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Continuity of Care & Authorizations for January 1, 2025

Date: 12/23/24

Healthy Blue, Sunflower and United logos

The KanCare 3.0 Contract will begin January 1, 2025, with Healthy Blue, Sunflower Health Plan and United. The purpose of this bulletin is to inform providers of the Continuity of Care period and to provide instructions regarding prior authorization, including use of Electronic Visit Verification (EVV).

Continuity of Care:

Each MCO is required to provide continuity of care for members who come from another MCO. This includes honoring existing services that were authorized by the previous MCO and paying authorized providers at least 100% of the Medicaid fee schedule.  Continuity of care begins on the date the member is eligible with the new MCO.

  • HCBS Services: HCBS service authorizations provided by the previous MCO will be used by the new MCO for up to 90 days, or until a new comprehensive assessment is completed and a Person-Centered Service Plan is developed. A member’s existing HCBS service providers will be paid at 100% of the Medicaid fee schedule unless a different contract rate or single case agreement is agreed upon by the new MCO.
  • Inpatient Services: The previous MCO is responsible for paying for inpatient stays for which they have given prior authorization, through the duration of the previous MCO’s authorization.
  • Hospitalizations: Members who are hospitalized on Dec. 31, 2024, will be covered by Aetna for the first 15 days of January 2025 or until discharge if discharged before Jan. 15, 2025. 
  • Other Services Requiring Prior Authorization: The new MCO will honor the authorization provided by the previous MCO through the end date of the authorization, up to 90 days, and will pay the authorized provider at a minimum of 100% of the Medicaid fee schedule. For services to continue past the authorization end date, or the maximum of 90 days, the provider will need to submit a prior authorization request to the new MCO.
  • Single Case Agreements: Continuity of care does not apply to contract rates held by the previous MCO, including single case agreements for rates negotiated above the Medicaid Fee Schedule. Providers will need to make any requests to the new MCO. Single case agreements for out-of-network providers will be paid by the new MCO at the Medicaid Fee Schedule rate unless otherwise requested by the provider and agreed upon by the new MCO.

Transfer of Authorizations:

The state and MCOs have an established process for securely transferring prior authorization information for members moving from one MCO to another. This includes members moving from Aetna to Healthy Blue, Sunflower and United.  

If providers do not see a needed authorization on January 1, they may refer to the continuity of care information provided above for what will be paid. Providers may also reach the MCOs using the following contact information:

Electronic Visit Verification (EVV):

For the services for which use of Electronic Visit Verification (EVV) is required, EVV will continue to be required. Authorizations are either sent to or created in AuthentiCare. Providers and MCOs will need to ensure the proper provider ID/location is used on the authorization.  Once correct, the provider can accept the authorization and schedule against it.

If an authorization from the new MCO is not present, the worker can continue to clock in and out using EVV following the AuthentiCare guidelines provided below. The provider may refer to the continuity of care information provided above to understand what will be authorized and paid. Providers may also contact each MCO using the contact list provided above.

AuthentiCare Instructions:

When a worker is ready to deliver service, they must either check in to AuthentiCare through the:

  1. The AuthentiCare Smartphone application;
  2. The AuthentiCare IVR; or 
  3. An approved third-party vendor.

If a worker is unable to use one of the three methods, then an approved administrator at the provider can manually enter visit information. If smart device and/or wi-fi connectivity is not available, AuthentiCare’s mobile application allows for "store and forward" capabilities. In this case, the EVV information is stored at the time of service and uploaded to AuthentiCare when connectivity resumes.  

When support is completed, the worker checks out of the visit by logging back in through one of the approved methods and completes the data entry to verify their visit and capture any observations. The information is then transmitted to the AuthentiCare application.  

A worker can use the Authenticare Smartphone application or the IVR to record services, and the provider can create a web claim without an approved authorization in Authenticare as long as there is an established association between the member and the provider agency. When using IVR for clock in, workers will be alerted that authorized units are not available and should follow the system prompts to acknowledge and provide unauthorized services. A claim will be created but will have a critical exception and will not be exported for payment until an authorization is in place with the status of Approved.