STATE DEPARTMENT OF SOCIAL                                        June 24, 2009
REHABILITATION SERVICES                                                
Integrated Services Delivery
Docking State Office Building
Room 681 - West
Topeka, Kansas 66612

OVERVIEW OF CHANGES

A brief overview of the major changes is described below. Other clarifications and technical corrections are also included and described in the next section.

Adult Protective Services – A new section is being added in the policy manual for how to handle requests for a guardian/conservator when the youth has been in the custody of SRS, and is in need of a guardian. When there is no open APS case and the individual may be in need of a guardian, the (contract) provider along with CFS worker and APS staff will meet to assess whether the youth is in need of a guardian, or if a less restrictive option is appropriate.

Cash Assistance – This revision includes policies that change the life time limit for Tier II General Assistance (GA) cases to 18 months and eliminates all hardship criteria.

Child Care – With this revision, it will become mandatory that staff use the Child Care Plan Hours Worksheet to determine the number of hours of child care to authorize for a child care plan.

This change is being made to simplify the process of determining the number of hours to authorize on a child care plan, and to make the process uniform statewide

Funeral Assistance – This revision includes policies changing the maximum allowable reimbursement to $550.

Medical Assistance –Medical – This revision implements a change in the Working Healthy (WH) premium requirements.  An increase in the average nursing home private pay daily rate used to calculate transfer penalties has been included.  The treatment of third-party trusts has been modified due to a recent clarification from the Centers for Medicare & Medicaid Services (CMS).

Clarification has been added concerning the definition of contiguous property.  Additional minor clarifications have been added to the trust section.  An updated Life Expectancy Table based on the current Social Security Administration (SSA) actuarial table as required by the Deficit Reduction Act (DRA) of 2005 has been included.  A note has been added to clarify that the 2-3 person plan is to be used in determining the Working Healthy (WH) premium level for a married couple. 

Successful Families – The purpose of this policy is to include referrals from Child and Family Services (CFS) into KEESM 3330.1 as a reason for referral to Solutions Recovery Care Coordination (SRCC) for assessment and assignment to treatment if appropriate.

The Health in Pregnancy Program (HIPP) which was piloted by CFS to provide drug and alcohol treatment services to pregnant women will be discontinued July 1, 2009.  When drug or alcohol abuse is reported to CFS, they will first check to see if the woman is receiving TAF.  If so, the referral will be sent to the Economic Employment Services (EES) worker to further assess through SRCC.  If the woman being reported does not have an open CFS case, one will not be opened at the time of the report and referral to EES. Those women who are currently in the HIPP program will be transitioned by SRCC into an appropriate treatment facility or program to continue treatment.

The current Grandparents as Caregivers (GA GP) program, implemented in January 2007, was designed to provide services for children who were being cared for by a legally responsible relative. GAGP was state funded. The Governors budget put forth for state fiscal year 2010 and subsequently passed by the legislature was not able to continue state funding the GA GP program. The program will now be funded with the federally funded TAF program.

In order to provide continuous service to those caretakers who will be losing GA GP benefits, we will be determining eligibility for caretaker relative benefits under the federally funded TAF program. In keeping with the intent of the Grandparents program as designed in 2007, we will now call TAF caretaker relatives the GPCG program and will update the ES-3100.9 application to access this program.

DESCRIPTION, PURPOSE, AND DETAILS OF POLICY CHANGE

1. ADULT PROTECTIVE SERVICES
   
   
   1. Changes
      
      
      1. Guardian/Conservators for youth in SRS custody – A new section, section 12715, is being added to address the process for determining whether a youth is in need of a guardian/conservator when they turn 18. The process will have APS staff work with the CFS worker and the contract provider to determine whether or not a guardian is needed. The process coincides with the PPM for children and family services.
         
         
2. Cash Assistance
   
   
   1. Changes
      
      
      1. Changes to the Life Time Limit for Tier II - Sections 2317 and 2318 are being modified to reflect changes to the GA life time limit for Tier II (GA/MediKan) cases. The Tier II caseload now has a life time limit of 18 months and all hardship provisions have been eliminated for the Tier II caseload.
         
         
   2. Clarifications
      
      
      1. Section 2312 are being revised to reflect that individuals applying for GA benefits must, in addition to TAF; not be eligible for SSA benefits and they may not voluntarily render them ineligible for SSA benefits either.
         
         
      2. Sections 2318 and 2319 are being revised to clarify that GA hardship provisions are only available to Tier I (GA/Medicaid) cases.
         
         
3. CHILD CARE
   
   
   1. Changes
      
      
      1. Determining Scheduled Hours – KEESM section 7620 is being modified to incorporate the mandatory use of the electronic Child Care Plan Hours Worksheet form W-13 to determine the number of hours authorized on a child care plan and to document information related to that calculation. The completed worksheet must be printed and placed in the case file. The exception to this would be for Flint Hills Job Corps participants, whose plan hours are determined based on the form ES-1611 or other specific documentation obtained from the Job Corps Center.
         
         
      2. Households Required to Change Report – KEESM 9121 and subsections are being modified to reflect that with the electronic child care plan hours worksheet, it will not be required that staff act on reported changes in hours of care needed for school age children if the change is due to (scheduled or unscheduled) days out of school for holidays, breaks, teacher in service, etc., as the worksheet considers those days out of school and averages the time over the months of the school year.
         
         
4. FUNERAL ASSISTANCE
   
   
   1. Changes
      
      
      1. Maximum Funeral Assistance Benefit – Section 2323 has been modified to reflect a reduction in the maximum allowable funeral assistance benefit. The maximum benefit has been lowered to $550.
         
         
5. MEDICAL ASSISTANCE
   
   
   1. Changes
      
      
      1. Working Healthy Premium Requirements – A new premium billing vendor will be installed effective July 1, 2009, prompting changes to the premium requirements. Effective with this change, recipients who are two full months delinquent in their premium payments will lose coverage under the program. Repayment agreements will no longer be used to regain access to the program following closure for non-payment.
         
         An implementation memo concerning the new Working Healthy (WH) premium requirements will be issued separately.
         
         KEESM section 2664.5 will be updated with this revision.
         
         
      2. Transfer of Property – The average nursing home private pay daily rate in the state has increased from $137.65 to 138.41. The new rate is effective with all penalty periods with a start date on or after July 1, 2009.
         
         KEESM section 5724.4(2) and Appendix item W-9 (Transfer of Property Worksheet) will be updated with this revision. In addition, the electronic Transfer of Property Worksheet will be updated and re- issued. Previous versions will be obsolete and should be discarded.
         
         
      3. Treatment of Third-Party Trusts – The Centers for Medicare & Medicaid Services (CMS) has provided recent clarifying guidance on the treatment of third-party trusts. A trust established with assets of someone other than the applicant/recipient is considered an available resource only if the individual has the ability to revoke/terminate the trust or direct the use of the trust assets for their own support/maintenance.
         
         Mandatory periodic payments received from the trust by the applicant/recipient may be considered an available resource unless there is a spendthrift clause or other restrictive language in the trust. KEESM section 5620(4) will be updated with this revision.
         
         
   2. Clarifications
      
      
      1. Contiguous Property – The section defining contiguous property for resource purposes has been reworded to more clearly convey that tracts of land lying side by side are still considered to be contiguous even if separated by streets, alleys, or other easements.
         
         KEESM section 5331 will be updated with this revision.
         
         
      2. Establishing A Trust – Minor wording changes have been included to further clarify when an individual is considered to have established a trust.
         
         KEESM section 5620 will be updated with this revision.
         
         
      3. Life Expectancy Table – An updated Life Expectancy Table has been included with this revision. The Deficit Reduction Act (DRA) of 2005 mandates that the current Social Security Administration (SSA) actuarial table be used in determining the actuarial soundness of certain annuities. The new table should be used with any determination completed on or after July 1, 2009.
         
         KEESM Appendix Item T-4 (Life Expectancy Table) will be updated with this revision.
         
         
      4. Working Healthy Premium Level – A note has been added to this section to clarify which household size is to be used in determining the premium amount. The 1 person plan is to be used for a single individual, while the 2-3 person plan is to be used for a married couple (including when only one of the two are a recipient).
         
         KEESM section 2664.5 will be updated with this revision.
         
         
6. SUCCESSFUL FAMILIES
   
   
   1. Changes
      
      
      1. SRCC Referral – Item ‘I’ will be added to 3330.1 allowing for CFS -1001 reports to constitute further assessment by SRCC.  No CFS case will be open if this referral is made to EES.  If the customer does not cooperate with SRCC a penalty may be assessed without consulting with CFS.  If further treatment is advised, then CFS will be invited to the Multi Team Meeting (MTM) as a resource of possible services to the customer.
         
         
      2. The GPCG (TAF caregiver relative) – This program mirrors the TAF program in many ways.  Similarities include use of the KAECSES system to determine eligibility under the ‘AF’ program type, benefit levels similar to county/household numbers/living arrangements, resource limits, child support referrals, 10 day reporting requirements, and others. 
         
         The policies that differentiate the GPCG from TAF are the following: 
         
         
         • The TAF relative caregiver program is now the Grandparent as Caregivers program (GPCG); 
           
           
         • The application for the GPCG program requests information for the child(ren) only;
           
           
         • A request for GPCG is not a request for medical;
           
           
         • There is no 60 month time limit to receive benefits;
           
           
         • Grandparent as Caregivers may be reviewed every two years;
           
           
         • There are no work related requirements, including the requirement to complete the Work Readiness Screening.
           
           

         The following KEESM sections are being changed as a result of these policy changes:

         • Items (1) and (3) have been added to KEESM 1111.
           
           
         • Item (d) is being added to KEESM 1322.1 (1).
           
           
         • all material related to GPGC is being removed from 2330 and 2340 and KEESM 2330 is being marked "Reserved."

FORMS (Explanation provided if not mentioned previously in this summary.)

1. Medical Assistance
   
   
   1. ES-3100.8, Medicare Savings Plans Application/Redetermination Form
      
      
   2. ES-3178, Authorization Form for the Release of Information – The ES-3178 has been developed at the request of field staff, nursing facilities and advocacy groups. This release of information allows SRS staff to communicate information, regarding eligibility status, pending eligibility questions and patient obligation amounts, concerning the applicant or recipient’s eligibility determination to the Nursing Facility.
      
      
2. Successful Families
   
   
   1. ES-3100.9, GPCG Application- The ES-3100.9 application is being revised to incorporate additional questions needed for eligibility determination.  These questions revolve around child support enforcement, resource and student information.
      

APPENDIX (Explanation provided if not mentioned previously in this summary.)

1. Child Care
   
   
   1. W-13, Child Care Plan Hours Worksheet - This form will now be mandatory for use in determining child care plan hours in most cases.
      
      
2. Medical Assistance
   
   
   1. T-4, Life Expectancy Table
      
      
   2. W-9, Transfer of Property Worksheet
      

MISCELLANEOUS FORMS (Explanation provided if not mentioned previously in this summary.)

CFS-1001, Report/Request for Services

EFFECTIVE DATE

All policies in this revision are effective July 1, 2009, and these policies apply to all applications and reviews received or processed on or after that date unless stated otherwise. They also apply to ongoing cases at the time of the next case change involving the affected policy unless stated otherwise. Additional information is being included in the Implementation Memo.

EFFECT ON LOCAL STAFF

Child Care: Implementation of this change will have a substantial effect on EES staff. The months of June and July will be very work intensive for staff, as all cases will need to be converted to the use of the worksheet no later than the benefit month of August, 2009. Following conversion, staff should see a substantial savings in the amount of time needed to process child care applications and reviews due to the use of the worksheet. Time savings will also be realized by not being required to add extra hours to child care plans throughout the school year when parents call to report days their school age children are out of school (scheduled or unscheduled) for holidays, teacher in-service, etc.

Medical: The medical changes concerning the new Working Healthy (WH) premium requirements will likely result in a slight increase in staff effort during the initial educational phase.

Successful Families: A small increase in referrals to SRCC, potentially causing a small increase in customers in Alcohol and Drug Component.

MATERIALS OBSOLETED BY THIS REVISION

COORDINATION EFFORTS

Within EES, the material in this letter and manual revision has been coordinated with staff in Economic and Employment Support, the EES Program Administrators, the Implementation Planning Team, the Training Advisory Team.  The medical material has been coordinated with KHPA.  Successful Families material has been coordinated with the Work Experience/Community Service Work Site Development/Utilization Work Group, SRS Legal, and KCSDV.

Sincerely,
Bobbi Mariani, Director
Economic and Employment Support
BM:AM:lf