KDHE outlines new KanCare oversight 'hub' and utilization-management reforms to speed medical review

KDHE officials told the Bethell committee on July 9 that the agency has launched a cross-agency coordination initiative — called the "One Kansas hub" — to centralize oversight of the state’s managed care program (KanCare) and improve how the state monitors MCO performance.

Christine Osterlund, KDHE deputy secretary and state Medicaid director, described a multi-agency working group that includes KDHE, KDADS and the Department for Children and Families to share data, align policy reviews and prioritize corrective action. The stated goals are to identify where state policies create barriers for members, to improve real-time monitoring and give clinicians more time for in-depth review of prior-authorizations.

Osterlund said KDHE reorganized internal teams to create a Medicaid data bureau and a clinician group that will focus on clinical review rather than administrative policy work. A data bureau will produce fiscal and utilization analytics; KDHE said it is already using that unit to analyze applications processed over 45 days and to separate presumptive disability applications, which have a different timeline.

KDHE also described efforts to standardize and streamline prior authorization workflows and to review policies where prior authorization creates administrative burden without clinical benefit. Officials said KDHE had been preparing to drop prior authorization for low-cost repairs to complex durable medical equipment (DME) — for example, wheelchair batteries and minor repairs under $500 — before a legislative proviso temporarily prohibited state prior authorization for wheelchair repairs and accessories. KDHE said it prefers a targeted threshold-based prior-authorization policy and plans to share monitoring data with the committee.

The agency said it will expand use of utilization-management reviews, in partnership with MCO CMOs and part-time KDHE medical directors, to audit whether MCOs apply clinical criteria appropriately and whether state policies should be rewritten.

Osterlund stressed the hub is intended to improve coordination across agencies and with the MCOs, not to centralize power in one office. The hub will maintain issue logs, convene subgroups for specific problems and escalate disagreements to a governance council of secretary-level leaders from the three agencies.

Ending: KDHE said the hub and the new data and clinical functions will let it remove low-value prior authorizations, target high-risk fraud and improve timeliness of decisions; the agency asked the committee to track the fiscal and service impacts over the next year.