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system.

Both KenPAC and managed care entities will solicit input through the committees comprised of providers, advocates and parents of children eligible for the program.

Managed care entities are required to demonstrate adequate provider networks and access to care prior to contract award and through periodic reporting, with monitoring by the Department for Medicaid Services.

The Department for Medicaid Services conducts an annual patient satisfaction survey, CAHPS, to KCHIP recipients.

7.2.2 Access to covered services, including emergency services as defined in 42 CFR 457.10. (Section 2102(a)(7)) 42CFR 457.495(b))

Emergency services are monitored in the same manner as 7.2.1.

7.2.3 Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a)(7)) (42CFR 457.495(c))

Enrollees with chronic, complex, or serious medical conditions may either have a medical home through enrollment in Passport Health Plan or the KenPAC program, or may be served through fee-for-service Medicaid. The Department for Medicaid Services routinely monitors services provided by Passport Health Plan, including management of enrollees with chronic, complex, or serious medical conditions, through review and follow-up of regular written reports, review and follow-up of complaint data, and on site reviews. Families, care coordinators, service providers and advocates monitor access to care for children with serious medical conditions. The Department relies primarily on complaints and grievances to track the population for KenPAC and fee-for-service enrollees. The KenPAC program of PCCM will remain until the program is bid out to a managed care system.

7.2.3 Decisions related to the prior authorization of health services are completed in accordance with state law or, in accordance with the medical needs of the patient, within 14 days after the receipt of a request for services. (Section 2102(a)(7)) (42CFR 457.495(d))

Decisions related to the prior authorization of health services are completed in accordance with the medical needs of the patients, within 14 days after the receipt of a request for services.