Medicaid and HealthWave Cost Containment
Initiatives
The Division of Health Care Finance (DHCF) is committed to an ongoing effort to control the cost of Medicaid and HealthWave. Those efforts can be generally divided into two categories:
Cost Avoidance: Policies and procedures aimed at preventing unnecessary costs from being incurred. This includes such things as prior authorization requirements for certain prescription drugs, reviewing and adjusting pricing policies for specific medical procedures or equipment, and implementing managed care systems for certain populations served by Medicaid and HealthWave.
Cost Recovery: Policies and activities aimed at recovering costs or overpayments that have previously been incurred. These include activities, including many required by federal regulations, such as third-party liability collections, estate recovery, payment audits, and prosecutions of fraud and abuse.
Procurement of Cost Containment Services
In order to provide the most effective service to the state of Kansas, DHCF sometimes contracts with private sector firms with experience and expertise in particular areas of health care management and cost containment. These services are procured through the State of Kansas purchasing system. Bid solicitations, Requests for Proposals (RFP) and Requests for Information (RFI) are posted on the Division of Purchases website. Listed below are cost containment projects currently in the procurement process:
Recovery Audit Contractor: This RFP for cost recovery services is issued pursuant to provisions of the State of Kansas FY 2011 budget. That legislation calls on KHPA to launch a Healthcare Cost Containment and Recovery Pilot Project. Please see the RFP documentation for details of the project and the specifications for proposals. Closing date: October 25, 2010.
RFP - Recovery Audit Contractor
RFP-RAC Attachment A (claims information)
RFP-RAC Attachment B non-Medicaid Mental Health (SRS)
Medicaid Cost Efficiencies: This RFI for cost avoidance services seeks proposals for innovative ways of reducing the cost of Medicaid services through improved care management, efficiency, and effectiveness. The KHPA Board of Directors endorsed this action at its Sept. 17, 2010 meeting to collect proposals to include in the budget process that could reduce future Medicaid costs. These projects may require an initial investment from DHCF , but will more than recover the costs by reducing Medicaid costs over time. Invitations are not necessary for participation in the Request for Information. However, in order to participate in the anticipated future Request for Proposal for these services, potential vendors must register with the Division of Purchases so they will be “invited” to the bid event. Closing date: October 29, 2010.
DHCF Program Improvement Initiative:
The Division of Health Care Finance maintains an ongoing process of reviewing elements of its programs and operations to identify opportunities for improvement, efficiencies and savings. The Program Improvements process began in 2008 with reviews of 14 major pieces of the Kansas Medicaid program. Those reviews led to the publication of the first Medicaid Transformation report in January 2009. That process is now being expanded, with an additional 13 reviews published in 2010, to cover all programs and operations within DHCF , including the State Employee Health Benefits Program and DHCF internal operations.
The overall purpose of the process is to produce and publish regular program reviews to monitor, assess, diagnose and address policy issues in each major program area within the agency. The presentation of these reviews is designed to serve as the basis for DHCF budget and policy initiatives on an ongoing basis.
Other Recent Activities
Forum on Cost Drivers in Medicaid
KaMMCO/Kansas Medical Society Office
623 SW 10th Street, Topeka
In order to examine the causes of continued Medicaid growth and to identify options for program administration, KHPA hosted a forum on Medicaid cost drivers beginning Monday, April 26, 2010, at the KaMMCO/KS Medical Society Office, 623 SW 10th Avenue, Topeka KS.
KHPA appreciates the support of AcademyHealth which is sponsoring Deborah Bachrach, a nationally-recognized Medicaid expert, to facilitate this discussion.
The first session featured a conversation with providers, representatives of Medicaid-related state agencies, and other stakeholders. The second session included legislators and other interested policymakers, and addressed the same set of issues.
Forum information and materials:
Agenda
Medicaid Savings Options Report - Revised and Updated April 26, 2010
Deborah Bachrach's Slide Presentation
Summary and Key Takeaways from the Forum
Audio:
Morning Session - Part 1 (mp3 file - 30:03) -
Introductions by Dr. Margaret Smith, M.D., DHCF Medicaid Medical Director; Presentation By Dr. Andy Allison, Ph.D., DHCF Executive Director
Morning Session - Part 2 (mp3 file - 37:31) - Presentation by Deborah Bachrach, J.D.
Morning Session - Part 3 (mp3 file - 1:06:02) - Forum discussion
Afternoon Session - Part 1 (mp3 file - 43:19) - Opening remarks by Dr. Andy Allison
Afternoon Session - Part 2 (mp3 file - 45:39) - Group discussion