Legislators press KDHE on provider payments, network adequacy and MCO oversight

Legislators questioned state Medicaid officials on Oct. 27 about delays in provider payments, network adequacy in rural counties and what tools the state uses to hold managed care organizations accountable.

Christine Osterlund, Deputy Secretary of Agency Integration and state Medicaid director with the Kansas Department of Health and Environment, described how members choose or are assigned to MCOs and what oversight the state exercises. "The members self select, so they can select the MCO that they prefer to work with," Osterlund said, adding that if a member does not choose, KDHE uses an auto-assignment process that prioritizes continuity of care and family unity. "And then once either you self select an MCO or you're auto assigned, you automatically get a 90 day open enrollment period," she said.

On oversight, KDHE said it uses contract enforcement tools, including pay-for-performance provisions and liquidated damages, and that the agency conducts quarterly network adequacy reviews that CMS must validate. Osterlund said the state requires MCOs to meet time-and-distance standards for provider types and, where a true provider desert exists, the agency evaluates exceptions with reference to licensure and availability.

Providers and representatives raised concerns about payment delays and claim denials. Representative Riley described constituent complaints that providers face lengthy claims processing and frequent denials for coding or documentation issues. KDHE officials pointed to existing grievance pathways, the KanCare oversight (Bethel) committee as a stakeholder forum and forthcoming public performance data to surface persistent issues.

Rural access and "deserts": Committee members asked how the state ensures adequate specialty coverage outside major population centers. KDHE officials said some specialties already operate on a regional clinic model (providers traveling to smaller communities periodically) and that MCOs sometimes pay above the state fee schedule to attract out‑of‑area providers where needed. "The contractual requirement to us is to meet provider network adequacy standards," Osterlund said; if an MCO cannot recruit sufficient providers within the fee schedule, the MCO may need to pay higher rates to secure network participation.

Telemedicine and workforce strategies: KDHE noted that telemedicine use expanded during the public health emergency and that the agency is studying other states’ experiences with telemedicine-only providers. Officials said telehealth has grown rapidly in the Kansas Medicaid program and may help address access gaps, particularly in specialties and sparsely populated counties.

Committee follow-up: KDHE said it will provide additional data and that the agency is building a public dashboard to show MCO performance metrics over time. Officials also committed to share details on grievance pathways and how providers can raise systemic issues to both KDHE and the Bethel oversight committee.

Ending: Committee members thanked agency staff and encouraged quicker public reporting of MCO performance and grievance mechanisms.