of Social and Rehabilitation Services
Janet Schalansky, Secretary
Integrated Service Delivery - Candy Shively, Deputy Secretary (785)
Economic and Employment Support - Bobbi Mariani, Director (785)
To: EES Program Administrators Date: September 20, 2004
All Asst. Reg. Directors
From: Bobbi Mariani, Director RE: Implementation Instructions KEESM
Economic and Employment Support
Rev. 20 Effective
October 1, 2004
This memo provides implementation instructions and information
for the following
October 1, 2004 KEESM changes:
• Medical Expenses and Medicare Approved Drug Discount Cards
Expunged Drug Felony
National Voter Registration Act of 1995
Minors Acting in Own Behalf
In-Home Child Care
Foster Care Child Care
EBT CC Data Collection for Child Care Providers
- ALL PROGRAMS
Medical Expenses and Approved Drug Discount Cards -
[See Summary of Changes, Item I, A. (3).] As noted
in the Summary of Change, special provisions are
being provided for treatment
of medical expenses for persons with Medicare Approved
Drug Discount Cards.
The Medicare Approved Discount Drug Card was established under
the authority of the Medicare Modernization Act and provides
Medicare beneficiaries the opportunity to receive reduced rates
on select prescription drugs. Discount cards are offered from
a number of carriers, each offering a unique formulary and network
of participating pharmacies. No direct payments are made from
the carrier to the pharmacy when a drug is purchased, rather,
a discount is given on the purchase price of the drug.
A special benefit is also offered to persons without full Medicaid
coverage who have incomes under 135% of poverty called Transitional
Assistance or the $600 Credit. Recipients are given a credit
of $600 toward the purchase price of medications.
Both CMS and USDA have recently clarified that neither Medicaid
or food stamp benefits are to be negatively impacted because
of the discount drug card. Eligibility and benefit levels are
to be determined without regard to drug costs reductions attributed
to the card or the $600 credit. This change in direction nullifies
previous instruction, provided during the May, 2004 teleconference
sessions, to use actual costs attributable to the beneficiary
for Medically Needy/spenddown purposes.
Prescription drug expenses for spenddown, patient liability reductions
or client obligation reductions are allowed at the pre-discount
drug card price. Regardless of the actual out of pocket expense
the client assumed, the full price the beneficiary would have
paid if not for the existence of the card is to be used. The
same is true of the $600 credit. If the $600 credit is used to
purchase the drug, the full price is still allowable in either
of the above situations.
To implement the new policy for spenddown cases, pharmacies will
be provided specific instructions to reflect the actual pre-discount
approved drug card price in their billing process. This will
also include an MMIS modification to always point to the correct
field when processing a spenddown claim. Do not use the KAECSES
MEEX screen to reflect these allowances. The MMIS spenddown claim
process will accommodate the change.
However, for HCBS and NF cases where MMIS billing will
not occur for non-covered expenses, it is necessary
to obtain the pre-discount
price from the pharmacy or beneficiary. Pharmacies track
and hold a number of different "prices" for various drugs,
primarily for insurance purposes. Pharmacies will maintain the
pre-drug card price as the "Usual and Customary" price.
Specific requests to pharmacies for this information
should utilize this specific phrase.
Example: Joe, a Medicare beneficiary uses his Orange Drug Card
to purchase blue pills. The cost of the blue pills to people
without the Orange Drug Card is $50.00. The Orange Drug Card
offers a discount on blue pills, so he gets them for $35.00.
- If Joe is covered under the Medically Needy program and has $100 left
on his current spenddown, the
full $50.00 is used toward the spenddown. The pharmacy should bill Medicaid $50.00.
to the spenddown.
- If Joe is an HCBS recipient or in an NF
and the blue pill in not covered by Medicaid,
the full $50.00 is used to reduce
the patient liability or client obligation.
- If Joe is receiving full Medicaid (including
met spenddown) and the blue pill is covered by
Medicaid, the pharmacy should
bill Medicaid as usual and the claim will be adjudicated
without regard to the Orange Card.
- If Joe also receives the $600.00 credit
and the credit is used to purchase the drug, the
entire $50.00 is still allowable.
For medical assistance, these instructions are effective upon receipt
of this memo. Because CMS specifically requires adjustment of
cases back to the inception of the discount card, (June 1, 2004),
it may be necessary to make retroactive adjustments. If requests
for adjustments are made, the following procedures are used:
- For Medically Needy cases, instruct the pharmacy
to rebill claims using the corrected amount.
The Medicaid Provider Representative
or Liaison can assist with this process.
If the provider will not rebill, reflect the
new claim amounts on a Beneficiary Billed
(BB) claim. However, if the pharmacy
has already billed and a portion applied to
spenddown, only used the amount of the actual
discount or credit which hasn’t previously
been allowed for the BB claim. Do not
use the MEEX process for this
- For HCBS or NF cases, reflect the additional
amounts to be allowed toward a future months obligation
allowance, as the
amounts are expected to be minimal.
For food stamp purposes, the pre-discount price of the
drug must be allowed when determining an allowable
food stamp medical expense.
For food stamp persons on a spenddown, the amount billed
to the MMIS will be the pre-discount price of the drug.
Staff will be
notified when this change to the MMIS is effective.
For food stamp persons who do not have a spenddown,
the pharmacy must
be contacted to ascertain the pre-discount price. Staff
are to request from the pharmacy the "usual and customary" price
of the drug and that amount will be allowed as a food
stamp medical expense. Please note that the State agency
is responsible for
determining the pre-discount price of a drug by contacting
the pharmacy. Clients are not to be required to provide
They are only required to provide an adequate description
of the prescription and the pharmacy where the prescription
filled. It is also important to remind staff that the
fact a person has a Medicare Approved Drug Discount
Card is not required
to be reported between certification and review. It
will be important, therefore, to ask appropriate consumers
at the time of application
or review if they have a Medicare Approved Drug Discount
Card and if so, the procedures described above will
apply. For purposes
of the Food Stamp Program, this policy change is effective
October 1, 2004 and no retroactive benefits are required.
Expunged Drug Related Felony -
[See Summary of Changes, Item 1, B. (1)] Some persons
with an expunged drug related felony are currently
assistance. It is necessary to determine who these
persons are and provide assistance based on the clarification
expunged drug related felonies do not have a negative
effect on eligibility. A report of all cash and food
on active cases coded DI and DF respectively will
be provided to staff. The list shall be used to review
cases and determine
if any of the persons currently disqualified for
an expunged drug related felony are eligible under
the revised policy
clarification. Benefits are to be provided effective
October 1, 2004. The printout will be sent separately
will be notified when it is available.
CSE Penalties -
[See Summary of Change, Item 1, A. (2)] The provision to
not penalize children when a non-legally responsible
person fails to cooperate with CSE is not retroactive; therefore,
staff are not required to identify cases currently on
When such a non-legally responsible person reapplies
for assistance for the children, however, there is no longer
a requirement that they cooperate prior to the children
being approved for assistance. If the non-legally responsible
adult requests assistance for himself/herself, cooperation
is still required prior to assistance being approved
for the non-legally responsible adult.
A referral should still be made to CSE even if a non-legally responsible
person indicates at the time of application an intention to not
cooperate with CSE. Support rights for Cash Assistance are still
assigned to SRS when an adult signs an application, and CSE will
pursue support whether or not the non-legally responsible adult
National Voter Registration Act of 1995 -
[See Summary of Change, Item 1, B. (4)] The requirements
of the National Voter Registration Act of 1995
placed in the manual as a reminder that staff still
have a responsibility under federal law to offer all
and recipients, as well as others who come through
our doors, the opportunity to register to vote. Staff
should have procedures
in place to 1) assure that all individuals are
offered the opportunity to register to vote or decline
to register to
vote at each application, review, change of address,
or change of name; 2) send voter registration forms
county election office; and 3) retain declination
forms for at least two years in the local office.
Since the October 2004 manual revision was completed,
the Secretary of State’s office has notified SRS of a change in state
law which became effective July 1, 2004. Based on this change,
SRS must attach a copy of a photo ID when submitting a voter
registration form for someone newly registering in the county.
If the individual does not have a photo ID, then a copy of a
current utility bill, bank statement, or other ID which connects
the individual to his/her current address should be attached.
Additionally, make sure all registrants have included a copy
of their driver’s license number or the last 4 digits
of their Social Security Number where requested on the voter
Because of this change in the law, the Secretary of State
has revised the voter registration form. You may find
a copy of the current
voter registration form at http://www.kssos.org/forms/elections/voterregistration.pdf.
Each local office should have copies of the voter registration
form available for use in the office and to mail to
consumers as needed. Because the voter registration
form is changed periodically,
it is suggested that no more than a 6 month supply be
copied at one time. KEESM Appendix #88 now links directly
to the Secretary
of State’s website so the most recent version of the
voter registration form is always available.
A stuffer is being included with the October medical cards to remind
recipients that they must register by October 18, 2004, to vote
in the November 2004 election.
- CASH ASSISTANCE
Minors Acting in Own Behalf -
[See Summary of Change, Item III, A. (1)] Each region
may establish its own procedure for determining
that it is in
the best interests of a minor to act in his/her
own behalf and for rescinding that decision. Staff
must note on INDA
for both TAF and MA-CM when a minor has been approved
to apply for and receive assistance on his/her
own behalf and
when that approval is rescinded. This will help
other EES staff and Clearinghouse staff who may
receive the case.
Health Care Policy will issue a policy memo to allow medical assistance
for a minor who has been approved to act in his/her own behalf
to receive TAF assistance. Once a minor is approved to receive
medical assistance on his/her own behalf, the minor will remain
continuously eligible for medical assistance until the end of
the review period even if the minor returns home or is no longer
allowed to receive TAF assistance in his/her own behalf.
- CHILD CARE
In-Home Child Care -
[See Summary of Changes, Item V, A. (1).] Effective with
this revision, clients choosing In-Home child care for
their children (hiring someone to come into the child’s
home for care) must provide verification of contact
with the Internal Revenue Service (IRS). Proof of receipt
a Federal Employer Verification Number (FEIN) shall
serve as verification of contact. The following document
through the IRS to assist parents with tax issues:
This document is Publication 926 (Rev. November 2003)
Household Employer’s Tax Guide For Wages Paid
in 2004. SRS staff are not expected to answer tax questions.
If parents have questions
regarding these IRS rules, they should be referred to
the IRS or a tax professional for assistance. For existing
staff should request the parent to supply verification
of FEIN no later than December 31, 2004. If an FEIN
is not provided,
staff should move to terminate any plans using In-Home
care. The parent remains eligible for child care subsidy,
choose another provider type. The C205 General Verification
Request notice on KsCares may be used to request information.
new In-Home child care requests, proof of FEIN shall
be part of approval for initial enrollment.
Staff are reminded that the FEIN is for eligibility
purposes only, and is NOT to be used when putting the parent
The parent’s SSN preceded by a "3" will
continue to be used for payment purposes.
A new In-Home statewide rate is also being implemented with this
revision. The new rate is $1.72/hour and will be paid automatically
once system migration has been completed. Letters were sent to
all In-Home cases on August 23, 2004 informing parents of the
rate change and of the FEIN requirement. After October 1, 2004,
staff should update existing Child Care Plans in KsCares and
send plans with the new rate to parents. Updating plans can be
done by accessing the CHCP screen and pressing Pf12. Once the
screen is updated, plans are printed by pressing Pf5. The case
listing that was sent to Assistant Regional Directors on August
23, 2004 can be used to identify In-Home cases by caseload.
Foster Care Child Care -
[See Summary of Changes, Item IV, A. (2).]
Effective October 1, 2004, requests for EES
child care subsidy for foster care
placements shall be the responsibility of
the Foster Care Contractor. EES child care
subsidy may be accessed where a foster parent
is in need of child care for a child (not
in custody) of a foster child (E.G. - teen
foster child with own child). For existing
cases, this policy change should be implemented
at the next case review.
EBT CC Data Collection for Child Care Providers -
[See Summary of Changes, Item V, A. (3).] A face to face
meeting is being held on September 22, 2004 in Topeka
to discuss implementation of these changes. Child Care staff
from all Regions are scheduled to attend.
- MEDICAL ASSISTANCE
Mandatory Verification Requirements-
[See Summary of Changes, Item I, B.(3)] For medical assistance
cases where program requirements include a resource test,
verification of real property, except for the home in which the
resides, is now required. This change essentially expands
verification requirements to include the home property if the
absent. This is applicable to all situations in which the
applicant/recipient is actually absent, including independent
living and spousal
impoverishment cases. However, it does not apply to temporary
absences, including persons entering LTC arrangements for
a planned brief stay where the stay is not expected to exceed
of entrance and following two months.
Generally, a copy of the deed reflecting ownership interests in
the property will satisfy this requirement. However, copies of
trusts or other related documents may also be needed to establish
The requirement is applicable for all new applications processed
on or after October 1, 2004. It also applies to changes processed
on or after this date. For example, verification must be obtained
for an HCBS consumer moving from his own home into an NF prior
to NF payment approval. For existing cases, verification shall
be obtained no later than the next review.
Estate Recovery, Contracts for Care, Annuities and
Shared Property Ownership -
[See Summary of Changes VII A.(2), (3) , (4) and B.
(3)] Implementation instructions were provided in materials
with the teleconference presentations in August, 2004.
Please see these materials for implementation instructions.
- SUCCESSFUL FAMILIES
Welfare to Work Component -
[See Summary of Change, Item VIII,A.] Welfare to Work (WtW)
is no longer an available component for TAF recipients.
A list of all TAF clients currently assigned to the
following components will be distributed the week of September
to Regional staff:
- Welfare to Work (WTW)
- Welfare to Work Competitive (WWC)
- Welfare to Work Goodwill (WWG)
- Welfare to Work Participant (WWP)
Other appropriate available component assignments should
be discussed with these clients and the new assignment
should be completed by December 31, 2004.
- Forms - [See Summary of Change, Item A.
Cash Assistance] The IM 3102 is obsolete effective September
30, 2004, and
has been replaced
by the ES-3102. Effective October 1, 2004, staff should use
the ES-3102 to inform clients of the consequences for
meet specific CSE and work program expectations. All TAF
clients should receive a copy of the ES-3102. (See KEESM
cc: Dennis Priest