STATE DEPARTMENT OF SOCIAL
REHABILITATION SERVICES
Integrated Services Delivery
Docking State Office Building
Room 681 - West
Topeka, Kansas 66612

12-01-05

TO:

Regional Directors
Assistant Regional Directors
Economic and Employment Support Program Administrators
Economic and Employment Support Staff
Other Staff

RE: Summary of Changes for Kansas Economic and Employment Support Manual (KEESM) Revision No. 26 Effective January 1, 2006

PURPOSE, BACKGROUND, and REASON FOR CHANGE

The purpose of this document is to transmit Revision No. 26 of the Kansas Economic and Employment Support Manual effective January 1, 2006.

Child Care - Changes are being made to the Income Eligible Employed child care section. The changes are intended to provide more specific direction regarding appropriate child care support for college and other training. Other clarifications are being made and are also listed below.

Food Assistance - This revision implements a new fixed 36-month period for ABAWDs, from January 1, 2006 through December 31, 2008. It also implements changes in policy regarding the restoration of aged off food stamp benefits. Due to the emphasis placed on timely processed food stamp applications, the manual is being clarified as to what constitutes a timely processed food stamp application. Several other clarifications to food stamp policy are also included.

Medical Assistance - The annual cost of living increase in the minimum and maximum resource allowance amounts is being transmitted with this revision. Based on federal law, the community spouse income and resource allowance standards under the spousal impoverishment provisions will be increased effective January 1, 2006. No increase in the HCBS income standard will be implemented.

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) established Medicare Part D to provide comprehensive prescription drug coverage to Medicare beneficiaries. Implementation of Medicare Part D and Medicare Part D Subsidy in this revision are directly resultant from this law.

Successful Families - When Kansas lost the TANF waiver in 2003, we redefined and repackaged work components and activities to address the following priorities:

Retain flexibility where possible to address wide variations in client barriers and needs;
Minimize policy changes for field staff;
Achieve 50% All Families work participation rate and 90% Two-Parent rate; and
Minimize system changes.

The changes made in 2003 emphasized community service and were expected to be short term changes that would most likely be modified when TANF Reauthorization occurred. Since TANF Reauthorization has not occurred, further program modifications are being implemented at this time to provide more structure to the community service aspect of EAP and Community Service components. States have had a great deal of flexibility in defining work activities and reporting work participation. There is increasing attention on how states meet the work participation requirements. The changes in this revision are the initial steps toward providing better customer service; reporting work participation hours more accurately; and reducing the state’s risk for a financial sanction.

MULTIPLE PROGRAMS
1. CHANGES
Cross Program Assessment - In June 2004, at the request of the Regional Directors, the agency chartered a Cross-Program Assessment Team to develop an assessment form for use in helping a customer self-direct their needs for ISD related services. This team has completed its work.

The “Customer/Family Needs Identification” (IS-7001) is designed as an interviewing tool for staff to use with customers who directly contact the local Service Center. The form will provide staff with discussion topics to assist in interviewing consumers and assessing their needs across programs as well as identifying their strengths. It will also document action plans and referrals to both ISD programs and community resources. Use of the form is optional and it is flexible enough to use in a variety of in-person and telephone interview settings.

The “How Can We Help” form in English and Spanish (IS-7000 and IS-7000S respectively) was designed for use by customers or prospective customers in self-assessing their needs when accessing information about our services at community sites and SRS Access Points. The form contains spaces for county/regional information and requires that a list of community specific resources be attached to assist the customer in accessing services other than those available from SRS. It contains information about applying for services online and includes the agency’s toll free number for making direct contact with the local Service Center. This form is available in both English and Spanish. Again, use of the form is optional but can be a valuable tool to aid the consumer in addressing needs and where to link with the appropriate services.

These forms are NOT to be used as an application for services under any of the EES programs. They are strictly assessment tools. The forms can be viewed in the Miscellaneous Forms Section of the KEESM and are available for order from the SRS Warehouse.
ADULT PROTECTIVE SERVICES
1. CHANGES
  Continuum of Interventions - In Section 12711, a new sub-item 11 is being added to include information about guardianships and conservatorships in a treatment facility or nursing facility to correspond with the ES-1012.
2. CLARIFICATIONS
  1. Intake Process - Section 12200 (4) is being clarified by being put into bullet form for easier reading. This relates to licensure and investigative responsibilities of KDOA and KDHE. Item (5), at the request of SRS Legal is being modified by adding additional instructions.
  2. Reasonable Efforts to Determine Safety - Section 12221 is being revised to clarify “authorized collateral."
  3. Findings and Case Decisions on Alleged Perpetrator(s) of Adult(s) Residing in the Community and/or Facilities Licensed/Certified by SRS - Section 12410 has been rearranged for easier reading and understanding by staff. A clarification has also been added to define “good cause.”
CHILD CARE ASSISTANCE
CHANGES
1. Social Service Child Care - Section 2833 is being modified to emphasize situations in which using the child care subtype is appropriate. The ES-1627, Request for Social Service Child Care is also being revised to simplify the process for authorizing SS child care. Check boxes are being added to facilitate completion online. Emphasis is placed on the family’s need and the reference to child’s needs and the enhanced rate are being removed.
2. Income Eligible Employed Child Care - Section 2834 is being changed to provide more specific instructions regarding allowable training and college activities. A bachelor or higher degree should not be supported. A BA is only allowed if completed within six months. Appendix item E-11 Education/Training Assistance Desk Aid is also being modified to reflect the changes.
3. The Child Care Plan - Section 7600 is being changed. The reference to special purpose rates being paid all day to sick-child centers only is being removed.
4. Action Affecting a Child Care Family Share Amount and/or Authorized Hours - Section 9121.3 is being removed from the KEESM. This section formerly instructed staff that changes to the family share could only be made during a current review period if the family share increased by two or more levels. By removing this section, staff will be required to make a change in family share allowing for timely and adequate notice based on ANY change in income reported by the household.
5. Child Care Adjustments - A new section 10210 is being added to provide a cross reference to Appendix Item V-1. The EBT System Guide (Appendix Item V-1) is being clarified regarding situations when a client overpays a provider.
CLARIFICATIONS
1. JO (TAF) Child Care - Section 2831 is being condensed and reworded for clarity. Some examples of allowable activities under this subtype do not need to be stated here as they are allowable activities for Work Programs. It is redundant to list them twice. Any special instructions related to certain components remains in this section.
2. The Child Care Plan - Section 7600 is being reworded to provide clarification to staff regarding enrollment fee assistance.
CHILD CARE PROVIDER ISSUES
1. CHANGES
  
  None
2. CLARIFICATIONS
  1. Child Care Payments - Miscellaneous clarifications are being made to Section 10200. Cross-references are being added.
  2. Rate Modification - Section 10250 is being expanded to include more examples of situations that result in a rate change.
FOOD ASSISTANCE
1. CHANGES
  1. ABAWD Tracking - A new fixed 36-month ABAWD eligibility period is beginning January 1, 2006 and ending December 31, 2008. KEESM 2520 and the ABAWD Tracking Form, ES-4312 are being modified to include this change. In addition, the ES-4312 has been modified to include another status code “X“ for a month residing in a labor surplus county. A definition of exempt ABAWD (living in a labor surplus county) is also included on the form. A clarification is also being included to provide that solely attending Alcoholics Anonymous (AA) meetings does not meet the criteria of regular participation in an alcohol or drug addiction treatment and rehabilitation program. Further instructions about the implementation of the new 36-month period will be provided in the Implementation Memo.
  2. Residents of Institutions - The Note at the end of Section 4230 that indicated that Flint Hills Job Corps is considered an institution which provides residents the majority of their meals is being modified. Residents of the single parent program only (mothers and children) are eligible to apply for the Food Stamp Program since the facility ceased providing the majority of meals on October 1, 2005.
  3. Electronic Benefit Transfer Issues - Changes are being made in Appendix Item V-1, Electronic Benefit Transfer System Guide, to support the following policy change regarding aged off food stamp benefits. Aged off food stamp benefits (benefits aged off after 90 days) must be restored to consumers if they reapply for food stamp benefits before the benefits are expunged at one year. Many of the benefits that currently age off are under $10, most are under a dollar, so a threshold of $10 is being included. If the aged off benefits are less than $10, they do not have to automatically be restored upon reapplication, but they do have to be restored if the consumer requests restoration. The policy of restoring aged off benefits upon reapplication is required by Federal food stamp regulations. This change is found in Items 7, 11 and 12 of Appendix Item V-1.
    In addition to the above changes, clarification of the child care/KsCares process to return benefits that have aged off the EBT system are included. Aged off examples have been included to help understand the process.
2. CLARIFICATIONS
  1. Timely Processing - Section 1413 (2) is being modified to clarify that for a food stamp approval to be considered timely, the household must be able to access their food stamp benefits by the last day of the processing time period (seven or 30 days). To insure this for a non expedited application, the application must:
    1. be approved and the consumer must be told verbally by the 28th day from the date of application to come into the office and pick up their Vision card and select a PIN number, and this must be DOCUMENTED in the case file; OR
    2. the application must be approved so that a notice regarding coming in to pick up the Vision card and select a PIN is mailed by the 27th day from the date of application; OR
    3. the Vision card and remote PIN instructions are mailed by the 27th day from the date of application; AND
    4. the food stamp benefits must be available in the EBT account by the 30th day from the date of application.
    To insure that the notices mentioned above are mailed by the 27th day from the date of application, the application must be approved by the 26th day or earlier if the 27th day falls on a weekend or holiday.
    
    To insure this for an expedited application, the application must:
    1. be approved and the consumer must be told verbally by the 5th day from the date of application to come into the office and pick up their Vision card and select a PIN number, and this must be DOCUMENTED in the case file; OR
    2. . the application must be approved so that a notice regarding coming in to pick up the Vision card and select a PIN is mailed by the 4th day from the date of application; OR
    3. the Vision card and remote PIN instructions are mailed by the 4th day from the date of application; AND
    4. the food stamp benefits must be available in the EBT account by the 7th day from the date of application.
  To insure that the notices mentioned above are mailed by the 4th day from the date of application, the application must be approved by the 3rd day or earlier if the 4th day falls on a weekend or holiday.
  
  If the above is followed, the application will be considered timely processed if the case is reviewed by Quality Assurance. This information is being included in the manual due to the recent emphasis placed on timely processing by USDA. States whose timely processing is below 90% must enter into a formal corrective action plan. Our QA timeliness rating is well below the 90% thus we were required to enter into a formal corrective action plan. (Please note that timeliness captured on KAECSES is not the same as QA timeliness. KAECSES captures timeliness based solely on when the application is processed, not on whether the consumer was able to access their benefits by the 30th or 7th day.)
  1. Irregular Earned or Unearned Income and Deductions - Section 7110 (4) is being amended to add a cross reference to Section 7225. This is to clarify that the Child Support Deduction for purposes of the Food Stamp Program is budgeted as described in 7225.
  2. Interim Report Form - Section 9122.6 is being clarified regarding completion of the interim report form. Some questions on the form can be left blank if the consumer has nothing to report for that item. This is acceptable unless the worker has reason to question the fact that the item is left blank. Prudent person judgment shall be used on a case-by-case basis to make these determinations. Any questionable responses should be followed up with the consumer and documented in the case file. This clarification was previously provided in a Policy Sharing to staff on September 30, 2005.
    Sections 9122.2 and 9122.6 are also being clarified regarding setting the interim report due date. There was confusion regarding setting this date when the review period was less than12 months. The manual indicated that the IR due date should be six months from the time the household was certified as a simplified reporter. This was intended for 12 month review periods. If the review period was less than 12 months, staff were hand calculating the IR due date (to insure the IR was due in six months) instead of using the IR Set Up Schedule (Appendix Item T-7), the IR Set Up Schedule, since the IR Set Up Schedule is based on the review due date. To simplify this process and insure that staff use the IR Set Up Schedule to set the IR due date, the manual is being revised to state this and to refer staff to the IR Set Up Schedule. Reference to submitting an IR six months from the time the household is certified has been removed.
LIEAP
1. CHANGES
  1. Self-Payment Requirement - Section 13350 is being updated to establish a minimum standard for the self-payment requirement. Households will be required to pay the lessor of 10% of their gross monthly income or $40 (or the amount owed, if less than the two amounts) to the utility for two months before meeting the self-payment requirement.
  2. Income Guidelines - Section 13362 is being updated to reflect changes in income standards as a result of the COLA increase.
  3. Benefit Matrixes - Section 13440 is being removed from the KEESM. The benefit matrixes for gas, electric, propane and other heating sources are sent under separate cover each year to LIEAP staff.
MEDICAL ASSISTANCE
1. CHANGES
  1. COLA Mass Change - Effective January 1, 2006 the minimum community spouse resource allowance will increase from $19,020 to $19,908 and the maximum resource allowance will increase from $95,100 to $99,540.
    
    In addition, the maximum community spouse income allowance is increasing from $2,377.50 to $2,489. Neither the minimum income allowance nor the dependent family member allowance is changing.
    KEESM sections 8144 and 8244 are being modified with this revision. The ES-3162 Resource Assessment and Allowance Determination Form, the ES-3163 Income Allowance Determination Form and the ES-3104.6, Determination Worksheet for Pickle Eligibles and Other Protected Medical Groups are also being revised with this revision.
  2. Medicare Part D - A new section 2911.10 is being added regarding Medicare Part D. Medicaid will not cover Part D prescription drugs for Medicare beneficiaries as of the date the person becomes entitled to Medicare Part D. Coverage of prescription drugs through Medicare will be through private plans, call Prescription Drug Plans, or PDPs. The Medicare beneficiary must enroll with the PDP directly to participate in the Part D. Some Medicare Advantage plans will also offer prescription drug coverage (MA-PDP). Each PDP will have an individual formulary of drugs the plan covers. Some may offer upgrades to a basic plan for an extra fee. A monthly premium will be charged and deductibles and copayment also apply.
    Persons with Medicare Parts A or B are also entitled to Medicare Part D. Persons who are entitled to Medicare Part D are not eligible for Medicaid payment of prescription drugs. Medicaid beneficiaries who do not enroll with a prescription drug plan will be auto-enrolled into a plan. The auto enrollment process may take several months and there will be no drug coverage through Medicaid beginning with the month of Part D entitlement.
    
    In addition, a clarification is being added to Section 2911 (4) that persons who are incarcerated are ineligible for Medicare D.
  3. Medicare Part D Subsidy - The MMA also provides help for Medicare Part D cost sharing expenses for low income individuals. A new benefit, Medicare Part D Subsidy, will be available to Medicare beneficiaries. Medicare D Subsidy is provided automatically to persons receiving any form of Medicaid coverage, including QMB, LMB and Medically Needy with met spenddown. Subsidy will also be determined eligible for Medicare Part D by SRS eligibility staff or by Social Security. There are several levels of subsidy available.
    Additional detail regarding these changes will be available through the implementation memo and face-to-face training.
    
    Sections 2675, 5130, 7330, 7430 , 7531, 8172.1, and 8270.1 are being modified to support these changes.
  4. Review Extension (Medical Assistance Only) - A new section 9310.1 is being added with this revision. Review extensions will be an option for certain Medicaid beneficiaries transitioning to or within Medicare Savings plans and Part D subsidy. Review extensions also apply to the TB program.
    A review extension permits the eligibility worker to complete a full review without a new application when persons are moving from QMB or LMB to Medicare Part D Subsidy, from QMB to LMB or vice versa, or from Medicaid (including Medically Needy) to QMB, LMB or Medicare Part D Subsidy and for any regularly scheduled review for a person eligible for TB only. Contact with the beneficiary will be required. Section 9370 is also being updated regarding this change.
2. CLARIFICATIONS
  1. Exempted Transfers - In Section 5721 (9), the cross-reference to 5730 (5) is being corrected to 5430 (5).
  2. Transfer of Property - Clarification is being added to Section KEESM 5724 (3) to treatment of transfers for certain relatives and close friends. In addition, the section is being reordered for clarity. Transfers of property to relatives or close friends are assumed to be for the purpose of gaining eligibility unless the Medicaid applicant/recipient can demonstrate the transfer was made for one of the following reasons:
    - The transfer involved a change in location for the beneficiary or was necessary to ensure an adequate standard of living. Health and safety issues may be explored and documented.
    - The transfer was related to a debt repayment. A debt is only recognized in instances where the individual entered into a contact outlining the specific terms and conditions of the debt prior to the exchange of any money, services or items. The contract must specifically lay out the terms and conditions of the arrangement. Any services or goods must be provided at market rates. Transfers to family members or friends outside of such arrangements fail to provide adequate compensation and are penalizable. Each contract is to be evaluated on the merits of the contact and the situation.
    - The transfer is made to salvage a business or investment.
  If any of the above is claimed, documentation is required. A fourth criterion, a transfer for the purpose of liquidating a resource to provide for living expenses, is being eliminated. Such transfers are considered to be done for the purpose of becoming Medicaid eligible, but a lower market value is considered when determining the uncompensated value.
  1. Veterans Income - Sections 8150 (3) and 6410 (60) are updated with a clarification regarding countable VA income toward patient liability. The full VA pension (including aid and attendance) of a veteran or spouse which has not been reduced to $90.00, but will be reduced to $90.00 upon notification to VA of Medicaid-NF payment approval, is countable toward patient liability. The portion of the benefit attributable toward unusual medical expenses (UME) continues to be exempt.
    
    Only persons without dependents are subject to the $90.00 payment. Veterans with a spouse or other dependent are not subject to the reduced VA benefit and the entire portion of UME and Aid and Attendance continues to be exempt toward patient liability.
    
    Upon receipt of notification of Medicaid approval, the VA will generally adjust the benefit within 90 days. The VA will adjust a benefit based on a report of Medicaid NF payment from the eligibility worker. Because of the additional benefit available to the veteran or spouse, the income will rarely be countable.
SUCCESSFUL FAMILIES
1. CHANGES
  None
2. CLARIFICATIONS
  1. Community Service - TAF (and FS in Designated Counties) - Additional clarification is being added to Section 3310.3 to require case documentation on how the volunteer work in the community relates to the individual’s employment goal and how the service is moving the individual toward self-sufficiency. Volunteer work in the community may only be counted for six months toward meeting the federal work participation requirement.
  2. Alcohol and Other Drug Assessment and Treatment - TAF Only - Guidance is being added to Section 3310.4 (1) regarding situations where a client does not follow through with RADAC recommended treatment or self-discharges. A work program penalty may be appropriate in these situations.
  3. Employment Assessment Process - TAF (and FS in Designated Counties) - Section 3310.4 (4) is being modified to: one, require case documentation to indicate how the community service relates to the individual’s employment goal and how the service is moving the individual toward self-sufficiency; when the EAP assignment continues past the initial work program assessment; two, limit EAP component assignment to six months; and three, change the community service goal from 20 to 24 hours per week.
  4. Orientation, Assessment, Referral, Safety (OAR) - TAF Only - The SFY 2006 EES contract with the Kansas Coalition Against Sexual Assault and Domestic Violence (KCSDV) specifies that joint client interviews/meetings including the EES case manager, OARS advocate and TAF client should occur when appropriate or at a minimum of once each year. This contract wording is being incorporated in Section 3310.4 (11). In addition, the ES-4321, OARS Status Change Form, is being replaced with the OARS Monthly Status Report Form which is located in the Miscellaneous Forms section. This section is also being reformatted.
  5. Job Skills Training/Post Secondary Education/Vocational Education Authorization Guidelines - Section 3322 is being modified to: Update terminology; correct formatting; reference internet learning; and promote the use of Demand Occupation information available on Kansas Job Link (KJL) in approving training plans for EES participants.

FORMS (Not previously discussed in this Summary)

Adult Protective Services
1. ES-1000 - Adult Protective Services Intake - is being revised to address concerns expressed by field staff.
2. ES-1001 - Adult Protective Services Screening Report - is being revised to make some cosmetic changes for clarification and to eliminate redundancy and to reinstate some items which were inadvertently omitted in the October 2005 revision.
Food Assistance
ES-1510.1 - Computation of Food Stamp Benefit - has been revised to incorporate the October 2005 annual adjustment to the standard deduction amounts, gross and net income limits and the excess shelter deduction.
Medical Assistance
ES-3100.8 - Application/Redetermination Medicare Savings Plan - is new. This application may be used by persons wishing to apply for only the following programs: Qualified Medicare Beneficiary (QMB); Low Income Medicare Beneficiary (LMB); or Medicare Part D Subsidy.

MISCELLANEOUS FORMS (Not previously discussed in this Summary)

The Child Care Provider Cover Letter is being removed. It is no longer applicable under EBT CC.

APPENDIX (Not previously discussed in this Summary)

The following appendix items are being removed from the KEESM. These Addenda to certain Child Care handbooks are obsolete with the implementation of EBT-CC:

C-12A - ES-1650 Addendum - Regulated Provider Enrollment;

C-13A - ES-1651 Addendum - Unregulated Provider Enrollment;

C-14A - ES-1652 Addendum - In-Home Child Care Request; and

C-15A - ES-1653 Addendum - Out-of-Home Relative Provider Enrollment.
Appendix Item C-22, KsCares Procedure: Child Care EBT Payments for RS Clients is being added. This procedure was developed for the EBT-CC implementation to identify steps for EES staff to take when a CC plan needs to be created for a Rehabilitation Services consumer.
Appendix Item C-23, EBT Child Care - Information for Parents is being added. A Spanish version is available as well. This can be used to help educate parents on EBT-CC.
Appendix Item C-24, Provider Tip Sheet is being added. This can be used to assist providers who cannot get traditional bank accounts.
Appendix Item F-8, Medicaid and HealthWave Standards is being updated to include thresholds for Medicare Part D Subsidy.
Appendix Item X-6, Definitions of Common Terms - A definition of “known to the agency” is being included in the Definitions. This definition states that for food stamps, cash and the medical programs, if the casefile or KAECSES AE clearly documents the caseworker’s direct knowledge of a change in circumstances, the change is considered known to the agency. For child care the same is true, except the information has to be in the KsCares system to be considered known to the agency.
Appendix Item X-10, SRS Institutions: Procedures for Placement of Names on the APS Central Registry is being added. This procedure affects only designated institutional staff and is not to be used by APS field staff in the regions.

EFFECTIVE DATE

All policies in this revision are effective January 1, 2006. Additional information will be in the Implementation Memo. Information regarding the COLA changes has been issued in an implementation memo dated 11-10-05. Medicare Part D implementation instructions are found in the implementation memo issued 11-07-05.

MATERIALS OBSOLETED BY THIS REVISION

None

EFFECT ON LOCAL STAFF

Other clarifications in this letter will have minimal impact on staff time.

COORDINATION EFFORTS

Within SRS, the material in this letter and manual revision have been coordinated with staff in the Economic and Employment Support, the EES Program Administrators, the Implementation Planning Team, EES Program Training Unit, the Medicare Part D Team Children and Family Services (CFS) staff, Child Support Enforcement (CSE), Kansas Department of Commerce, KCSDV, Addiction and Prevention Services and SRS Legal.

Sincerely,

Bobbi Mariani, Director
Economic and Employment Support

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