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The Centers for Medicare and Medicaid Services (CMS) requires Medicaid programs to reimburse for professional services on behalf of their beneficiaries. This report will focus on three provider types: physicians, advanced registered nurse practitioners (ARNPs), and physician assistants (PAs) and the professional services they provide. Services are delivered in a variety of settings and include preventive care, well child services, and treatment for illnesses, chronic diseases, and traumatic injuries. This report targets cited professionals delivering services to Medicaid beneficiaries through Fee for Service Programs (FFS). All three provider types are able to bill Evaluation and Management Codes, or E & M codes, write prescriptions, and must enroll and bill independently. Mid-level practitioners, however, provide a more limited range of services when compared to physicians and are subject to a reduced payment, receiving 75 percent of maximum rates.

Rehabilitative therapy services are optional Medicaid services which include physical therapy, occupational therapy, and speech and language therapy services. Rehabilitative therapy services are provided following an injury or illness to restore functional status. For example, rehabilitative therapy services may be provided following an illness in an attempt to restore strength and endurance. These services may also be provided after a traumatic injury such as a broken hip or a cerebrovascular accident (CVA). The objective in both examples would be to restore the individual to their pre-illness or pre-injury functional ability. In extreme cases the focus would be to assist the individual in performing basic activities of daily living (ADLs) such as feeding, dressing and bathing.

Kansas Medicaid maintains an out-of-state program for situations which require a Kansas Medicaid beneficiary to receive services in another state. The out-of-state program, described in this review, includes only those services provided to individuals enrolled in the fee for service program. The Managed Care contractors manage the out-of-state services provided to the HealthWave population.

The primary purpose of prior authorization (PA) is to facilitate cost containment by ensuring fee for service (FFS) medical services provided to Medicaid/HealthWave beneficiaries are medically necessary and cost effective. This is accomplished by identifying, researching, and reviewing designated procedures or services, and implementing measures to promote performance and reimbursement of services considered to meet the specified criteria set forth by KHPA.

HealthConnect Kansas (HCK) is a primary care case management program established in 1994 to provide Medicaid beneficiaries increased access to quality care and continuity of service, while controlling costs for specialty care. Case management was instituted by contracting with Primary Care Case Managers (PCCMs) to provide primary care to HCK members and coordinate their specialty care.

Testimony to review on-going chronic care management initiatives at KHPA and discuss the medical home initiative in particular.

Testimony giving an overview of the HealthWave Program's history, the services it provides, and it's goals for the future.

PowerPoint presentation giving an overview of KHPA's goals, initiatives and programs with regard to health care reform in Kansas.

Packet of reference materials to provide additional detail on several of the the issues and initiatives that were discussed in testimony given by Connie Hubble and Dr. Marcia Nielsen, as well as the testimony given by Dr. Andrew Allison, both of which were presented at the May 31, 2007 meeting of the Joint Committee on Health Policy Oversight.

Testimony to provide an update on several major initiatives and issues in Medicaid, the State Employee Health Benefits Plan (SEHBP), and other KHPA programs.

Testimony "regarding the Community Health Record pilot project in Sedgwick County and various e-prescribing projects that the Kansas Health Policy Authority is working on."