Special Committees on Targeted Case Management and Sedation Dentistry

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Special Committees on Targeted Case Management and Sedation Dentistry

Join us for Health at the Capitol, a Kansas Health Institute webcast focused on health-related policy discussions and action at the Kansas Legislature. As interim committees meet at the Kansas Statehouse, we will provide updates on the health-related discussions.

By Valentina Blanchard, M.P.H., L.M.S.W.

Targeted Case Management

During the Special Committee on Targeted Case Management meeting that occurred on Wednesday, Oct. 9, representatives from targeted case management providers and organizations testified regarding conflict-free case management for individuals receiving Medicaid home and community-based services. The Kansas Department for Aging and Disability Services spoke about the need to separate case management from service provision (conflict-free case management) to avoid conflicts of interest and maintain participant choice in addition to meeting the rules outlined by the Centers for Medicare and Medicaid Services (CMS). The conferees provided examples of how states like South Dakota and Wyoming have addressed similar challenges and emphasized the need for person-centered planning and ensuring that case managers are solely focused on participant needs, not provider interests.

Committee members asked questions about the practicality of implementing conflict-free case management, particularly in rural areas with limited provider options. They discussed concerns about potential disruptions for individuals currently receiving services, especially for those with long-term relationships with their case managers. There also was discussion about Kansas' status in complying with federal rules, with some Committee members expressing frustration about the timeline for compliance and the impact on pending waiver applications.

Committee members stressed the importance of continued collaboration with stakeholders to explore program changes and grant opportunities to support providers in transitioning to conflict-free models. The committee plans to keep communication open with CMS to ensure that Kansas can meet compliance requirements as the new community support waiver will not be approved until conflict-free case management is in place. There also will be ongoing discussions with stakeholders to ensure that transitions are as smooth as possible for participants and providers.

Sedation Dentistry

The Special Committee on Sedation Dentistry met on Thursday, Oct. 10, and heard testimony from multiple organizations, including state health departments and dental associations, addressing Medicaid coverage and reimbursement for sedation dentistry in Kansas. Testimony from the Kansas Department of Health and Environment, providers and advocacy organizations highlighted the challenges providers face in delivering sedation services, particularly for pediatric and special needs populations, and underscored the disparities in reimbursement rates between Kansas and neighboring states. Presenters provided data on dentist participation in Medicaid, geographic gaps in services and the additional needs of children with complex health conditions. Organizations discussed ongoing efforts to explore new Medicaid codes that could support more comprehensive care, including behavioral management and case management related to sedation dentistry​.

Committee members discussed how provider reimbursement is calculated and monitored, particularly the 15-minute billing increments used for sedation services. Committee members also expressed concerns about potential discrepancies in billing or overuse of additional time increments and asked for more clarity on the availability of sedation dentistry providers in relation to the overall number of dentists in Kansas counties. There also was interest in understanding how the state's reimbursement rates compare to neighboring states and in exploring whether the state's current system offers sufficient incentives to maintain a strong provider network​.

The Committee discussed the possibility of gathering more comprehensive data, particularly a comparison between the total number of dentists in each county and those providing sedation services. They also requested further analysis on potential new Medicaid codes and complete data on total expenditures for sedation dentistry under Medicaid in 2023. Committee members indicated they may explore the option of moving to a flat fee arrangement for sedation services, rather than the current 15-minute incremental system, as a way to streamline billing and improve efficiency​.