. This application can be delivered, mailed or faxed to your local DCF Office.

• How to locate the nearest DCF Service Centerhttp://www.dcf.ks.gov/services/Pages/DCFOfficeLocatorMap.aspx

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How to apply for KanCareElderly and Disabled

• Apply Online!• https://cssp.kees.ks.gov/apspssp/– There is a quick screen for eligibility or– Apply for Medical Assistance

• Remember to keep a copy of what is sent to the KanCare Clearinghouse.

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KanCare/Medicaid for Elderly & Disabled

• The front page of the KanCare application gives a very good description of the benefits available to elderly and disabled persons.

• See this link to the elderly and disabled application http://www.kancare.ks.gov/download/advisory_council/KC1500_ED_Medical_Application.pdf

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KanCare/Medicaid for Elderly & Disabled

• Medically Needy– Spend down

• Working Healthy• HCBS– Home and Community Based Services

• Nursing Home• Child in an institution• PACE– Program of All-Inclusive Care for the Elderly (PACE)– This particular program is not a part of KanCare

• Medicare Savings Program

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Medicaid in Kansas• We have looked at the Medicaid Timeline in Day 1 of

training and discussed that until 2013 Elderly and Persons with Disabilities (Medicaid) was a fee-for-service program.

• This program was not sustainable for Kansas and changes had to be made. Fee for service program was expensive and costs were increasing every year.

• KanCare was implemented in place of original Medicaid and is a managed care system.

• This is a trend among states over the past several years in order to more efficiently run the Medicaid program and meet budgetary constraints. What does Medicaid look like in other states?

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Medicaid in Other States

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Medicaid in Other States• Remember that Medicaid is a federal/state

joint project.– Each state has it’s own distinct Medicaid program.

See the link below if you are interested in how Medicaid works in other states.

– Medicaid cases do not transfer from state to state.• http://

www.medicaid.gov/medicaid-chip-program-information/by-state/by-state.html

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How many states have managed care Medicaid systems?

• What does Medicaid look like in all 50 states plus Washington, DC– http://www.gao.gov/assets/600/593781.pdf• See page 5 map

– See the chart on page 5 for more specific information on the types of Medicaid – four classifications

• What does Medicaid look like in surrounding states?

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Other States Medicaid• Nebraska Medicaid website– http://

dhhs.ne.gov/medicaid/Pages/med_medindex.aspx• Oklahoma Medicaid website– http://okhca.org/

• Missouri Medicaid benefits– http://dss.mo.gov/fsd/msmed.htm

• Colorado Medicaid home page– https://

www.colorado.gov/pacific/hcpf/colorado-medicaid

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Reminders

• Each state has it’s own Medicaid system that is unique to meet the needs of the people of that state.

• Medicaid cases and services do not transfer from state to state. If a Medicaid beneficiary moves from one state to another they will have to complete a new application in the new state and realize that it takes time for the application to be completed.

• You are doing a great job!!

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Medicaid and Waivers

• We discussed in Day 1 of training that federal law requires each state designate a SSMA, a Single State Medicaid Agency.

• In Kansas, that agency is Kansas Department of Health and Environment (KDHE).

• KDHE is responsible and accountable for the implementation of the State Plan and administration of the Medicaid program.

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KanCare Waivers

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Medicaid and Waivers

• The SSMA / KDHE establishes:– Eligibility standards within federal parameters.– Selects services to be offered, specifying the

amount, duration, and scope.– Designs the delivery of services.– Determines payment, and – Administers the program

• Remember – the Social Security Act contains the legislation (rules) of Medicaid.

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Medicaid and Waivers

• Each state has their own Medicaid plan filed with the federal government.

• The State Plan specifies the eligibility groups served, benefits provided and how the program is operated.

• All state plans and amendments must be reviewed and approved by the federal government.

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Medicaid and Waivers

• Title XIX (19) of the Social Security Act contains the federal laws with regard to Medicaid.– http://www.ssa.gov/OP_Home/ssact/title19/1900.htm

• The link above is the table of contents of the law. It is very extensive and detailed federal law.

• The federal Medicaid law permits the Secretary of Health and Human Services to grant waivers of various statutory provision.

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Medicaid and Waivers

• What are waivers?– Waivers allow states to test new or existing ways

to deliver and pay for health care services in Medicaid and CHIP.

• There are three main types of waivers1. Section 1115 Research and Demonstration Waiver

• This is the type of waiver that created KanCare

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KanCare is a Demonstration Waiver

KanCare is an 1115 waiverIt required a research and demonstration component with an independent evaluation to determine access.The entire process is documented on the KanCare website

http://www.kancare.ks.gov/medicaid_reform.htm#1115• An 1115 Waiver must demonstrate budget neutrality –

this means federal and state spending is not more than providing services without the demonstration waiver like KanCare. This type of waiver usually expires after 5 years.

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Medicaid and Waivers

2. Section 1915b – called “freedom of choice” or Managed Care waivers– States can apply for waivers to provide services

through managed care delivery systems or otherwise limit people’s choice of providers

3. Section 1915c or Home and Community Based Services (HCBS) waivers– States can apply for waivers to provide long-term

care services in home and community settings rather than institutional settings

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Another type of Waiver, Title XIX

• HCBS Waivers • In 1983, Kansas had only three waivers:– FE, I/DD, PD

• Kansas now has seven waivers: Autism, Frail Elderly (FE), I/DD, PD, Technology Assisted (TA), Traumatic Brain Injury (TBI), and Severely Emotionally Disturbed (SED).

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Waiver Details• States must submit a separate application for each

waiver type.• Because waivers are approved from different time

periods, renewals must be prepared separately. (Separate from state Medicaid application)

• The waiver application has to be submitted by the SSMA.

• Public comment is required.• Must be approved by multiple levels of federal

agencies and sometimes subject to additional requirements.

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Waiver Details

• We can view all waivers available in Kansas on the Medicaid website.– On the left side of the page under State (s)• Unclick All States, scroll down• Click on Kansas only

• We can also look at a resource in the training notebook which simplifies the information.

• http://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/waivers_faceted.html

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HCBS Waiver Details

• The Home and Community Based Programs Resource found in your Training Handbook provides information on each waiver: – What is the institutional equivalent of the waiver?– What is the purpose of the waiver?– What is the target population of the waiver?– How to access each program.

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HCBS Waivers• Are an alternative to institutionalized care.• HCBS provides opportunities for Medicaid members to

receive services in their own home or community.• These programs serve a variety of targeted

populations.• Person Centered Planning

– One of the most recent rules on HCBS services states that service planning for participants must be developed through a person centered planning process that addresses health and long-term services and support needs in a manner that reflects individual preferences and goals.

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HCBS Programs

• The Home and Community Based Programs chart will be vital to have on hand as we assist people with issues with Medicaid.

• Rather than repeating the information, on the next few slides we will create a flow chart to put the information together so you can begin to see the pieces of the information in training come together.

• First let’s look at the Frail Elderly waiver and the steps to obtain services.

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HCBS FE Waiver

MCO assigns a Care Coordinator (HCBS or Expensive)

Eligible for or apply for KanCare

*ADRC performs an assessment which shows the client meets the required score for services under

the HCBS FE waiver.

Once eligible for KanCare – choose/assigned an MCO

*Meet the criteria of the Frail Elderly (FE Waiver)*

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A Plan of Care is developed by the MCO

++Services are provided to the Frail Elderly client++

The client’s financial eligibility is reviewed yearly

Care Coordinator is required to visit the FE client two times per year (every 6 months)

The MCO performs their own assessment

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HCBS Waiver Flow Chart

• During the in-person training to become a KanCare Ombudsman Volunteer we will go through each waiver to track the process and discuss the different agencies involved in the process.

• There are blank HCBS flow charts available in your training handbook.

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More details!!Changes to Plan of Care

• A form called a 3160 is required to make changes to a Plan of Care in any program

• See the 3160 Flow Chart in your Training Handbook to track how this process works.– 3160 is submitted by the MCO Care Coordinator– Approved by KDADS

• PD, I/DD, TBI only approved by KDADS

– Passed on to DCF for coding– Returned to MCO– Changes to Plan of Care implemented.

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Waiver Waiting Lists

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Waiver Waiting Lists

• A waiting list for HCBS Waiver services occurs when the demand for services exceeds the amount of service available in a state

• Kansas currently has waiting lists for these waivers:– PD, Physical Disability– I/DD, Intellectually/Developmental Disability– Autism

• Wait list time varies

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Targeted Case Management

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Targeted Case Management

• There are some waiver programs that still receive Targeted Case Management.– SED Waiver, Severely Emotionally Disturbed– I/DD Waiver, Intellectual/Developmental Disability

• Targeted Case Management vs Care Coordination– http://

www.aging.ks.gov/HCBSProvider/Documents/TCM-CC_Handout_01_2014.pdf

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PACEProgram of All Inclusive Care for the Elderly

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PACE • Program of All-Inclusive Care for the Elderly– Please note, PACE is not a part of the KanCare Managed

Care Program. If someone choses PACE, they are opting out of KanCare/Medicaid.

• PACE is not a waiver program but still needs to be mentioned when we discuss someone who is eligible for Medicaid and needs a nursing home level of care.

• PACE is an alternative to inpatient nursing facility care.• The PACE beneficiary can be Medicare/Medicaid

eligible or Medicare/Private Pay.

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PACE• What is PACE?– The Program of All-Inclusive Care for the Elderly (PACE)

model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families/caregivers to be served in the community whenever possible.

– PACE serves individuals who are• age 55 or older• certified by their state as needing nursing home care• able to live safely in the community at the time of

enrollment• Live in a PACE service area

– Note – PACE is expanding but not yet available statewide.

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PACE• Delivering all needed medical and supportive services, a PACE program

is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:– adult day care that offers nursing, physical, occupational and recreational

therapies, meals, nutritional counseling, social work and personal care– medical care provided by a PACE physician familiar with the history, needs and

preferences of each participant– home health care and personal care– all necessary prescription drugs– social services– medical specialties, such as audiology, dentistry, optometry, podiatry and

speech therapy– respite care– hospital and nursing home care when necessary

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PACE

• Medicare and Medicaid – Full Dual Eligible– Medicare and Medicaid split the capitation amount paid

to the PACE facility to provide care.• Medicare and Private Pay– The capitation amount paid to the facility is paid by

Medicare and the person receiving PACE care.• If a consumer is interested in PACE have them

contact the local PACE facility. • PACE expansion in Kansas– http://www.khi.org/news/article/managed-care-progra

m-elderly-expand-kansas/

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Money Follows the Person (MFP)

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Money Follows the Person (MFP)

• Money Follows the Person is a federal demonstration grant to help residents of qualified institutional settings move back into their communities to live.

• This grant serves four distinct populations:1. Frail Elderly (FE)2. Physically Disabled (PD)3. Traumatic Brain Injury (TBI)4. Intellectual/Developmental Disabilities (I/DD)

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Money Follows the Person (MFP)

• Qualifications of Money Follows the Person (MFP)– A current resident of a nursing facility or

intellectual developmental disability institution with 90 days continuous stay. (Note: This does not include days reimbursed by Medicare.)

– Medicaid eligible.– Meets eligibility for waiver services.– Have an interest in moving back to the

community.

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Money Follows the Person

• See the Money Follows the Person Brochure for the General Process on how the program works.

• What kind of services may the Money Follows the Person receive?

• Unfortunately, the last transition for Money Follows the Person is December 2017 as the funding for the grant ends.

• The grant continues until 2020.

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Health Homes

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Health Homes

• Health Home services are additional services available to KanCare/Medicaid members with a serious mental illness.– The Managed Care Organization (MCO) identifies

these members through claims data or the member may be referred.

– The MCO then makes the assignment to a community provider which we call a Health Home Partner.

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Health Homes– The Health Home Partner Care Coordinator reaches out to

the member to preform a health assessment and develop a Health Action Plan.

– The Health Action Plan includes several health related goals.

• Health Home Services are defined by CMS as comprehensive case management, care coordination, comprehensive transitional care, patient and family support, referral to community and social supports and health promotion.

•Health Home website: http://www.kancare.ks.gov/health_home.htm

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Other Agencies Involved inKanCare/Medicaid

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Agencies and What They Do - HHS

• We are providing a listing of agencies involved in the Medicaid process working from the National level down to the local Kansas level.– Each agency is listed by name and by function in

the Medicaid process.• HHS, Health and Human Services - protects

the health of all Americans and provides essential human services, especially for those least able to help themselves.

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Agencies and What They Do - CMS

• CMS, Centers for Medicare and Medicaid Services – an agency of the Department of Health and Human Services. CMS covers 100 million people through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace. To achieve a high quality health care system, CMS aims for better care at lower costs and improved health.

• Oversees Medicare, Medicaid and CHIP.

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Agencies and What They Do - KDHE• KDHE, Kansas Department of Health and Environment –

KDHE is a large and varied agency in the State of Kansas. KDHE Division of Health Care Financing is the Single State Medicaid Agency in Kansas. SSMA’s functions:– Allow individuals to apply for assistance and determine their

eligibility– Determine which providers are qualified to furnish covered

benefits and how much they will be reimbursed– Have a system for processing claims submitted by providers– Monitor the quality of care provided to members– Maintain the MMIS – Medicaid Management Information

System

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Agencies and What They Do- KDHE

• KDHE has other functions in Kansas as well– Division of Public Health– Division of Environment– Division of Health Care Finance– Health and Environmental Laboratories– Their website http://www.kdheks.gov/

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Agencies and What They Do

• KDHE Out-stationed Eligibility Workers – see the list of workers in your training notebook.– Started out as a grant program to increase access to

Medicaid and CHIP. – They can assist, accept, and process

KanCare/Medicaid applications– They determine eligibility– Provide Education about KanCare/Medicaid– Some have multiple locations they serve– Many are located in Federally Qualified Health Care

Centers

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Agencies and What They Do - KDADS• KDADS, Kansas Department for Aging and Disability

Services• The agency administers services to older adults;

administers behavioral health, addiction and prevention programs; manages the four state hospitals and institutions; administers the state’s Home and Community Based Services waiver programs under KanCare, the state's Medicaid program; and directs health occupations credentialing.

• KDADS is the second largest agency in state government, both in terms of budget and total number of employees.

• Website: www.kdads.ks.gov

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James Bart• James Bart is the KanCare Director of Managed Care.

– Mr. Bart started as the very first KanCare Ombudsman and transitioned to this position

– Mr. Bart is the contact for providers with questions or issued with KanCare

James BartKanCare Director of Managed Care

503 S Kansas AvenueTopeka, KS 66603

(785) 296-6754james.bart@kdads.ks.gov

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Agencies and What They Do - DCF

• DCF, Department for Children and Families– Formerly known as SRS, Social and Rehabilitation

Services– Kansas SRS was established in 1973 as an umbrella

agency to oversee the delivery of social services and the provision of care to the vulnerable. Today, the agency serves more than 500,000 Kansans.

– DCF Mission: To protect children, promote healthy families and encourage personal responsibility.

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Agencies and What They Do - DCF• More info on DCF

– The Department of Social and Rehabilitation Services (SRS) became the Department for Children and Families (DCF). This transition marked the beginning of a new agency more centrally focused on the wellbeing of children and families in Kansas.

– The Disability and Behavioral Health Services division of SRS, as well as oversight of the five state hospitals moved to the newly named Department for Aging and Disability Services.

– DCF retained its children and adult protection services, adoption services, foster care support, child support services, welfare and food assistance programs, as well as services dedicated to vocational rehabilitation, among others.

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Agencies and What They Do - MCO• Managed Care Organizations, MCO– If approved for medical assistance, your services will be

provided by one of three MCOs, Managed Care Organizations. Those services include medical, mental health, dental and long term care.

– Three MCOs in Kansas • Amerigroup• Sunflower Health Plan• United Health Care

• The MCOs are paid a capitation amount to provide services to KanCare members.

• KDHE oversees the MCOs.

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Agencies and What They Do - ADRC• ADRC, Aging and Disability Resource Centers– ADRCs are a trusted source of information where

people of all ages, abilities and income levels - and their caregivers - can go to obtain assistance in planning for their future long-term service and support needs.

– The ADRC is designed to empower older adults and persons with disabilities to make informed choices about their services and supports.

– Staff at the ADRC provide objective information and assistance to help people access private or publicly funded service programs.

– KDADS contracts with the ADRCs.

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Agencies and What They Do - CDDO

• CDDO, Community Developmental Disability Organization– Community Developmental Disability Organizations

(CDDOs) are local agencies that contract with Kansas Department for Aging and Disability Services and are responsible for ensuring service access and availability within a system of service delivery to persons with developmental disabilities in Kansas.

• Website http://www.kscddocoalition.com/sub_pages/facts.htm

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Agencies and What They Do

• CRC-KS– Provide the assessment for those on the HCBS TA

waiver– Working with Laura Leistra to get more

information 5/5/2015, emailed

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Agencies and What They Do

• KVC– Working with Laura Leistra to get correct

information 5/5/2015, emailed – Provide assessments for HCBS-Autism waiver– Need more info

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Agencies and What They Do - CMHC• Community Mental Health Centers, CMHC– There are currently 27 licensed Community Mental Health

Centers operated in the state.– These Centers have a combined staff of over 4,000 providing

mental health services in every county of the state in over 120 locations.

– They form an integral part of the total mental health system in Kansas.

– The independent, locally owned centers are dedicated to fostering a quality, free standing system of services and programs for the benefit of citizens needing mental health care and treatment.

– CMHCs contract with KDADS

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Agencies and What They Do - CMHC

• More Community Mental Health Centers– Community Mental Health Centers are more than

just another group of providers. They are the county’s legally delegated authorities to manage mental health care in Kansas.

– These centers function as the local mental health authorities.

– As such, the Kansas mental health system is a relationship of shared governance between two governmental entities, the state and the counties.

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Agencies and What They Do

• KanCare Ombudsman’s Office– Kerrie Bacon, KanCare Ombudsman– Housed in the Kansas Department for Aging and

Disability Services Office– Independent of KanCare Entities– Purpose is to provide assistance to KanCare

members– Appeal and Grievance information– State Fair Hearing information

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HCBS Waiver Flow Chart

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Resources for Online Training

• Websites– www.hhs.gov– www.cms.gov– www.medicare.gov– www.medicaid.gov– www.kancare.ks.gov– www.kdads.ks.gov– www.kdheks.gov– www.kff.org– www.dcf.ks.gov

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Resources for Online Training

• A huge thank you to the staff at KDHE for sharing several of their presentations that were used in compiling training materials for the KanCare Ombudsman Volunteer Program.