Sunday, November 28, 2010

KY Improving Systems

Kentucky’s Governor Beshear is taking steps to balance the Commonwealth’s $6 billion Medicaid budget. Currently, there are 815,655 citizens in the state depending on the Medicaid program while the number eligible for services increased by 3,000 per month in the last two years. A gap in the Medicaid budget of $100 million in state funds exists for FY 2011.The Cabinet for Health and Family Services has saved $86.5 million in state funds in the current fiscal year and plans on saving $80.2 million in FY 2012.

Additional cost containment and other actions are planned. One of the actions includes using public-private partnerships to implement innovative cost saving measures and improved health outcomes. In addition, Requests for Information (RFI) and Request for Proposals (RFP) will be issued to look at the strategies that other states are using to contain Medicaid spending. The state will then study action plans and programs to implement savings based on the results of the RFIs.

RFIs submitted can include details on:

• Performance-based managed care programs for all eligible Medicaid citizens in the state
• Pay-for-performance physician and primary care provider incentive plans
• Performance-based managed care dental programs for children
• Performance-based pharmacy capitation programs
• Long term care coordination program for institutional and community-based care

In another move to save money, the Department for Medicaid Services (DMS) is contracting for a third party to work with DMS to more aggressively identify provider fraud and abuse.

In addition, to help Medicaid save on the high cost for radiologic and imaging services, another RFP will select a vendor to manage high cost radiologic and imaging services estimated to save $7 to $10 million annually.

The Kentucky Cabinet for Health and Family Services (CHFS) Office of Health Policy received a $1 million federal grant to help CHFS, the Kentucky Public Protection Cabinet, and the Department of Insurance plan and develop the state insurance exchange.

The grant will be used to assess the state’s current information technology systems, infrastructure, and determine if new requirements must be developed. The governance and operational structures for the exchange must be analyzed along with a review on any regulatory and statutory changes needed to implement an exchange. In addition, the eligibility and enrollment systems across Medicaid and KCHIP with the exchanges must be coordinated.

The Kentucky Department of Public Health is going to receive $1 million in federal grant funding to collect data to help make decisions, monitor and evaluate quality, and to make improvements throughout the state’s public health system. Efforts will focus on establishing a Center of Performance Management within the Department for Public Health to provide the infrastructure needed to develop and operate a complete performance management system.

The Kentucky Child Support Enforcement Program (CSE) is developing new technology to improve service. One of the major changes will be to establish a customer service web site to allow custodial and noncustodial parents to view details on their case, data on payments, on appointments, their case status, as well as any updated information. The general public will be able to access general child support information, including how to apply for services online and also noncustodial parents will be able to be able to make payments.

Other initiatives will make it possible for child support staff to simultaneously search a variety of systems. The information will provide additional resources needed to locate participants in a child support case. Business intelligence will help CSE staff access data in the current child support system and to electronically complete federally required reporting. The system will enable staff to electronically store, view, receive, and send information concerning applications, court orders, and insurance documentation to courts and other agencies.