News

Budget Reduction Restoration

Date: 07/13/2017

Effective with the processing date of July 28, 2017, retroactive to dates of service on and after July 1, 2017 (or discharge dates on and after July 1, 2017, for inpatient claims), the provider payment reductions that were implemented on July 1, 2016, will be restored, with the exception of the Health Care Access Improvement Program (HCAIP) enhanced payment rate for hospital inpatient claims for in-state hospitals. The HCAIP enhanced payment rate for inpatient claims will continue to receive the 2.14% reduction, which is taken off of the base DRG payment.

In addition, the inpatient DRG outlier payments for hospitals will be restored to 75% for both the cost outlier and the day outlier. Other nonclaim payment reductions, Medicaid Disproportionate Share Hospital payments, and Graduate Medical Education payments will also be restored.

To avoid reworking and reprocessing claims, providers who are able to hold claims until the configuration is complete are encouraged to do so. Any claims submitted with a date of service between July 1, 2017, and July 28, 2017, will be reprocessed.
Appropriate updates will be made on the KMAP website (including the Hospital Fee-for Service Provider Manual), and additional notification will be sent.

Note: The effective date of the policy is July 1, 2017. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates.