Health and Family Services Cabinet
Cabinet Solicits Information Regarding Medicaid Managed Care Initiatives
CHFS Creates New Branch to Oversee Managed Care Activities
The Kentucky Cabinet for Health and Family Services (CHFS) today announced the release of six Requests for Information (RFIs) for Medicaid managed care initiatives, as part of the Department for Medicaid Services’ (DMS) cost containment efforts recently announced by Governor Steve Beshear.
CHFS also announced the creation of a new Medicaid Managed Care Oversight Branch to oversee the department’s managed care activities. Earlier this week, Gov. Beshear signed the executive order creating the branch.
The actions follow Gov. Beshear’s November announcement of further steps to balance Kentucky’s $6 billion Medicaid budget while still providing the care that vulnerable Kentuckians need from the program. The steps announced included utilizing public-private partnerships to implement innovative cost saving measures and improve health outcomes.
“Through the RFI process, we are casting a wide net to gauge the interest and capacity of both public and private entities to partner with the state to explore ways to expand managed care initiatives in our Medicaid program,” said Gov. Beshear. “The private sector can bring efficiency and innovation to the Medicaid program, both of which will be critically important as we continue to provide the care needed by the more than 800,000 Kentuckians who depend on the program, while also containing its rising costs.”
The RFIs issued today are based on strategies used by other states to manage health care costs. Action plans to implement programs based on the results of the RFIs will be put in place in time to realize program savings during the biennium. Responses are due to the Finance Cabinet in five weeks from the issue date.
RFIs for program innovations are:
Managed Care RFI
To obtain ideas for innovative managed care models and other strategies for the delivery of quality coordinated, comprehensive care under a capitated payment system to Medicaid members within the context of a member medical home, leading to improved health outcomes while containing the costs of care.
Capitated Pharmacy Management
To obtain ideas for a highly innovative and robust patient-centered pharmacy management program that operates under a capitated payment system. The proposed model should identify and optimize opportunities to stretch health care dollars while maintaining the highest level of patient care for Medicaid members.
Dental Home for Children Only
To obtain information on how to improve or transform the dental delivery system for children enrolled in Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) in order to significantly expand access to dental benefits, particularly preventive dental care, while improving comprehensive dental health outcomes and containing the costs of care. DMS is extremely interested in solutions that will enhance the current network by incentivizing providers to participate in the program and can be administered with current DMS personnel and resources.
Dental Managed Care Organization/Pay for Performance RFI
To obtain information on creative dental service delivery models or purchasing options to assist DMS in increasing the number of members who receive dental visits, with an emphasis on preventive dental care. DMS is seeking innovative and viable strategies that will address dental access at a local, regional or statewide level for the Fee for Service Medicaid population, while improving comprehensive dental health outcomes and containing the costs of care.
Managed Care of Program of All Inclusive Care for the Elderly (PACE)
To obtain ideas for innovative PACE models and other capitated strategies for the delivery of quality, coordinated, comprehensive care under a capitated payment system to elderly Medicaid members within the context of a member medical home, leading to improved health outcomes while containing the costs of care.
Pay for Performance
To obtain information on Pay-for-Performance program models that are being successfully used to improve the quality and efficiency of health care and could be utilized to enhance the objectives of the KenPAC program.
Establishing a branch within DMS to focus on oversight of the department’s managed care initiatives provides the structure needed to pursue and managed such initiatives, including the Passport plan.
“Managed care can be an effective tool to provide more effective and efficient services,” said Gov. Beshear. “However, the use of contractors requires additional monitoring and oversight capacity, and this new structure will serve to provide that needed framework.”
“As we move forward, it is essential that we have in place the programmatic oversight structure to ensure the appropriate supervision and monitoring of managed care contracts are in place and that these organizations will coordinate care, provide evidence-based medicine and improve patient outcomes,” said CHFS Secretary Janie Miller.
Interested parties may access the RFIs by logging onto the Commonwealth’s eProcurement website at https://eprocurement.ky.gov/ and accessing the Vendor Self Service application (VSS). Within the VSS, click on View Solicitation, and the RFIs will be listed. If you have any questions concerning the eProcurement website, contact the Finance and Administration Cabinet’s Customer Resource Center at Finance.CRCGroup@ky.gov or phone (502-564-9641 or toll-free 877-973-HELP). The Help Desk is open Monday through Friday from 7:30 a.m. until 5 p.m. EST.