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Acute Care Services
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Benefits by State: Kansas (October 2008) Notes
 
 
 
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Acute Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered


Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes $3/date of service Limited to specified surgical procedures Fee for service CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes Capitated payment or fee for service CN & MN
Federally Qualified Health Center Services
Yes $3/encounter Prospective cost based rate/visit CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes $48/admission Elective surgery limited to sterilizations, rehab therapies must be restorative and post-trauma, transplants of some organs not covered, psych care limited to daily therapy, substance abuse limited to detox Prospective payment/discharge using DRG or percentage of charge for specific hospitals and services CN & MN
Outpatient Hospital Services
Yes $3/non-emergency visit Non-emergency visits count toward physician visit limit, rehab must be restorative Fee for service CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes Specified substance abuse services Capitated payment or fee for service CN & MN
Rural Health Clinic Services
Yes $2/encounter Prospective cost based rate/visit CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes Fee for service CN & MN
Chiropractor Services
No
Dental Services
Yes $3/date of service Specified services Limited to emergency treatment for relief of pain and infection Fee for service CN & MN
Medical and Remedial Care - Other Practitioners
Medical/Surgical Services of a Dentist
Yes $3/date of service Specified services Fee for service CN & MN
Nurse Midwife Services
Yes Fee for service CN & MN
Nurse Practitioner Services
Yes 12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month Fee for service at 75% of physician fee CN & MN
Optometrist Services
Yes $2/date of service 1 refractive exam/4 years, 2 exams/month for medical conditions, orthoptic and pleoptic training not covered Fee for service CN & MN
Physician Services
Yes $2/visit - see state-specific FN 12 office visits/year, 1 inpatient hospital visit/day, 1 nursing facility visit/month, 1 office consultation/2 months, 1 inpatient hospital consultation/10 days Fee for service CN & MN
Podiatrist Services
Yes 12 office visits/year included in physician limit Fee for service CN & MN
Psychologist Services
Yes $3/office visit Fee for service unless included in behavioral health managed care contract CN & MN
Prescription Drugs
Prescription Drugs
Yes $3/Rx Specified drugs Adult vitamins limited to pregnancy supplements AWP-13% for brand Rx, AWP-27% for generic Rx, plus $3.40 dispensing fee for each CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes $1/visit Limited to post-trauma/illness only, rehab potential required Fee for service CN & MN
Physical Therapy Services
Yes $1/visit Limited to post-trauma/illness only, rehab potential required Fee for service CN & MN
Services for Speech, Hearing and Language Disorders
Yes $3/date of service Limited to speech pathology for post-trauma or illness only, physician order and rehab potential required, specified limits regarding audiological testing and evaluation Fee for service CN & MN
Products and Devices
Dentures
No
Eyeglasses
Yes Contact lenses 1 pair eyeglasses/4 years, post-cataract surgery lenses and eyeglasses covered for 1 year Reasonable charge with limits CN & MN
Hearing Aids
Yes Replacement hearing aid, repairs costing more than $75 1 hearing aid/4 years, limits on batteries, hearing aids in eyeglasses and repairs costing less than $15 not covered Reasonable charge with limits CN & MN
Medical Equipment and Supplies
Yes $3/service or item Only services or items that would reduce or prevent institutionalization or necessary for school, employment or life support Reasonable charge with limits CN & MN
Prosthetic and Orthotic Devices
Yes $3/service or item Reasonable charge with limits CN & MN
Transportation Services
Ambulance Services
Yes $3/date of service for non-emergency trip Reasonable charge with limits CN & MN
Non-Emergency Medical Transportation Services
Yes Specified modes of travel See service-specific FN CN & MN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women
Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes Specified lab and x-ray procedures only Fee for service CN & MN
Targeted Case Management
Yes Reasonable charge CN & MN


Long-Term Care Services

Community Based Care
Home and Community Based Services Waiver
Yes Services for the following populations: 1, 2, 4, 6, 7 & 8 - see service-specific FN Dependent upon the services provided CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes $3/skilled nurse visit 1 home health aide visit/day, therapies limited to 6 months, psychiatric nursing covered if medically necessary Fee for service CN & MN
Hospice Care
Yes Prospective rates based on Medicare methodology CN & MN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes See service-specific FN Capitated payment based on eligibility CN & MN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes $48/hospital admission 10 hosp leave days/acute care hospitalization, 21 hosp leave days/psychiatric hospitalization and 21 therapeutic leave days/year - leave days apply to nursing facilities for mental health only Cost based payment for state-operated hospitals, prospective payment/discharge using DRG for other hospitals, prospective cost based per diem with leave days paid at 67% of facility's rate for nursing facilities CN & MN
Inpatient Psychiatric Services, under age 21
Yes 5 hosp leave days per acute care hospitalization, 7 therapeutic leave days for visitation/stay, 5 days/year for other types of leave Prospective cost based per diem CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes 10 hosp leave days per acute care hospitalization, 21 therapeutic leave days/year Private facilities paid prospective cost based per diem with limits, cost based payment for public facilities CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes Admission of a child under age 16 10 hosp leave days/acute care hospitalization, 18 hosp leave days/psychiatric hospitalization Prospective per diem based on cost, leave days paid at 67% of facility's rate CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No


Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA). These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 300 percent of the federal poverty level (FPL). Beneficiaries in this group with income above the FPL pay an income-based monthly premium. The copayment requirement for physician services is applicable to and in addition to any amount payable to hospitals for outpatient services. This State imposes a $2 copayment requirement on dually eligible Medicare and Medicaid beneficiaries for each date of service for which the State is asked to pay the coinsurance and/or deductible amount.
 
 
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