38-2001.Insurance coverage for children;development of plan; provisions of coverage; powers and duties of the Kansashealth policy authority; program funding.(a) TheKansas health policy authority shalldevelop and submit a plan consistent with federal guidelines established undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa et seq.; title XXI).
(b) The plan developed under subsection (a) shall be a capitated managed careplan coveringKansas children from zero to 19 years which:
(1) Contains benefit levels at least equal to those for the early andperiodic screening,diagnosis and treatment program;
(2) provides for presumptive eligibility for children where applicable;
(3) provides continuous eligibility for 12 months once a formal determinationis made that a child is eligible subject to subsection (e);
(4) has performance based contracting with measurable outcomes indicating ageappropriate utilization of plan services to include, but not limited to, suchmeasurable services as immunizations, vision, hearing and dental exams,emergency room utilization, annual physical exams and asthma;
(5) shall use the same prior authorization standards and requirements as usedfor health care services under medicaid to further the goal of seamlessness ofcoverage between the two programs;
(6) shall provide targeted low-income children, as defined undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa, et seq.), coverage subject to appropriations;
(7) shall provide coverage, subject to appropriation of funds and eligibilityrequirements, for children residing in a household having a gross householdincome (A) for 2009, at or under 225% of the 2008 federal poverty incomeguidelines and (B) for 2010 and subsequent years, at or under 250% of the 2008federal poverty income guidelines; the participants receiving coverage shallcontribute to the payment for such coverage through a sliding-fee scale basedupon ability to pay as established by rules and regulations of the Kansashealth policy authority; and
(8) contains a provision which requires the newly enrolled participants witha family income over 200% of the federal poverty income guidelines to wait atleast 8 months before participating in this program, if such participantspreviously had comprehensive health benefit coverage through an individualpolicy or a health benefit plan provided by any health insurer as defined inK.S.A. 40-4602, and amendments thereto. This waiting period provision shall notapply when the prior coverage ended due to loss of employment other than thevoluntary termination, change to a newemployer that does not provide an option for dependent coverage,discontinuation of health benefits to all employees, expiration of COBRAcoverage period or any other situations where the prior coverage ended due toreasons unrelated to the availability of this program.
(c) The Kansas health policy authority is authorized to contract withentities authorized to transact health insurance business in this state toimplement the health insurance coverage plan pursuant to subsection (a)providing for several plan options to enrollees which are coordinated withfederal and state child health care programs, except that when contracting toprovide managed mental health care services the Kansas health polityauthority shall assure that contracted entities demonstrate the ability toprovide a full array of mental health services in accordance with the early andperiodic screening, diagnosis and treatment plan. The Kansas health policyauthority shall not develop a request for proposal process which excludescommunity mental health centers from the opportunity to bid for managed mentalhealth care services.
(d) When developing and implementing the plan in subsection (a), theKansashealth policy authority to the extent authorized by law:
(1) Shall include provisions that encourage contracting insurers to utilizeand coordinate with existing community health care institutions and providers;
(2) may work with public health care providers and other community resourcesto provide educational programs promoting healthy lifestyles and appropriateuse of the plan's health services;
(3) shall plan for outreach and maximum enrollment of eligible childrenthrough cooperation with local health departments, schools, child carefacilities and other community institutions and providers;
(4) shall provide for a simplified enrollment plan;
(5) shall provide cost sharing as allowed by law;
(6) shall not count the caring program for children, the Kansas healthinsurance association plan or any charity health care plan as insurance undersubsection (e)(1);
(7) may provide for payment of health insurance premiums, includingcontributions to a health savings account if applicable, and, in conjunctionwith an employer sponsored insurance premium assistance plan, may provide thatsupplemental benefits be purchased outside of the capitated managed care plan,if it is determined cost effective, taking into account the number of childrento be served and the benefits to be provided;
(8) may provide that prescription drugs, transportation services and dentalservices are purchased outside of the capitated managed care plan to improvethe efficiency, accessibility and effectiveness of the program; and
(9) shall include a provision that requires any individual to be a citizen oran alien lawfullyadmitted to the United States for purposes of establishing eligibility forbenefits under the plan and to present satisfactory documentary evidence ofcitizenship or lawful admission of the individual. The criteria for determiningwhether the documentation is satisfactory shall be no more restrictive than thecriteria used by the social security administration to determine citizenship. Adocument issued by a federally-recognized Indian tribe evidencing membership orenrollment in, or affiliation with, such tribe, such as a tribal enrollmentcard or certificate of degree of Indian blood shall be satisfactory documentaryevidence of citizenship or lawful admission.
(e) A child shall not be eligible for coverage and shall lose coverage underthe plan developed under subsection (a) of K.S.A. 38-2001, and amendmentsthereto, if such child's family has not paid the enrollee's applicable share ofany premium due.
If the family pays all of the delinquent premiums owed during the year, suchchild will again be eligible for coverage for the remaining months of thecontinuous eligibility period.
(f) The plan developed under section 4901 of public law 105-33 (42 U.S.C.1397aa et seq., and amendments thereto) is not an entitlement program. Theavailability of the plan benefits shall be subject to funds appropriated. TheKansas health policy authorityshall not utilize waiting lists, but shall monitor costs of the program andmake necessary adjustments to stay within the program's appropriations.
(g) Eligibility and benefits under the plan prescribed by subsection (b)(7)are not and shall not be construed to be entitlements, are for legal residentsof the state of Kansas and are subject to availability of state and federalfunds and to any state and federal requirements and the provisions ofappropriation acts. If the Kansas health policy authority determines that theavailable federal funds and the state funds appropriated are insufficient tosustain coverage for the income eligibility levels prescribed by subsection(b)(7), a lower income level shall be adopted and implemented by the Kansashealth policy authority, within the limits of appropriations availabletherefor, and all such changes shall be published by the Kansas health policyauthority in the Kansas register.
38-2001.Insurance coverage for children;development of plan; provisions of coverage; powers and duties of the Kansashealth policy authority; program funding.(a) TheKansas health policy authority shalldevelop and submit a plan consistent with federal guidelines established undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa et seq.; title XXI).
(b) The plan developed under subsection (a) shall be a capitated managed careplan coveringKansas children from zero to 19 years which:
(1) Contains benefit levels at least equal to those for the early andperiodic screening,diagnosis and treatment program;
(2) provides for presumptive eligibility for children where applicable;
(3) provides continuous eligibility for 12 months once a formal determinationis made that a child is eligible subject to subsection (e);
(4) has performance based contracting with measurable outcomes indicating ageappropriate utilization of plan services to include, but not limited to, suchmeasurable services as immunizations, vision, hearing and dental exams,emergency room utilization, annual physical exams and asthma;
(5) shall use the same prior authorization standards and requirements as usedfor health care services under medicaid to further the goal of seamlessness ofcoverage between the two programs;
(6) shall provide targeted low-income children, as defined undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa, et seq.), coverage subject to appropriations;
(7) shall provide coverage, subject to appropriation of funds and eligibilityrequirements, for children residing in a household having a gross householdincome (A) for 2009, at or under 225% of the 2008 federal poverty incomeguidelines and (B) for 2010 and subsequent years, at or under 250% of the 2008federal poverty income guidelines; the participants receiving coverage shallcontribute to the payment for such coverage through a sliding-fee scale basedupon ability to pay as established by rules and regulations of the Kansashealth policy authority; and
(8) contains a provision which requires the newly enrolled participants witha family income over 200% of the federal poverty income guidelines to wait atleast 8 months before participating in this program, if such participantspreviously had comprehensive health benefit coverage through an individualpolicy or a health benefit plan provided by any health insurer as defined inK.S.A. 40-4602, and amendments thereto. This waiting period provision shall notapply when the prior coverage ended due to loss of employment other than thevoluntary termination, change to a newemployer that does not provide an option for dependent coverage,discontinuation of health benefits to all employees, expiration of COBRAcoverage period or any other situations where the prior coverage ended due toreasons unrelated to the availability of this program.
(c) The Kansas health policy authority is authorized to contract withentities authorized to transact health insurance business in this state toimplement the health insurance coverage plan pursuant to subsection (a)providing for several plan options to enrollees which are coordinated withfederal and state child health care programs, except that when contracting toprovide managed mental health care services the Kansas health polityauthority shall assure that contracted entities demonstrate the ability toprovide a full array of mental health services in accordance with the early andperiodic screening, diagnosis and treatment plan. The Kansas health policyauthority shall not develop a request for proposal process which excludescommunity mental health centers from the opportunity to bid for managed mentalhealth care services.
(d) When developing and implementing the plan in subsection (a), theKansashealth policy authority to the extent authorized by law:
(1) Shall include provisions that encourage contracting insurers to utilizeand coordinate with existing community health care institutions and providers;
(2) may work with public health care providers and other community resourcesto provide educational programs promoting healthy lifestyles and appropriateuse of the plan's health services;
(3) shall plan for outreach and maximum enrollment of eligible childrenthrough cooperation with local health departments, schools, child carefacilities and other community institutions and providers;
(4) shall provide for a simplified enrollment plan;
(5) shall provide cost sharing as allowed by law;
(6) shall not count the caring program for children, the Kansas healthinsurance association plan or any charity health care plan as insurance undersubsection (e)(1);
(7) may provide for payment of health insurance premiums, includingcontributions to a health savings account if applicable, and, in conjunctionwith an employer sponsored insurance premium assistance plan, may provide thatsupplemental benefits be purchased outside of the capitated managed care plan,if it is determined cost effective, taking into account the number of childrento be served and the benefits to be provided;
(8) may provide that prescription drugs, transportation services and dentalservices are purchased outside of the capitated managed care plan to improvethe efficiency, accessibility and effectiveness of the program; and
(9) shall include a provision that requires any individual to be a citizen oran alien lawfullyadmitted to the United States for purposes of establishing eligibility forbenefits under the plan and to present satisfactory documentary evidence ofcitizenship or lawful admission of the individual. The criteria for determiningwhether the documentation is satisfactory shall be no more restrictive than thecriteria used by the social security administration to determine citizenship. Adocument issued by a federally-recognized Indian tribe evidencing membership orenrollment in, or affiliation with, such tribe, such as a tribal enrollmentcard or certificate of degree of Indian blood shall be satisfactory documentaryevidence of citizenship or lawful admission.
(e) A child shall not be eligible for coverage and shall lose coverage underthe plan developed under subsection (a) of K.S.A. 38-2001, and amendmentsthereto, if such child's family has not paid the enrollee's applicable share ofany premium due.
If the family pays all of the delinquent premiums owed during the year, suchchild will again be eligible for coverage for the remaining months of thecontinuous eligibility period.
(f) The plan developed under section 4901 of public law 105-33 (42 U.S.C.1397aa et seq., and amendments thereto) is not an entitlement program. Theavailability of the plan benefits shall be subject to funds appropriated. TheKansas health policy authorityshall not utilize waiting lists, but shall monitor costs of the program andmake necessary adjustments to stay within the program's appropriations.
(g) Eligibility and benefits under the plan prescribed by subsection (b)(7)are not and shall not be construed to be entitlements, are for legal residentsof the state of Kansas and are subject to availability of state and federalfunds and to any state and federal requirements and the provisions ofappropriation acts. If the Kansas health policy authority determines that theavailable federal funds and the state funds appropriated are insufficient tosustain coverage for the income eligibility levels prescribed by subsection(b)(7), a lower income level shall be adopted and implemented by the Kansashealth policy authority, within the limits of appropriations availabletherefor, and all such changes shall be published by the Kansas health policyauthority in the Kansas register.
38-2001.Insurance coverage for children;development of plan; provisions of coverage; powers and duties of the Kansashealth policy authority; program funding.(a) TheKansas health policy authority shalldevelop and submit a plan consistent with federal guidelines established undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa et seq.; title XXI).
(b) The plan developed under subsection (a) shall be a capitated managed careplan coveringKansas children from zero to 19 years which:
(1) Contains benefit levels at least equal to those for the early andperiodic screening,diagnosis and treatment program;
(2) provides for presumptive eligibility for children where applicable;
(3) provides continuous eligibility for 12 months once a formal determinationis made that a child is eligible subject to subsection (e);
(4) has performance based contracting with measurable outcomes indicating ageappropriate utilization of plan services to include, but not limited to, suchmeasurable services as immunizations, vision, hearing and dental exams,emergency room utilization, annual physical exams and asthma;
(5) shall use the same prior authorization standards and requirements as usedfor health care services under medicaid to further the goal of seamlessness ofcoverage between the two programs;
(6) shall provide targeted low-income children, as defined undersection 4901 of publiclaw 105-33 (42 U.S.C. 1397aa, et seq.), coverage subject to appropriations;
(7) shall provide coverage, subject to appropriation of funds and eligibilityrequirements, for children residing in a household having a gross householdincome (A) for 2009, at or under 225% of the 2008 federal poverty incomeguidelines and (B) for 2010 and subsequent years, at or under 250% of the 2008federal poverty income guidelines; the participants receiving coverage shallcontribute to the payment for such coverage through a sliding-fee scale basedupon ability to pay as established by rules and regulations of the Kansashealth policy authority; and
(8) contains a provision which requires the newly enrolled participants witha family income over 200% of the federal poverty income guidelines to wait atleast 8 months before participating in this program, if such participantspreviously had comprehensive health benefit coverage through an individualpolicy or a health benefit plan provided by any health insurer as defined inK.S.A. 40-4602, and amendments thereto. This waiting period provision shall notapply when the prior coverage ended due to loss of employment other than thevoluntary termination, change to a newemployer that does not provide an option for dependent coverage,discontinuation of health benefits to all employees, expiration of COBRAcoverage period or any other situations where the prior coverage ended due toreasons unrelated to the availability of this program.
(c) The Kansas health policy authority is authorized to contract withentities authorized to transact health insurance business in this state toimplement the health insurance coverage plan pursuant to subsection (a)providing for several plan options to enrollees which are coordinated withfederal and state child health care programs, except that when contracting toprovide managed mental health care services the Kansas health polityauthority shall assure that contracted entities demonstrate the ability toprovide a full array of mental health services in accordance with the early andperiodic screening, diagnosis and treatment plan. The Kansas health policyauthority shall not develop a request for proposal process which excludescommunity mental health centers from the opportunity to bid for managed mentalhealth care services.
(d) When developing and implementing the plan in subsection (a), theKansashealth policy authority to the extent authorized by law:
(1) Shall include provisions that encourage contracting insurers to utilizeand coordinate with existing community health care institutions and providers;
(2) may work with public health care providers and other community resourcesto provide educational programs promoting healthy lifestyles and appropriateuse of the plan's health services;
(3) shall plan for outreach and maximum enrollment of eligible childrenthrough cooperation with local health departments, schools, child carefacilities and other community institutions and providers;
(4) shall provide for a simplified enrollment plan;
(5) shall provide cost sharing as allowed by law;
(6) shall not count the caring program for children, the Kansas healthinsurance association plan or any charity health care plan as insurance undersubsection (e)(1);
(7) may provide for payment of health insurance premiums, includingcontributions to a health savings account if applicable, and, in conjunctionwith an employer sponsored insurance premium assistance plan, may provide thatsupplemental benefits be purchased outside of the capitated managed care plan,if it is determined cost effective, taking into account the number of childrento be served and the benefits to be provided;
(8) may provide that prescription drugs, transportation services and dentalservices are purchased outside of the capitated managed care plan to improvethe efficiency, accessibility and effectiveness of the program; and
(9) shall include a provision that requires any individual to be a citizen oran alien lawfullyadmitted to the United States for purposes of establishing eligibility forbenefits under the plan and to present satisfactory documentary evidence ofcitizenship or lawful admission of the individual. The criteria for determiningwhether the documentation is satisfactory shall be no more restrictive than thecriteria used by the social security administration to determine citizenship. Adocument issued by a federally-recognized Indian tribe evidencing membership orenrollment in, or affiliation with, such tribe, such as a tribal enrollmentcard or certificate of degree of Indian blood shall be satisfactory documentaryevidence of citizenship or lawful admission.
(e) A child shall not be eligible for coverage and shall lose coverage underthe plan developed under subsection (a) of K.S.A. 38-2001, and amendmentsthereto, if such child's family has not paid the enrollee's applicable share ofany premium due.
If the family pays all of the delinquent premiums owed during the year, suchchild will again be eligible for coverage for the remaining months of thecontinuous eligibility period.
(f) The plan developed under section 4901 of public law 105-33 (42 U.S.C.1397aa et seq., and amendments thereto) is not an entitlement program. Theavailability of the plan benefits shall be subject to funds appropriated. TheKansas health policy authorityshall not utilize waiting lists, but shall monitor costs of the program andmake necessary adjustments to stay within the program's appropriations.
(g) Eligibility and benefits under the plan prescribed by subsection (b)(7)are not and shall not be construed to be entitlements, are for legal residentsof the state of Kansas and are subject to availability of state and federalfunds and to any state and federal requirements and the provisions ofappropriation acts. If the Kansas health policy authority determines that theavailable federal funds and the state funds appropriated are insufficient tosustain coverage for the income eligibility levels prescribed by subsection(b)(7), a lower income level shall be adopted and implemented by the Kansashealth policy authority, within the limits of appropriations availabletherefor, and all such changes shall be published by the Kansas health policyauthority in the Kansas register.
