Patients can see regular doctors, providers will be reimbursed at full rate during transition period.
KanCare replaced Medicaid and HealthWave in Kansas on Jan. 1, but patients can continue seeing the same doctors for up to 90 days, even if they were assigned to a managed care organization (MCO) with which their doctor is not contracting.
Local providers — Pratt Regional Medical Center, Pratt Family Practice and Pratt Internal Medicine Group — have not signed agreements with United Healthcare of the Midwest. Beneficiaries who were assigned to that company will need to change, if they want to continue with the same provider, but they have until April 4 to do it, Miranda Steele, communications director with the Kansas Department of Health and Environment, said.
Until then, under Continuity of Care provisions, patients can be seen by their regular provider, and the provider will be reimbursed at the in-network rate, Steele assured. The same is true for in-home helpers.
The three KanCare MCOs must make sure specialty care is available to all members. They are required to meet federal and state distance or travel time standards. If an MCO does not have a specialist available within those standards, it must allow members to see out-of-network providers.
Emergency services are not limited to in-network hospitals. As required by federal law, the state's KanCare contract requires each MCO to cover and pay for emergency services, including services needed to evaluate or stabilize an emergency medical condition, regardless of whether the provider that furnishes the service has a contract with the MCO.
Nursing homes have up to a year to sign with the health plans. A resident in a home not contracting with their MCO will not have to move.
After the transition period, reimbursement would be reduced to 90 percent when MCOs for patients and providers do not match, but the patient would not make up the difference, according to information on the KanCare website, www.kancare.ks.gov.
"We want a smooth transition, to eliminate as many bumps in the road as possible," Steele said.
Services covered by KanCare include doctor's office visits, vaccines and check-ups, hospital services, blood work and lab services, pharmacy and prescription drugs, eye doctor visits, behavior health services, dental care, transportation to medical appointments, home and community based services and nursing facility services.
New services include heart and lung transplants for adults, weight loss surgery, some preventive dental care for adults and value-added services offered by each of the MCOs.
More information is available at www.kancare.ks.gov.