Volume 43 - Issue 18 - May 2, 2024

State of Kansas

Department of Health and Environment
Division of Health Care Finance

Notice of Hearing on Proposed Administrative Regulations

A public hearing will be conducted at 9:00 a.m. July 5, 2024, in Room 9E, 900-N, Landon State Office Building, 900 SW Jackson, Topeka, Kansas to receive comments concerning the revocation of K.A.R. 129-7-65, the amendment of 129-1-1, the promulgation of new permanent regulations numbered 129-7-1 et seq., 129-8-1 et seq., and 129-9-1 et seq. This will include amendments to the Article titles for Articles 7 and 9 for Agency 129 and the promulgation of a new title for Article 8 for Agency 129. These proposed actions will create new administrative hearing procedures for the Kansas Medical Assistance program (Medicaid hereafter) covering eligibility, managed care, and providers. The Kansas Department of Health and Environment (KDHE) is the Kansas Medicaid agency. The Division of Health Care Finance administers the Kansas Medicaid programs and is identified as Agency 129.

This 60-day notice of the public hearing shall constitute a public comment period for the proposed regulations as stated in K.S.A. 77-421(a)(3). All interested parties may submit written comments before the hearing to Dorothy Noblit, KDHE, Division of Health Care Finance, Room 900-N, Landon State Office Building, 900 SW Jackson, Topeka, KS, 66612-1220, or by email at dorothy.noblit@ks.gov. The Division of Health Care Finance will give all interested parties a reasonable opportunity to present their views at the hearing, but it may be necessary to request each participant to limit any oral presentation to five minutes.

A copy of the regulations and the economic impact statement may be obtained by contacting Dorothy Noblit at 785-296-8903.

Any individual with a disability may request accommodation in order to participate in the public hearing and may request the proposed regulation and economic impact statement in an accessible format. Requests for accommodation should be made at least five working days before the hearing by contacting Dorothy Noblit at 785-296-8903 or by calling the Kansas Relay Center at 800-766-3777.

A summary of the regulatory changes, a statement concerning federal mandate, the overall economic impact of these proposed Kansas regulatory changes, and the affected parties follow.

Proposed Revocation of K.A.R. 129-7-65. “Notice to recipients of intended action.” This regulation specifies the requirements for notice to a recipient when the Kansas Medicaid program decides an eligibility matter. This regulation is the only regulation currently in Article 7, “Appeals, Fair Hearings and TAF/GA Disqualification Hearings.” This regulation will be duplicative and, potentially, confusing with the proposed new Kansas Medicaid administrative hearing regulations for Article 7 once they are adopted. Revocation of this regulation will promote clarity.

Proposed Amendment of K.A.R. 129-1-1. “Definitions.” This proposed amendment adds new terms to the existing regulation. The new terms are used in the proposed new Kansas Medicaid administrative hearing regulations. KDHE determined that adding the definitions to the main definitions regulation for the Division of Health Care Finance would centralize the definitions in one location and allow for easier access to those terms.

Proposed Amendment of the title for Article 7, Agency 129. Currently, Article 7 of Agency 129 is titled, “Appeals, Fair Hearings and TAF/GA Disqualification Hearings.” The proposed amended title for Article 7 is “Medical Assistance Grievances and State Fair Hearings for Eligibility and Fee-for-Service.” This amendment will make the Article title more descriptive for the proposed permanent regulations for Article 7.

Proposed Amendment of the title for Article 9, Agency 129. Currently, Article 9 of Agency 129 is titled, “Managed Care Provider Grievances, Reconsiderations, Appeals, External Independent Third-Party Review, and State Fair Hearings.” The proposed amended title for Article 9 is “Medical Assistance Grievances, Reconsideration, Appeals, External Independent Third-Party Review, and State Fair Hearings involving Providers.” This amendment will make the Article title more descriptive for the proposed permanent regulations for Article 9.

Proposed New Title for Article 8, Agency 129. Currently, there is no Article 8 for Agency 129. The proposed new title for Article 8 is “Medical Assistance Grievances, Appeals, and State Fair Hearings for Managed Care Enrollees.” The proposed title would be descriptive of the proposed permanent regulations dealing solely with procedures for grievances, appeals and administrative hearings brought by Kansas Medicaid enrollees against Kansas Medicaid’s managed care organizations.

Proposed New Permanent Regulations. The proposed new regulations are divided into three Articles.

Article 7. “Medical Assistance Grievances and State Fair Hearings for Eligibility and Fee-for-Service.” This group includes proposed permanent regulations 129-7-1, 129-7-2, 129-7-3, 129-7-4, 129-7-5, 129-7-8, 129-7-10, 129-7-11, 129-7-12, 129-7-13, 129-7-14, 129-7-16, 129-7-17, 129-7-18, 129-7-19, 129-7-20, 129-7-21, 129-7-22, 129-7-23, 129-7-24 and 129-7-25. This group provides procedures for the Kansas Medicaid program’s eligibility grievances, notices, and state administrative fair hearings involving applicants and currently eligible beneficiaries. This includes grievance and hearing procedures for fee-for-service cases. These are completely new regulations.

Article 8. “Medical Assistance Grievances, Appeals, and State Fair Hearings for Managed Care Enrollees.” This group includes proposed permanent regulations 129-8-1, 129-8-3, 129-8-4, 129-8-5, 129-8-7, 129-8-8, 129-8-10, 129-8-11, 129-8-12, 129-8-13, 129-8-14, 129-8-17, 129-8-18, 129-8-19, 129-8-20, 129-8-21, 129-8-22, 129-8-23, 129-8-24 and 129-8-25. This group provides procedures for the Kansas Medicaid program’s managed care grievances, notices, appeals, and state fair hearings for enrollees involving Kansas Medicaid’s managed care organizations (MCOs). This is a completely new Article and regulations.

Article 9. “Medical Assistance Grievances, Reconsideration, Appeals, External Independent Third-Party Review, and State Fair Hearings involving Providers.” This group includes proposed permanent regulations 129-9-1, 129-9-2, 129-9-3, 129-9-4, 129-9-5, 129-9-6, 129-9-7, 129-9-8, 129-9-10, 129-9-11, 129-9-12, 129-9-13, 129-9-14, 129-9-15, 129-9-17, 129-9-18, 129-9-19, 129-9-20, 129-9-21, 129-9-22, 129-9-23, 129-9-24 and 129-9-25. This group provides procedures for the Kansas Medicaid program’s grievances, notices, reconsiderations, appeals, and state fair hearings for providers of services to enrollees of MCOs and to beneficiaries of fee-for-service services.

Federal Mandate

42 C.F.R. 431.205 requires a state Medicaid program to maintain a hearing system for the state’s Medicaid program. 42 C.F.R. Part 431, Subpart E, states general requirements for due process, notices, continuation of benefits, and similar matters. Federal Medicaid law does not specify specific details for how a state hearing system is to operate. The proposed Kansas regulatory changes specify those procedural details for the Kansas Medicaid hearing system.

Economic Impact

The economic impact is hard to quantify since the agency can’t control who requests a hearing. Since KDHE, as the state’s Medicaid agency, has to provide a hearing system, the costs would be included as part of Kansas Medicaid operations. As a guide, during SFY 2023, Kansas Medicaid was a named party in approximately 800 administrative cases challenging eligibility, reimbursement, or provider decisions. During SFY 2023, Kansas Medicaid paid the Kansas Office of Administrative Hearings approximately $500,000 for administrative hearing services provided to Kansas Medicaid. Kansas Medicaid does not anticipate the cost to substantially change due to these proposed changes.

Affected Parties

Kansas Medicaid program, Kansas Medicaid applicants and recipients, KanCare managed care entities, and Kansas Medicaid and managed care providers.

Christine Osterlund
Kansas Medicaid Director
Division of Health Care Finance
Department of Health and Environment

Doc. No. 052104