This section sets forth the guidelines regarding persons who receive home care services through the State's approved home-and-community based services waivers. Such services may be provided in either a non-institutional (e.g., own home) or institutional (e.g., assisted living or residential health care facility) setting and may be either medical and/or non-medical in nature. Services are designed to provide eligible persons with the least intensive level of care which maintains or improves the overall physical or mental condition of customers who may otherwise be placed in a nursing facility, hospital, or intermediate care facility for individuals with intellectual disabilities.
To receive HCBS, individuals must be eligible for medical assistance. Categorical as well as financial and nonfinancial requirements must be met. Categories for individuals aged 18 and under include SI, Medically Needy, and Caretaker Medical programs. For individuals aged 19 and older, categories are limited to Caretaker Medical, SI and Medically Needy. HCBS is not available to persons covered under the Breast and Cervical Cancer group, Working Healthy or MediKan recipients. For persons between the ages of 19 and 65 a disability determination is required except for those ages 19-21 in the HCBS TA and SED waivers.
The HCBS effective date establishes the date an individual is considered an HCBS recipient. A person is an HCBS recipient if he or she has been assessed, found in need of long term care services, chooses to receive HCBS services and those services are available, and services have been scheduled to begin.
For all HCBS waivers, (FE, PD, BI, I/DD, TA, SED, and AU waivers), Program Manager approval is required prior to authorizing coverage and the effective date is the actual date eligibility staff take action to approve coverage.
For persons placed on a waiting list, HCBS is not effective until such time that funding becomes available to serve the individual on the waiver. When funding becomes available, the HCBS Program Manager will notify the agency of the HCBS effective date using ES-3160, Notification of KanCare HCBS Services form.
Persons receiving HCBS must have an approved plan of care or person-centered service plan, depending on the specific waiver. The plan of care/person-centered service plan outlines the services the individual will receive, the provider authorized to provide the services, and the rate at which the services will be reimbursed. Plan of care/person-centered service plan development and approval is the responsibility of the appropriate care coordinator. The total cost of the approved plan is included on the plan of care/person-centered service plan. This cost, less any standard amount included for acute care costs, is the HCBS cost of care.
The finalized person-centered service plan can require time to develop; therefore, a provisional plan of care/person-centered service plan will be developed by the assessing entities that screen for functional eligibility. The provisional plan of care/person-centered service plan is required for all HCBS waivers and must be obtained prior to authorization of services. The assessing entity shall provide this provisional plan of care/person-centered service plan to the agency when the consumer is found functionally eligible to receive services and an ES-3160 is provided.
As part of the HCBS service package, the organization responsible for the administration of HCBS services for the applicant/recipient shall provide a designated individual to coordinate such services. Communication between the HCBS entity and the eligibility worker is essential to ensure that services are properly coordinated.
All pertinent events which impact eligibility or the HCBS plan must be communicated to the partner entity. Examples of pertinent events include establishment of initial eligibility, case closure, changes in client obligation, changes in address or living arrangement, significant changes in the cost of the HCBS plan, and death. (NOTE: An ES-3161 is not required to be sent by KDHE when the only change is a change in address that does not impact the eligibility determination.) These events shall be communicated timely using an appropriate method of communication as defined in this section.
The ES-3160 and ES-3161, Notification of KanCare, HCBS Changes and Updates, have been specifically designed as tools to communicate ongoing changes between entities. Encrypted email is the method used for communicating between entities. The appropriate form must be included in the encrypted e-mail, a general e-mail describing the change is not sufficient. As with the ES-3160, a change report can be initiated by either party and must be sent promptly. A report may be used in place of individual ES-3161s for COLA and HCBS recipients whose eligibility was discontinued for failing to return their annual renewal. This report will be sent to the appropriate entities by encrypted email.
NOTE: HCBS waiver reinstatements that occur in accordance with 1423 or 9332 do not require an ES-3160 or ES-3161 consultation with the HCBS Program Manager. See PM2019-12-02, HCBS Effective Dates – FE, PD, BI and I/DD Waivers and Reinstatement of HCBS at Review and PM2021-09-01, State Institutional Alternative (SIA) Policy Implementation.
The ES-3160 shall be completed for each individual initially requesting HCBS. The form may be initiated by either the HCBS entity or the eligibility worker as a referral for services. When a decision is made regarding the availability and eligibility for HCBS, the HCBS entity completes necessary information, including the estimated cost of care and information related to the effective date, and sends the form to the appropriate eligibility worker. The eligibility worker will report eligibility information, including the start date and client obligation, to the HCBS entity, where the original form is kept. For new approvals, this form must be used to inform the other entity of HCBS eligibility.