Kan. Admin. Regs. § 30-5-174

Current through Register Vol. 43, No. 50, December 12, 2024

Section 30-5-174 - Delivery of managed care

Counties shall be selected by the secretary pursuant to K.S.A. 1994 Supp. 39-7,112, as amended, to participate in managed care service delivery options. Subject to provider availability, any beneficiary may be required to choose a managed care option in order to access covered program services.

(a) Managed care contractors shall be selected by the secretary from willing providers based upon the best professional judgment of the secretary or designees in the best interest of the agency.

(b) Before signing a contract to provide services, each provider of capitated managed care shall have the ability to meet contract requirements, including but not limited to:

(1) financial solvency;

(2) a panel of service providers who shall be:

(A) appropriately credentialed;

(B) in active practice;

(C) available to provide services to program enrollees; and

(D) culturally competent, which means a demonstrated ability to provide services which are sensitive to the needs of a diverse population including individuals of any income level, racial or ethnic background, language, handicapped condition or sexual preference;

(3) an approved quality management process; and

(4) other requirements determined by the secretary. In order to participate as a managed care provider, each contractor shall abide by every provision of the contract. Penalties for failure to abide by contract provisions shall be imposed by the secretary or other appropriate actions, as enumerated in the contract provisions may be taken.

(c) Each capitated managed care contractor shall be reimbursed at a rate set by the secretary on an actuarially sound basis. Each provider of primary care case management shall be reimbursed for those medically necessary services which are covered on a fee for service basis, plus a case management fee as determined by the secretary.

(d) The effective date of this regulation shall be September 1, 1995.

Kan. Admin. Regs. § 30-5-174

Authorized by and implementing K.S.A. 39-708c; effective Sept. 1, 1995.