Next Round of Managed Care Companies Will Soon Bid for KanCare Contract
Heather Braum | October 30, 2023
On October 2, the state released a new request for proposal (RFP) to solicit bids for the next round of KanCare managed care organizations (MCOs). Over the next 15 months, the state will work through the procurement and contract processes. Selection decisions will have profound effects on Kansans enrolled in KanCare, as different companies may have different coverage policies and practices.
Why Does This RFP Matter to Kids and Families?
Children make up nearly two-thirds of KanCare’s membership, the state’s program for Medicaid and CHIP (Children’s Health Insurance Program). The companies selected through this RFP process will become an important part of kids’ health care for the next three years. It’s crucial this contract ensures that the EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) pediatric benefit works smoothly for all kids, no matter if they have medically complex requirements, are on waivers, or have mental health or substance use disorder needs.
This RFP and new contract are opportunities to better serve the needs of children, pregnant people, and families by holding the MCOs more accountable, reducing administrative burdens for families, and proactively and effectively addressing numerous social determinants of health that Kansas families face when they attempt to address their health needs.
Ultimately, we are hopeful this contract effectively addresses the needs of Kansas kids and families within the KanCare system by creating opportunities for improving health without making it more difficult for these families to interact with the system as it currently is.
History
Since 2013, Kansas has twice selected three managed care insurance companies to oversee the day-to-day delivery of KanCare services. These companies enable almost all Kansans who have Medicaid or CHIP to access coverage through the state. The current RFP is the third time the state has undergone the procurement process.
Timeline
With the state’s release of the new RFP, we now know the timeline of the many steps ahead for the procurement process:
- Release of the RFP: October 2, 2023
- Mandatory RFP pre-bid conferences for potential bidders: October 16, 2023
- RFP questions and answers: October 23, 2023—November 22, 2023
- Questions from prospective bidders due by October 23, 2023
- Office of Procurement and Contracts (OPC) posts answers to questions, November 22-28
- Stakeholder engagement report-out: October 24—26, 2023
- Evaluator training: December 18-19, 2023
- RFP bid closing date/proposals due: January 4, 2024
- RFP evaluation process: January 5 – March 21, 2024
- Negotiations, contract award, and contract signing: March 22—April 12, 2024
- Contract awards announced: April 12, 2024
- Bid protest period: April 15—May 17, 2024
- Implementation: May 20—December 31, 2024
- Go live: January 1, 2025
These steps involve prospective companies asking the state questions; the state answering those questions; the companies submitting their bid proposals (including a cost proposal and a technical proposal responding to 37 questions and scenarios); evaluators reviewing the proposals following an evaluation matrix; contracts being awarded; and implementation of the contracts. The new contracts will go live January 1, 2025.
What's in the RFP?
Based on feedback from public input sessions this spring, agency priorities, and other stakeholder engagement, the state spelled out its priorities for the next KanCare RFP. More than 485 individuals and organizations submitted their written feedback and/or attended a meeting; 57% of those shared written letters with the state, including KAC.
The state laid out its vision, goals, and enhancements for the program to improve health outcomes by emphasizing integrated, whole-person care; addressing social determinants of health, including accountability measures for the MCOs; and expanding the provider network.
Technical Proposal
In the technical proposal section of the RFP, the state is asking for different page limits for responses, based on different areas of focus. The weighting of different page limits indicates where the state is likely placing its attention. In particular, the state is asking for up to 60 pages to respond to questions around integrated, whole-person care; up to 55 pages on the provider network; and up to 90 pages on the 11 different scenarios.
Additionally, the evaluation matrix on p38-39 of the proposal shows different levels of maximum points awarded to different questions, for a total of 1,000 possible points. For example, integrated, whole-person care has a maximum of 50 points; transportation, including in rural and frontier areas of the state, has a maximum of 25 points; and provider administrative burden has a maximum of 15 points.
This weighting can be further seen when reviewing the different case scenarios, where bidders are asked to respond to different KanCare members’ situations and how the company would plan for and address the member’s needs. Public meetings by the state indicated some of these scenarios came straight from the public feedback.
Reviewing the scenarios, the RFP includes members navigating complex medical situations; needing waiver services; and experiencing geographic, social, and other barriers. The different scenarios also carry different maximum points for the final evaluation. Responses from the bidders will be telling on how they choose to serve these different members.
Highlights from the Scope of Services and Penalties
Within the RFP, there is consistent reference to social determinants of health, emphasizing that prospective bidders must explain their strategies for addressing members' needs that have a direct impact on their health.
When we provided recommendations to the state for this RFP back in May, we had asked that the next contract prioritize innovative ways to recognize and address how issues like housing stability and adequacy, food security, child care, travel time to medical appointments, paid leave access, and transportation impact KanCare members’ access to health care systems and services. All these directly impact a patient’s access to medical services, and we welcome the RFP’s inclusion of compelling bidders to develop plans to address these kinds of needs. The companies are also each required to have a health equity coordinator on staff.
A large focus of the RFP is around improvements in care coordination (MCO-assigned staff to help individuals coordinate all their health care needs, particularly those with chronic and/or complex health conditions). This includes accountability, requiring more qualifications and training, broadening eligibility for care coordination, improving response time, and refusing to pay MCOs if, for example, they don’t provide personal care services and specialized medical care hours in a member’s person-centered service plan. This priority will hopefully help the families of kids with chronic and/or complex medical needs more easily navigate the systems of care — if the selected MCOs design the program correctly.
A new focus in the RFP is on maternity care coordination for both low- and high-risk members during pregnancy and through one-year postpartum. High-risk includes chronic physical health conditions, mental health conditions, substance use disorder, and any social determinants of health that will impact the health of the mother or baby (the document spells out a number of other details of what this program will look like on p97-99). This is an important step toward prioritizing the health of families, to give mom and baby (and family) stronger support during the critical perinatal period.
But will these moms only be referred to providers and services? Or will they be directly connected to providers and/or will appointments be set up on behalf of the mom and/or baby? That’s a question that remains unanswered in the RFP. We ask this question because more involved referrals and appointment set-ups in maternity care can result in significant differences in patients’ level of care uptake.
Unfortunately, the RFP missed an opportunity to go all in on pregnancy and postpartum care by only encouraging — not requiring — MCOs to provide value-added services like doulas, peer supports, home visiting, and lactation consultants.
The RFP also attempts to address ongoing challenges that some face when accessing a major children’s benefit – EPSDT — including requiring the MCOs to include an EPSDT benefit coordinator on their staff and additional monitoring and oversight of EPSDT. Liquidated damages include $2,500/per occurrence when an MCO fails to provide medically necessary EPSDT services for child members.
Finally, the RFP includes provisions for each MCO to create an annual health equity report card to track stratified performance measures, including data broken out by member race, ethnicity, disability, and geography. Several required reports will track some kids’ health measures, such as geographic mapping and network adequacy. This will provide more information about where kids’ health providers are located throughout the state.
Conclusion
KanCare is an important program that provides health care access and impacts the health outcomes of nearly 500,000 Kansans. The procurement process plays an integral role in getting those Kansans efficient, timely, and high-quality care so they can lead healthy lives.
Large milestones ahead for the current procurement process include:
- The closure of bids on January 4, soon after which we should know which companies submitted bids; and
- When the awarded contracts will be announced on April 12.
Formal updates from the state will be limited, as strict rules govern the procurement process. We expect the next publicly available updates will be after bids are due on January 4, 2024.
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