8210 Description of Waiver Programs - Policy regarding specific functional criteria are found in the appropriate waiver manual. The following HCBS and model waiver programs are currently operated in the State.

8211 Frail Elderly Waiver (HCBS/FE) - This waiver serves individuals who are elderly (65 or older) and who meet the long term care clinical threshold.

Persons who are assessed and found in need of long term care will be offered either HCBS services only or, if appropriate, a choice between nursing facility or HCBS services. If HCBS services are chosen, a person-centered service plan will be developed and the cost of services determined. Cost cap exceptions may be granted when the HCBS cost exceeds the average Medicaid reimbursement for nursing facility or other institutional services if warranted by the customer's care needs and approved by the care coordinator and the agency.

Designated care coordinators for this waiver are responsible for developing and maintaining a person-centered service plan to meet the individual's needs. Eligibility staff are responsible for referring the individual to the appropriate ADRC for assessment (if necessary) and informing the care coordinator regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the individual for Medicaid application (if necessary) and providing information to eligibility staff concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client's living arrangement. The  ES-3160/ ES-3161 shall be used for these purposes.

8212 Physical Disabled Waiver (HCBS/PD) -This waiver serves individuals who have been determined physically disabled by Social Security disability standards and found in need of long term care services to accomplish the normal rhythms of the day. Those individuals between 21 and 64 whose primary diagnosis is severe and persistent mental illness (SPMI), severely emotionally disturbed (SED), or intellectual /developmentally disabled (I/DD) are excluded from this waiver.

This waiver serves persons between the ages of 16 and 64. Persons on the PD waiver on their 65^th birthday may remain on the PD waiver. No other persons may receive PD services past the age of 64. Persons who elect to remain on the PD waiver past the age of 64 may move to the FE waiver in the future. Persons choosing the FE waiver may not move back to the PD waiver at a later point.

NOTE: The eligibility worker shall assume the person will remain on the PD waiver. Do not make a change until notification from the care coordinator is received.

As with the HCBS/FE waiver, persons who are assessed and found in need of long term care will be offered either HCBS services only or, if appropriate, a choice between HCBS or nursing facility services. If HCBS is chosen, a person-centered service plan will be developed along with the cost of services.

Designated care coordinators are responsible for developing and maintaining a person-centered service plan to meet the individual's needs. The eligibility staff are responsible for referring the individual for assessment (if necessary) and informing the care coordinators regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the individual for Medicaid application (if necessary) and providing information to Eligibility worker concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client's living arrangement. The ES-3160/ ES-3161 shall be used for these purposes.

8213 - Intellectual and Developmental Disability Waiver (HCBS/IDD) -  This waiver serves individuals who are 5 years of age or older and are intellectually or developmentally disabled and who meet the criterion for ICF-IID level of care as determined by screening. The Substance Abuse, Mental Health and Developmental Disabilities Commission is responsible for determining eligibility for ICF-IID level of care based on screening assessments submitted by recognized Community Developmental Disability Organizations (CDDOs).

Eligibility staff are responsible for referring all clients who are potentially in need of ICF-IID level of care to the HCBS Program Manager who will route to the appropriate CDDO for screening.  The ES-3160 form shall be used for all referrals.

Ongoing case management will also be provided by the local CDDOs.  Eligibility staff are responsible for informing the appropriate center concerning the Medicaid eligibility decision, the amount of any client obligation, and any changes in obligation or eligibility. The CDDO case manager is responsible for providing information to eligibility staff concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client's living arrangement. The ES-3160/ ES-3161  shall be used for these purposes.

8214 Technology Assisted Waiver (HCBS/TA) - This waiver serves chronically ill and medically needy individuals under age 22 who are hospitalized or at imminent risk of hospitalization.

Individuals seeking coverage under this waiver will be referred directly to the Children’s Resource Connection via the ES-3160 HCBS referral form. An assessment of the individual’s needs will be completed by a MATLOC Eligibility Specialist (MES). The MES will then complete the ES-3160, including the care coordinator, choice date, the date services are to commence, and return the form back to the eligibility specialist.

Ongoing case management will be provided by the care coordinator. The care coordinator is responsible for development of a person-centered service plan and providing information to the eligibility worker concerning the cost of care, a change in the person-centered service plan or the individual’s living arrangement.  Eligibility workers are responsible for informing the care coordinator of the Medicaid eligibility decision, the amount of any client obligation, and of any change in eligibility or obligation. This communication between the care coordinator and the eligibility worker shall be via the ES-3160 and  ES-3161 The forms should be sent by encrypted e-mail to expedite delivery.

8215 - Brain Injury Waiver (HCBS/BI) - This waiver serves individuals who have a traumatically acquired head injury which has caused structural brain damage resulting in residual deficits and disabilities and who would otherwise require care in a rehabilitation facility as determined by screening. Also included under this waiver are individuals with an acquired brain injury caused by stroke, brain trauma, infection of the brain, brain tumor, anoxia or other similar cause.  The local ADRC is responsible for determining if the head injury criteria have been met based upon screening assessments submitted by designated case managers.

This waiver serves persons be from birth to age 64. Some persons may continue on the HI waiver past the age of 64, as approved by the waiver manager.

Designated case managers are responsible for assessing the need for HCBS/BI services and developing and maintaining a person-centered service plan to meet the individual's needs.  Eligibility staff are responsible for referring the individual for assessment (if necessary) to the local ADRC. Eligibility workers are also responsible for informing the care coordinator of the Medicaid eligibility determination, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the individual for Medicaid application (if necessary) and providing information to eligibility staff concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client's living arrangement. The ES-3160/ ES-3161 shall be used for these purposes.

8216 Serious Emotional Disturbance Waiver (HCBS/SED) - This waiver serves children who are determined to meet severe emotional disturbance criteria and who are between the ages of 4 and 18, or between 18-22 if approved by the Program Manager. The child must be determined to be clinically eligible based on the severity of his or her emotional disturbance and the related impact on the child's potential for functioning successfully in the available home and community environment without special supports. Generally, the children served by this waiver would otherwise be admitted to a state mental hospital without the availability of waiver services.

The families of children who are assessed and found to meet clinical eligibility criteria will be offered a choice between state mental health hospitalization or HCBS services. If HCBS is chosen, a plan of care will be developed along with the cost of services. 

Designated case managers in each of the Community Mental Health Centers (CMHC's) will be responsible for developing and maintaining a plan of care to meet the child's needs as well as provide ongoing case management. Final approval of clinical eligibility and the care plan rests with staff in the Commission on Mental Health/Developmental Disabilities.  Eligibility staff are responsible for referring the family and child to the appropriate CMHC for assessment (if necessary) and informing the case manager regarding Medicaid eligibility, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for referring the family for a Medicaid application (if necessary) and providing information to eligibility staff concerning the plan of care, the cost of care, and any changes in that care or the child's living arrangement. The  ES-3160/ ES-3161 shall be used for that purpose.

8217  Autism Waiver (HCBS/AU) - This waiver serves children under the age of 6 years old who are determined to meet functional eligibility criteria of an Autism Spectrum Disorder (ASD) and would otherwise be at risk of placement in a state mental health hospital. Participation under this waiver shall be limited to a maximum of three years. A one year extension may be approved by the Autism Review team if the child has demonstrated continued improvement.

Individuals seeking coverage under this waiver will file a preliminary functional eligibility application with the waiver program manager. A limited number of children will be served under this waiver. Those children qualifying for an opening will be referred by the program manager for a screening assessment. A wait list (proposed recipient list) will be maintained for those requesting services when no openings exist.

Functional Eligibility Specialists contracted across the state will complete the screening assessments for the waiver. The families of children who meet the clinical autism eligibility criteria will be offered a choice between state mental health hospitalization and HCBS services. If HCBS services are chosen, the family must file an application for medical assistance with the KanCare Clearinghouse.  Once eligibility has been approved by eligibility staff, the Managed Care Organization (MCO) identified on the HCBS choice form will be notified. Autism Specialists will be responsible for developing and maintaining an Individual Behavioral Program/Plan of Care (IBP/POC) including the cost of services to meet the child's and family's needs. HCBS/Autism services may not start until the IBP/POC is authorized by the MCO.