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Policy and Procedure Clarifications

January 9, 2012 - Information Regarding: Kansas AuthentiCare - POC Timeframe - ATR's - EDR's - Issued by Krista Engel

August 18, 2011 - Clarification of Webinar Issues - Issued by Susan Fout

Attached Memorandum

January 26, 2011 - New Level I Plan of Care Approvers - Issued by Andrea Gould

I am happy to officially announce our new Level I POC Approvers; Kendra Alvarez-Holmes and Sandra Andrews. As it was mentioned back in December, both have been in training and working very hard to learn the Approval Process.

Effective February 1, 2011, you will start to send your POC to your new POC Approver (if it changed). I have listed below the area's that each will be covering, along with their e-mail and phone number. You will also be receiving a new yellow pamphlet with their name's and numbers on them.

If you have questions, please feel free to call your Level I POC Approver, or myself. Please keep in mind, there is always a learning curve with this job and both are still learning, as we all are.

I would like to thank you all for your patience with KDOA, as we have been going through these changes.

Kendra - 02, 07, 11, 5999, 6868
Kendra.AlvarezHolmes@aging.ks.gov
(785) 296-1492

Sandra - 01 ,06, 09, 10, 5790, 6805, 6807
Sandra.Andrews@aging.ks.gov
(785) 368-7324

Todd - 03, 04, 05, 08, 6817
Todd.Haug@aging.ks.gov
(785) 296-5544

November 9, 2010 -ANESRS and ANEKDOA Reminder - Issued by Angel Nott

As a reminder: When a Case Manager has made a report to either SRS or KDOA on a suspected Abuse, Neglect, or Exploitation of a customer they are to be entering an indication that they made a report onto the KAMIS POC (do not put on the paper POC.) There should be one line in the POC per report, therefore if the Case Manager makes three separate reports there should be three separate lines on the KAMIS POC.

Instructions for POC data entry:

POC Field What to Enter
AAA/CMEAutomatically populates with the agency code that is making the report.
Service codeUse ANESRS when making a report to SRS, use ANEKDOA when making a report to KDOA.
Funding SourceUtilize the funding code listed in the taxonomy to indicate which funding source the Case Management for that customer is paid out of (such as TCM, OAA, SCA, ESD, etc). If the customer only received ASMT funded through TCMSGF then select that funding code.
ProviderSRS or KDOA (depending on which agency is contacted for the report).
Units1
PerReport
Total units monthly1
Start DateThis should be the date the Case Manager makes the report to either SRS or KDOA.
End DateThe date notification is provided or the Case Manager finds out the results of the report they made.
Discharge Codeonly three codes are an option. Either use 36, 37, or 38. Any other code is not a valid option. If the Case Manager is having a difficult time obtaining the screening determination contact Angel Nott at KDOA.
Cost of UnitThere is no cost.
Customer Obligation/CopayThere is no CO or Copay.
Monthly costThere is no cost.

If there are issues occurring with data entry, please contact the KDOA Help Desk. Thanks for your cooperation!

October 19, 2010 - Cost Cap Exception (CCE) Online Submission Tips/Notes - Issued by Andrea Gould

With almost two months of submitting Cost Cap Exception online, I thought it was a good time to thank everyone for their hard work in learning the new process. Hopefully, this new process has been able to help out each of you in your own office's and getting NOA out to providers sooner.

While we have had several CCE submitted and approved without additional information needed, we have also had many CCE that have been sent back. Below is a list of the repetitive errors KDOA has seen from CCE submitted. The errors have been seen statewide.

If you have any questions, please feel free to contact Krista or myself.

June 22, 2010 - Changes in Forms Effective July 1, 2010 - Issued by Angel Nott

Today, forms will be published to the Provider Resource Website. Most of the changes are more paper in nature to correct an earlier misprint or update a form while others will be to meet reporting or federal Performance Measures. These new forms coming out are to be used starting July 1, 2010.

We realize it is short notice however most of the larger changes required KAMIS system changes and we needed to ensure those were going to be able to be completed before implementing changes across the state. It appears the changes are all in KAMIS and ready to go for July 1, 2010. Our hope is that everything will work, but whenever there are multiple changes in a computer system there is always a chance of error. If you find an error when doing data entry after July 1, 2010 please contact the KDOA Help Desk to work through those data entry errors.

Below are some highlights and instructions on use:

Taxonomy:

The biggest change with the taxonomy is the ANESRS and ANEKDOA code. Part of the Federal Performance Measures require a tracking of reports made and results of suspected abuse, neglect, or exploitation of our customers. Starting July 1, 2010 if your agency makes a report then the appropriate taxonomy code is to be put on the Plan of Care. The start date is to be the date the report is made and the end date is to be the date you are notified (or request final status) of the outcome. The Discharge/Closure Code will indicate the result of the report (screened out, investigated but not substantiate, investigated and substantiated). It will not require your agency to find out the details of the investigation, who was substantiated on, etc. To help facilitate this change on reporting, Bessie Walker at SRS is notifying the Regional SRS APS investigators. Should your agency have a difficulty time in acquiring the needed information please notify me and I will assist in working through the issue.

The other prominent change in the taxonomy is the addition of a new codes for SCA for customers who self-direct. There are changes within the POC that necessitated this change.

The changes with HCBS/FE codes are to reflect currently policy definition.

UAI, AUAI, and UPR:

The change that affects all three forms is adding a question for the Nutrition Risk Screen that will trigger that at least ONE question will have to be selected.

There is a major change for the UAI and AUAI which is the Disaster Red Flag categories. The two new categories are defined below and changes will be made in the Instruction Manual soon.

No Informal Support: Customer with uninvolved family in town, no family/informal supports in town, and people who have family that live in another state and lack the resources necessary in the event of a disaster

Physical Impairment: Customer is unable to seek safety in the event of a disaster due to physical limitation (bedridden, w/c bound, blind, deaf, hard of hearing)

UAI:

Page 1 - You will notice not only the Disaster Red Flag changes but format changes as well. The format changes allowed for a location to put whether the customer is going to open (or will be opening) an ESDPND plan of care. It also has a new question of "Receive Veteran Benefits". The other changes are to put AAA/CME as the provider of assessment agency, "yes" and "no" for some questions, and to add lines for comments.

Page 3 - A new question was added to the Nutrition Risk Screen (see prior information on this)

Page 4 - The changes for data entry of the UAI will come out from the KDOA IT Help Desk however I do want to mention that this page does have a correction for data entry purposes (which affects how your staff will utilize this part). You will only answer the question about Participant Status - Home Delivered Meals if the customer was marked "yes" on any of the three questions pertaining to whether they meet the eligibility to receive a home delivered meal. Please note this page has the Clock Draw on the bottom of page 4. Your agency is welcome to utilize this page or the Clock Draw page separate that has the same size clock. Do NOT use the enlarged clock that has circulated within CARE. 

Page 10 (Plan of Care) - Mostly just formatting changes to the POC. We removed the SSN from the page to aid in the prevention of Identity Theft (a change on the CSW will also remove SSN). Within the service listing table there are changes in the categories include putting AAA/CME, removing the Self-Direct Column, removing the Disaster column, moving the Release up a little on the page (to make it more clear that it is just for the providers listed above in the services coordinate by your agency), and added a second signature line for when an update is made to the paper POC.

AUAI:

Changed the form number.

UPR:

Added the question as to whether customer is interested in receiving Congregate Meals or Nutrition Counseling.

April 1, 2010 - Crisis Exception Request - Notification to HCBS/FE Participants - Issued by Joyce Smith

During the HCBS/FE Waiver Amendment approval process with CMS, KDOA was requested to implement a procedure to ensure direct notification to each HCBS/FE participant of the Crisis Exception Request process as an option to apply for certain services.

All participants (current and new) must be directly notified of alternatives under the waiver. The Crisis Exception process is an alternative for receiving services that have been suspended if the participant meets the criteria. Participants should be aware of this process to advocate on their behalf.

During the next quarter (April - June), KDOA will require Targeted Case Managers (TCMs) to implement the following procedure.

  1. As TCMs conduct their quarterly required contacts, or during a contact for a significant change, with each of the waiver participants, the service plan will be reviewed for additional service needs and documented in the case log notes.
  2. The TCM will explain the Crisis Exception Request process. This discussion will be documented in the case log notes.
  3. The TCM and the participant will determine if a Crisis Exception Request should be completed and submitted to KDOA for consideration. If KDOA approves the Crisis Exception Request, the services will be implemented according to current policy. If the customer is denied a Crisis Exception by KDOA, the participant will receive an NOA from the TCM with the right to appeal the decision.
  4. As new participants are assessed for services, the TCM will explain the Crisis Exception Request process. The TCM and the participant will determine if a Crisis Exception Request should be completed and submitted to KDOA for consideration. If KDOA approves the Crisis Exception Request, the services will be implemented according to current po licy. If the participant is denied a Crisis Exception by KDOA, the participant will receive an NOA from the TCM with the right to appeal the decision.

Beginning with the July - September Quality Review visits (reviewing April - June case files), KDOA staff will include this in the protocol to verify the Crisis Exception Request discussion occurred with each HCBS/FE participant.

If you have any questions concerning this requirement, please contact Krista Engel at 785-296-0385 or email Krista.Engel@aging.ks.gov. Thank you, in advance, for implementing this requirement.

March 2, 2010 - Crisis Exception Clarification and Revised Form - Issued by Krista Engel

After a few weeks of processing the Crisis Exceptions, KDOA has made some revisions to the Crisis Exception Criteria Checklist (CECC) in an effort to make the process more efficient for the case manager and the Crisis Exception Committee.

Form Changes:

The original form instructed the case manager not to complete the remainder of the form if more than two boxes were checked in column B under the Preliminary Questions. The committee discovered this did not provide the second page in these instances, so the service(s) requested was not noted. This also meant the Narrative and the KDOA response section was not submitted.

Therefore, the instructions were eliminated under the preliminary questions. The case manager will complete the entire form for each request and fax both pages to KDOA.

Additionally, the Sleep Cycle Support section was revised to more clearly request the information needed for determination. The requirement to provide a doctor's letter to explain the health & welfare needs and/or medical interventions was eliminated. The case manager will now provide this information.

Please notify your case managers they must complete both pages and the Narrative Section is required. The revised CECC is is also available at: http://www.aging.state.ks.us/Forms/TCM_Forms.html and is effective immediately.

Crisis Exception Policy Clarification:

Case managers were informed to complete the CECC when a customer requested one of the four services that has the additional limitations. Case managers should only complete this form for requests if the customer has a demonstrated need and meets the normal criteria for the service.

If the case manager would have authorized the service prior to the limitations, they should submit the CECC for the customer. If the case manager would not have authorized the service previously, they should not complete the CECC. For example, if a customer does not have a cognitive impairment, but requests Comprehensive Support; the case manager should explain to the customer they do not qualify for this service and the reason. The case manager would not complete the CECC in this instance. However, a NOA would be sent to the customer explaining they are not eligible for Comprehensive Support since there is not a cognitive impairment to warrant the service.

Case Managers should continue to perform their function of identifying needs and appropriate services to meet those needs, just as they did prior to the additional limitation of the crisis exception. The only difference now is that if a customer would otherwise qualify for one of the four services, a crisis exception is submitted for KDOA to determine if the customer meets the limitation for the service to be added to the POC.

By completing the CECC, is the case manager inadvertently advocating for the customer to receive the service even though they believe the situation is not a crisis and the customer has adequate alternatives? If a customer requests any of the services with the crisis limitations and is otherwise eligible for the service, regardless of their informal supports, a crisis exception should be submitted. If the case manager does not submit a crisis exception request in these situations, the customer is denied the opportunity to appeal the determination. If the crisis exception is denied, a NOA with the right to appeal would be sent to the customer. The case manager is not considered advocating for the customer when they submit the CCEC since KDOA determines the eligibility for the crisis.

When completing a NOA, the Field Service Manual (FSM) reference to use is the limitation listed under each of the four services under Section 3.4. The case manager would site the FSM section for the service requested and additionally FSM 3.5. Appendix H, which is the Crisis Exception Process. For example, a customer denied a crisis exception for Comprehensive Support, would receive a NOA with both FSM 3.4.1.D. and FSM 3.5 Appendix H listed.

Please contact us if any of this is unclear or you have additional questions or concerns.

February 1, 2010 - ESD Procedure with Title 19 - Issued by Angelia Nott

With the opening of ESD to allow Title 19 customers that are awaiting coding changes at SRS to be on the HCBS-FE program to now use ESDPND there are some important steps in paperwork and getting it set up in KAMIS.

First, you still have to complete the ESD Worksheet (located in the UAI) and have the customer sign the ESD agreement. In addition, do not put the Medicaid (Bene ID) number into KAMIS when entering the UAI. If you enter a Bene ID # then it locks out ESDPND as an option on the POC. Once you receive notification from SRS that the codes have been changed then you will enter the Bene ID number on the ESD Worklist area (do NOT enter it on the POC, keep the UAI in limbo waiting on the approval, ask to have the UAI put back as a WIP, etc).

I would encourage every CME to have a procedure in place to avoid accidentally inputting a Medicaid Bene ID # onto the UAI. In training one suggestion we make is to write "ESD" across the top of the UAI and to not even write the Bene ID number on the UAI. We always tell the new assessors at UAI and CCM training to find out what their agency's procedure is. Since ESD may not have been used much in your agency in the past you may want to develop a procedure to ensure everything runs smooth.

If an error is made... we can fix this at KDOA... but as all things it takes time and extra effort than if it were done correct the first time. If you find you aren't sure what to do, please give me a call (or email) and I'll help walk you through.

For those who have worked more with ESD, you know I contact you after a certain amount of time to see how things are going. When you put a case log into KAMIS that this is an ESD customer, also make a notation the customer currently has Title IX and you are only waiting on getting the codes changed.

January 15, 2010 - EDR Addition - Issued by Andrea Gould

Effective Immediately, KDOA is adding an additional requirement when a Case Manager is requesting Effective Dating. In addition to the current required format (Appendix D), the Case Manger will need to add the services that the customer will be receiving. This addition is being made due to the recent suspended services. This will help to ensure the suspended services are not being adding to POCs.

January 14, 2010 - Private paying for suspended services and client obligation - Issued by Laura Graham

It was determined that customers and their families may private pay for Comprehensive Support and Sleep Cycle Support while they are suspended. The question was then asked, if customers private paid for these services, could it be applied towards their monthly client obligation? This question was forwarded to KHPA, who determined that the amount the customer private pays for these services cannot be applied towards the monthly client obligation. However, SRS has determined that the amount private paid for Sleep Cycle Support may positively impact the amount of food assistance a customer receives, if the service is recommended by the treating physician or other licensed medical professional. Comprehensive Support is not considered an allowable medical expense according to USDA rules, so would not affect a customer's food assistance.

KHPA further clarified that Oral Health Services may be used to offset a monthly client obligation as it is not approved through a plan of care. The Medical Necessity document defines what SRS considers an allowable expense to offset a monthly client obligation. It lists dental services not covered by Medicaid as an allowable expense if certification from the case manager that it is not covered under the waiver is provided. Regarding Assistive Technology, if the item is listed on the attached Medical Necessity document, it should also be allowable.

December 30, 2009 - Access Suspended For Comprehensive Support & Sleep Cycle Support - Issued by Laura Graham

I sent out several e-mails last week to clarify how the suspension of comprehensive support and sleep cycle support would be handled. We are still receiving questions, so I'm sending this out with all of the information combined, plus instruction regarding the 3161.

TCMs do not need to end date POCs in KAMIS for the suspension of comprehensive support and / or sleep cycle support. This will be handled by KDOA during the mass update of POCs that is occurring for the change in the ACCC line. This will occur January 8th through the 12th. The paper POC will need to have these services end dated 01/15/2010. The customer or their representative may sign the POC at the next home visit.

I've attached the Word template NOA that should be used to notify customers that receive comprehensive support and / or sleep cycle support that access to these services have been suspended effective 01/15/2010. TCMs will need to add the service(s) that are being suspended for each customer to the table on the NOA with a termination date of 01/15/2010. The NOA should be sent out to customers and their providers effected no later than January 4th 2010 to allow for timely notice. Customers have the rigtht to appeal the suspension of these services, but these services will not be re-instated during the appeal process as these services are suspended per policy. The suspension of these services affects less than 500 people state wide.

In addition to the NOA a 3161 will need to be sent to SRS to notify the eligibility worker of the change in the monthly costs of services.

Please contact me if you have additional questions or concerns.

September 9, 2009 - Effective Dating Process - Issued by Andrea Gould

There are no changes to the Effective Dating Request (EDR) policy, but KDOA is adding reinforcement changes to the process.

Right now, when an EDR is approved, policy states "the POC must be entered into KAMIS within three (3) working days of discharge, correction or approval (depending the criteria it is approved under). There have been several POC that have taken longer than the three days. In these case, I e-mail the Case Manager (CM) to see what the status of the POC is and given them a week to respond. If I don't hear back, I re-send my original e-mail and give another week. On the third e-mail, I give the CM another week and inform them that if I don't hear back from them, the EDR will be revoked. With the current process, it is giving the CM almost a month to get the POC entered or to let me know what is going on with the customer. The problem with allowing a month for KAMIS entry to approve the POC, the provider is unable to bill.

Beginning October 1st, there will be a new process.

I understand there are some situations that might come up (customer still coded NF/SN, CM has the 3160, but codes have not cross to MMIS, etc). KDOA is always willing to work with the CME, as long as there is contact to let KDOA know what is going on.

May 6, 2009 - Documentation of customer obligation on paper POC - Issued by Laura Graham

The question has come up about whether or not the customer obligation should be deducted from the Monthly Cost on the service line. According to the current UAI manual, "Monthly Costs: The total monthly cost of each service the customer will be receiving. The formula is cost per unit x total units monthly - customer obligation or co-pay = total monthly cost." So yes, the customer obligation should be deducted from the monthly cost on the service line. However, the customer obligation should be added back in to the HCBS/FE monthly costs including customer obligation below. I know that this is different from KAMIS, which does not subtract the customer obligation from the monthly cost on the service line, and may be where the confusion has come from. I pulled some charts and observed that the customer obligation is not consistently being deducted from the monthly cost on the service line. Please pass this information along to your TCMs.

February 1, 2009 - Changes to CME's HCBS/FE Plan of Care Approver Assignment - Issued by Andrea Gould

As of February 1, 2009 several CMEs will be seeing a change in whom the DE/TCM will send the HCBS/FE POC to for approval. An updated pamphlet will be sent to each area to be given out to the TCM/DE to help with whom they will need to contact for questions. A few reminder e-mails will be sent out before 2/1/09. Below is a list of the changes that will be occurring. If you are an CME that will be changing POC approvers, please continue to send POC to your current POC approver thru Jan 31st, 2009. Then starting February 1st, POC's will be sent to the new POC approver.

Also, with the change from PSA to CME (Dec 15th 2008), the EDR request will also see some changes to the subject line. On the subject line start including the following:

Example: CMEXX, Customer Name, TCM name

November 3, 2008 - Level II Provider Change Clarification - Issued by Andrea Gould

Recently POCs have been sent in for PROVIDER changes (only) and 3 days are being given. KDOA has said before PROVIDER changes can occur with in 3-4 days, but A PHONE CALL IS REQUIRED TO THE Level II or Level III approver to let them know the change is needed.

If you are needing a PROVIDER change (only) to occurring sooner than the 10 days, a phone or e-mail from the Case Manager is required.

September 29, 2008 - Follow-Up to August 29, 2008 E-Mail - Issued by Andrea Gould

On August 29, 2008, I sent out an e-mail regarding POC with decreases for LV II/III. I would like to give more clarification on the subject and also include when there are changes in the POC. I apologize for any confusion.

If the POC does not have a cost change, (i.e. Prov change) the POC can be approved within 3-4 days, but a phone call is required to let myself or Laura know that it is coming, so we can approve the POC.

If a POC is increasing in cost, appropriate paperwork is required (UAI, CSW, POC, etc) along with 10 working days for approval. Unless the customer meets the Effective dating criteria or a phone call has been made and verbal permission has been given by the LV II/III approver to start sooner. In the case of verbal permission given, all the paperwork and POC must be received before the start date.

If the POC is decreasing in cost, the policy with the NOA will take over with time needed. If the customer is choosing the action to be sooner than the time required, a phone call is required to the LV II/III approver prior to entering in KAMIS and changing on paper POC and a note in the KAMIS case log needs to be given.

Otherwise, all POC will be operated based on the 10 working days required for approval. Also a reminder with NOA. NOA cannot be sent out until the POC is approved on KAMIS. As we have said before, anytime they are questions or changes needs sooner, to call the LV II/III approver to work with you.

August 29, 2008 - General Information - - Issued by Andrea Gould

Items to refresh your memory.

When you are working on a POC (in KAMIS), please remember to click on the UNLOCK AND CLOSE link, as opposed to using the big X in the top right corner of the window when closing the POC. If you do not use the unlocked and closed link, the POC will show LOCKED, making the Approver wait 30 minutes or more before they can work in the POC. This can cause a problem, when a POC needs to be approved ASAP (especially at the end of the day).

If you are sending in a Cost Cap Packet that contains a UAI, the Clock draw page needs to be sent in as well, since it is part of the UAI. I have informed some Case Managers that if the customer scores a 9 on it, they can make a note on the Comments Section at the bottom of Page 2 (but only if the customer scores a 9).

POC, for new customers, have been submitted, but have been sent back because codes are not in InMMIS. If a POC is sent back, instead of sending the POC back the next day, either call your LV I approver (to have them check codes) or go to the KMAP website (if you have access). The web address is located in the blue pamphlet. (The pamphlet's are handed out to new CM at the TCM training. If you have misplaced yours, please let me know and I can send you another one.)

POC are being submitted before the required time frame. Level I Approvers have 72 hrs to approve a POC, while Level II/III have 10 working days to respond. POC need to be submitted in accordance to policy. KDOA is willing to working with CM, if a POC needs to be approved before the 72 hr or 10 day time frame. The CM needs to call the POC Approver to discuss a possible start date. However, the POC still needs to be approved before or on the discussed start date. (THIS IS NOT EFFECTIVE DATING)

To coincide with the possible earlier start date. If a CM is given the OK to start a POC sooner, a note needs to be made in the case log.

EXAMPLE: CM SPOKE WITH AG AND SHE OK'D TO START 9/5.

Do not enter - customer has Effective dating, unless they actually do. POC have been sent back when Approver's are unable to find ED in our mail box for the customer.

February 4, 2008 - FE Choice Date Clarification - Issued by Krista Engel

As we indicated at the field training in November 2007 the TCMs need to use the customer choice date for HCBS as the "chooses HCBS" date and the start date of services will be the "effective date of services" on the ES-3160 to SRS. If you are not doing this currently, you must start immediately.

KHPA sent an email to the SRS field today regarding the same process and that SRS staff should be using the "chooses HCBS" date on the ES-3160 as the effective date of HCFE eligibility. This content of the SRS email is below.

TCMs will complete Section III. (HCBS Information) of the ES-3160 form by entering the date the individual choose services in the "Chooses HCBS" field and entering the date services are actually to begin in the "Effective Date of HCBS Services" field. The date entered in the "Chooses HCBS" field will be the start date for eligibility purposes.

Example: The eligibility worker receives the ES-3160 from the HCBS case manager indicating a choice date of 2/15/2008 with a 3/1/2008 effective date. HCBS budgeting would commence for the month of 2/2008 with a PIL of $716. The LOTC screen would reflect a HC/FE Living Arrangement/Level of Care code with a LA/LOC Payment Effective Date of 02/15/08.

SRS Email:

"The HCBS FE Waiver effective date has been changed from the date services actually begin back to the choice date.  This change is effective immediately.  KEESM 8200.2 (HCBS Effective Date) will reflect this change with the next scheduled revision (May 2008).  Eligibility staff should begin using the choice date as reported on the ES-3160 immediately.  The Area Agencies on Aging (AAA’s) will be instructed by the Kansas Department on Aging (KDOA) to complete Section III. (HCBS Information) of the ES-3160 form by entering the date the individual choose services in the “Chooses HCBS” field and entering the date services are actually to begin in the “Effective Date of HCBS Services” field.  The date entered in the “Chooses HCBS” field will be the start date for eligibility purposes.

Example: The eligibility worker receives the ES-3160 from the HCBS case manager indicating a choice date of 2/15/2008 with a 3/1/2008 effective date.  HCBS budgeting would commence for the month of 2/2008 with a PIL of $716.  The LOTC screen would reflect a HC/FE Living Arrangement/Level of Care code with a LA/LOC Payment Effective Date of 02/15/08.

If there are any questions about this change please contact me.

Tim T Schroeder

Elderly & Disabled Medical Eligibility Policy Manager

Kansas Health Policy Authority"