CHAPTER 36 SENATE BILL No. 162 An  Act relating to Kansas insurance coverage for children; prior authorization; amending
K.S.A. 1998 Supp. 38-2001 and repealing the existing section. Be it enacted by the Legislature of the State of Kansas:

      Section  1. K.S.A. 1998 Supp. 38-2001 is hereby amended to read as
follows: 38-2001. (a) The secretary of social and rehabilitation services
shall develop and submit a plan consistent with federal guidelines estab-
lished under section 4901 of public law 105-33 (42 U.S.C. 1397aa et seq.;
title XXI).

      (b) The plan developed under subsection (a) shall be a capitated man-
aged care plan covering Kansas children from zero to 19 years which:

      (1) Contains benefit levels at least equal to those for the early and
periodic screening, diagnosis and treatment program;

      (2) provides for presumptive eligibility for children where applicable;

      (3) provides continuous eligibility for 12 months once a formal de-
termination is made that a child is eligible subject to subsection (e);

      (4) has performance based contracting with measurable outcomes in-
dicating age appropriate utilization of plan services to include, but not
limited to, such measurable services as immunizations, vision, hearing and
dental exams, emergency room utilization, annual physical exams and
asthma; and

      (5) shall use the same prior authorization standards and requirements
as used for health care services under medicaid to further the goal of
seamlessness of coverage between the two programs; and

      (5) (6) will provide targeted low-income children, as defined under
section 4901 of public law 105-33 (42 U.S.C. 1397aa, et seq.), coverage
subject to appropriations.

      (c) The secretary is authorized to contract with entities authorized to
transact health insurance business in this state to implement the health
insurance coverage plan pursuant to subsection (a) providing for several
plan options to enrollees which are coordinated with federal and state
child health care programs, except that when contracting to provide man-
aged mental health care services the secretary shall assure that contracted
entities demonstrate the ability to provide a full array of mental health
services in accordance with the early and periodic screening, diagnosis
and treatment plan. The secretary shall not develop a request for proposal
process which excludes community mental health centers from the op-
portunity to bid for managed mental health care services.

      (d) When developing and implementing the plan in subsection (a),
the secretary to the extent authorized by law:

      (1) Shall include provisions that encourage contracting insurers to
utilize and coordinate with existing community health care institutions
and providers;

      (2) may work with public health care providers and other community
resources to provide educational programs promoting healthy lifestyles
and appropriate use of the plan's health services;

      (3) shall plan for outreach and maximum enrollment of eligible chil-
dren through cooperation with local health departments, schools, child
care facilities and other community institutions and providers;

      (4) shall provide for a simplified enrollment plan;

      (5) shall provide cost sharing as allowed by law;

      (6) shall not count the caring program for children, the Kansas health
insurance association plan or any charity health care plan as insurance
under subsection (e)(1); and

      (7) may provide for payment of health insurance premiums, including
contributions to a medical savings account if applicable, if it is determined
cost effective, taking into account the number of children to be served
and the benefits to be provided.

      (e) A child shall not be eligible for coverage and shall lose coverage
under the plan developed under subsection (a) of K.S.A. 1998 Supp. 38-
2001, and amendments thereto, if:

      (1) During the prior six months, the child was covered with a com-
prehensive health insurance policy by an insurance company, health
maintenance organization or nonprofit hospital and medical insurance
corporation authorized to do business in this state and such insurance is
still available to the child; or

      (2) such family has not paid the enrollee's applicable share of any
premium due.

      If the family pays all of the delinquent premiums owed during the year,
such child will again be eligible for coverage for the remaining months
of the continuous eligibility period.

      (f) The plan developed under section 4901 of public law 105-33 (42
U.S.C. 1397aa et seq., and amendments thereto) is not an entitlement
program. The availability of the plan benefits shall be subject to funds
appropriated. The secretary shall not utilize waiting lists, but shall monitor
costs of the program and make necessary adjustments to stay within the
program's appropriations. 
Sec.  2. K.S.A. 1998 Supp. 38-2001 is hereby repealed.
 Sec.  3. This act shall take effect and be in force from and after its
publication in the statute book.

Approved March 30, 1999.
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