Kansas Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Kansas's plan contracts, statutes and notices. For 20 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 20of 21
- Plans on record
- 7
- Directed payments
- 14
- Capitation cells
- 18$5,331.76–$10,096.83 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans must pay at least thisPlans must pay at least the published rate | 30,466 | Paid by the state, outside plans |
| Hospital outpatient | Plans must pay at least thisPlans must pay at least the published rate | 18,823 | Paid by the state, outside plans |
| Equipment & supplies | Plans must pay at least thisPlans must pay at least the published rate | 5,831 | Paid by the state, outside plans |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 5,747 | |
| Radiology | Plans must pay at least thisPlans must pay at least the published rate | 5,123 | Paid by the state, outside plans |
| Lab & pathology | Plans must pay at least thisPlans must pay at least the published rate | 4,968 | Paid by the state, outside plans |
| Pharmacy | Plans must pay at least thisPlans must pay at least the published rate | 2,214 | Paid by the state, outside plans |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 1,577 | |
| Dental | Plans must pay at least thisPlans must pay at least the published rate | 708 | Paid by the state, outside plans |
| Vision & hearing | Plans must pay at least thisPlans must pay at least the published rate | 371 | Paid by the state, outside plans |
| Nursing facility | Plans must pay at least thisPlans must pay at least the published rate | 291 | |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 246 | Paid by the state, outside plans |
| Behavioral health | Plans must pay at least thisPlans must pay at least the published rate | 162 | Paid by the state, outside plans |
| Therapy (PT/OT/speech) | Paid by the state, outside plansPaid directly by the state, outside managed care | 133 | Plans must pay at least this |
| Other home & community services | Plans must pay at least thisPlans must pay at least the published rate | 65 | Paid by the state, outside plans |
| Home health | Plans must pay at least thisPlans must pay at least the published rate | 44 | Paid by the state, outside plans |
| Other | State-directed paymentDirected payments add to plan rates | 32 | |
| IDD services | Plans must pay at least thisPlans must pay at least the published rate | 32 | |
| Personal care & attendant | Plans must pay at least thisPlans must pay at least the published rate | 31 | Paid by the state, outside plans |
| ABA / autism services | Paid by the state, outside plansPaid directly by the state, outside managed care | 21 | Plans must pay at least this |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 15 | Plans must pay at least this |
| Clinics (FQHC/RHC) | Not classified yet | 1 |
State-directed payments
Payments CMS approved under 42 CFR 438.6(c) that plans must make on top of, or as a minimum for, their negotiated rates.
Frequently asked questions
Do Kansas Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Equipment & supplies, Hospital inpatient, Radiology, Lab & pathology, Pharmacy, Hospice, Dental, Vision & hearing, Nursing facility, Transportation, Behavioral health, Therapy (PT/OT/speech), Other home & community services, Home health, IDD services, Personal care & attendant, ABA / autism services, Private duty nursing. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Kansas's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.