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KDHE rate study finds MCOs sometimes pay above fee schedule; state wins 10‑year $17M maternal health grant
Summary
KDHE described an ongoing Medicaid fee‑schedule rate study that shows managed care plans are paying above state fee schedules in some codes and reported that Kansas won a 10‑year, $17 million federal maternal health grant to pilot reforms in 30 counties.
KDHE updated the committee on two program analyses with near‑term policy implications: a fee‑schedule rate study and a newly awarded federal maternal health (T‑MH) grant.
On the rate study, KDHE said analysts compared Kansas Medicaid fee‑for‑service rates to neighboring states and Medicare for a broad set of codes. The preliminary finding is that some managed‑care organizations are routinely paying providers above the Kansas fee schedule in order to secure network adequacy (a dental code example: Kansas fee schedule $19.80 vs. MCO average payments of ~$23). KDHE said those discrepancies can create financial pressure on MCOs and flagged the need to study alternative payment methodologies in some services (non‑emergency transport was given as an example). KDHE recommended repeating this study every three to five years to track trends and advised the legislature to consider targeted rate adjustments informed by the study.
KDHE also described a U.S. Health Resources & Services Administration‑funded maternal health award (referred to in testimony as a 10‑year $17,000,000 award). The grant requires a pilot (test) region and a comparison region; KDHE selected 30 counties in southwest and central Kansas for the pilot and a northwest/central region for comparison. The grant funds infrastructure, alternative payment methodologies, workforce development, telehealth, and other maternal‑and‑infant health strategies through a staged, multi‑year timeline that begins with planning and infrastructure and moves toward larger outcome measurement in later years. KDHE said it is finalizing implementation milestones and expects to begin grant activities in earnest around April.
