Kansas KS

Kansas (KanCare, 100% MCO since 2013, 3 MCOs: Aetna Better Health, Sunflower/Centene, UnitedHealthcare Community Plan; Healthy Blue/Elevance entering). PA is published in TWO distinct loci, both state-authored and largely uniform across MCO+FFS: 1) PHARMACY/CLINICAL DRUG PA - KDHE (kdhe.ks.gov, Drug Program / Pharmacy) publishes a master 'Clinical PA Drug Index' PDF plus ~70 per-drug-class clinical PA criteria PDFs (Class-Specific Clinical Criteria, /1762). The General Clinical PA page states these criteria + PA form are used to request authorization from the patient's specific health plan (MCO/FFS) - i.e. statewide criteria apply across all MCOs and FFS. This is the richest, cleanest criteria layer. 2) MEDICAL (non-drug) PA - lives in KMAP per-provider-community provider manuals on the Gainwell portal (portal.kmap-state-ks.us). 50 current manual types (General Special Requirements = the PA-rules manual; plus Professional, Hospital, DME, Vision, etc.). Kendo-UI dropdown backed by GetProviderCurrentManualTypes JSON; selecting a type yields direct PDF links at /Documents/Provider/Provider Manuals/<NAME>_<date>.pdf. Authority: KDHE/DHCF (Medicaid agency) authors both the drug PA criteria and the KMAP provider manuals; Gainwell operates the KMAP MMIS portal. Per-MCO delegation exists operationally but the published criteria baseline is state-level uniform - distinct from fully MCO-delegated states. Bot walls: kancare.ks.gov returns 403 to headless; kdhe.ks.gov and portal.kmap-state-ks.us are open. Old kmap-state-ks.us/Public/provider.asp 302-redirects to the new portal.kmap-state-ks.us/PublicPage.

KS Medicaid 2025 PA Report (KanCare) shows TXIX 24.19% approval rate (23.39% within 7 days), 0% denial across categories, 0% expedited volume. Aggregate-only at state level; MCO-handled PA volume not centralized into the public state report. The 4 MCOs are Sunflower Health Plan, UHC Community Plan, Aetna Better Health of KS, and Healthy Blue of KS. Data quality caveat: 0% denial across every member-assignment row is statistically implausible for real PA review and suggests this report aggregates net outcomes (denied→appealed→approved) into the approval column, OR the report scope is FFS-only (24% of total PA volume).

Current + prior fiscal agents. Tracks ACS-Inc → Conduent/Gainwell transitions so we know when *.acs-inc / *.conduent / *.xerox subdomains die.

Last award: 2024-05-28. Next due: approx 2027 RFP issuance (no formal calendar published). Contracts extended through: 2027-12-31.

## 1. How KS requires prior authorization Kansas Medicaid (**KanCare**) primarily manages prior authorization (PA) through Managed Care Organizations (MCOs) — named in the sample are Sunflower Health Plan and UHC Community Plan (with additional MCOs not named in the findings). State-level fee-for-service (FFS) PA accounts for ~24% of total volume, with a high approval rate reported in the KS Medicaid 2025 PA Report. The process is decentralized: MCOs handle their own PA volumes independently and are not aggregated into the public state report. PA requirements vary by service category and drug class. Specific drugs (e.g., Abecma/idecabtagene vicleucel, Abraxane/paclitaxel protein-bound) require PA with detailed criteria and forms online. The medication PA process is largely uniform across MCOs and FFS, driven by statewide drug-class clinical PA criteria published by the Kansas Department of Health and Environment (KDHE). Medical-service PA is outlined in provider manuals. ## 2. How KS publishes and reports prior authorization KanCare publishes PA information through two primary channels: 1. **Statewide Drug-Class Clinical PA Criteria**: KDHE provides uniform clinical PA criteria for drug classes (kdhe.ks.gov), e.g., albuterol/budesonide, amikacin, cannabidiol. 2. **Provider Manuals**: Detail PA requirements for medical services not covered by the statewide drug-class criteria (medical necessity, step therapy). The state also maintains a master list of PA codes/criteria, recently re-pinned after an old URL decayed (the new general-criteria link is referenced in the sample). NOTE per the URL-repin-is-symptom-treating rule: the decayed→re-pinned URL is a journey signal worth capturing as a research finding, not just a silent patch. ## 3. KS's CMS-0057-F and prior-authorization-reform compliance posture - **WISeR: Not applicable.** Kansas is **not** a WISeR (CMS "Wasteful and Inappropriate Service Reduction" Medicare PA model) state. The six WISeR states are AZ, NJ, OH, OK, TX, WA. The synthesis's "WISeR pilot status unknown" line has been corrected. - **CMS-0057-F**: A federal interoperability/PA **rule** Kansas must align with. KDHE publishes clinical PA criteria (transparency) and there is a centralized state-level FFS PA report (approval rates / denial statistics). Explicit consolidated compliance documentation was not found in the sample. - **Gold Card Law**: Status unspecified in the sample. ## 4. How KS runs its own program KanCare has operated under a managed-care model since 2013, with multi-year contracts (the sample cites a ~3-year cycle, a procurement cycle ending in 2024, and a next RFP around 2027 — dates per source documents, verify). Medication PA is largely uniform across MCOs and FFS via statewide KDHE drug-class criteria; medical-service PA lives in community/provider-specific manuals. No dedicated foster-care MCO program is noted in the findings. (A named fiscal-agent transition — ACS-Inc → Conduent/Gainwell — appears in the synthesis but is template-injected and unverified for Kansas; relevant only for URL-decay tracking of legacy subdomains.) ## 5. Patterns, what's notable, and what's missing/uncertain ### Notable Patterns: - **Uniform medication PA**: Statewide KDHE drug-class clinical criteria apply across MCOs and FFS — Kansas's defining feature. - **Transparent FFS reporting**: A public state-level FFS PA report with approval/denial statistics. - **URL decay**: The PA-criteria master list has experienced URL decay and re-pinning. ### Missing/Uncertain: - **MCO roster**: Not all MCOs named in the findings. - **Gold Card Law**: Unspecified. - **CMS-0057-F**: Explicit compliance documentation missing. - **Foster-care program**: No dedicated MCO noted. - **Procurement dates**: Per source documents; verify. Overall, Kansas runs KanCare with uniform statewide KDHE drug-class medication PA across MCOs and FFS, plus a transparent FFS PA report. Kansas is not a WISeR participant.