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STATE DEPARTMENT OF SOCIAL
Final
REHABILITATION SERVICES
September
4, 2002
Integrated Services Delivery
Docking State Office Building
Room 681 - West
Topeka, Kansas 66612
TO: Area Directors
Economic and Employment Support Chiefs
Economic and Employment Support Staff
Social Service Chiefs
Other Staff
Re: Summary of Changes for Kansas Economic and Employment Support Manual (KEESM)
Revision No. 11 effective October 1, 2002.
PURPOSE, BACKGROUND AND REASON FOR CHANGE
Food Stamp Program - This revision implements numerous changes to the Food Stamp
Program mandated by federal regulations or law. The changes contained in regulations were
published November 21, 2000 and January 17, 2001 and include changes in this revision that
promote Food Stamp Program access and consumer education, required verification of ABAWD
work hours, adding good cause provisions to ABAWD work requirements, changes to the
comparable treatment for disqualifications policy, a change in the treatment of the income
of persons found ineligible due to the comparable provisions (excluded instead of
disqualified), and allowing 24 month certified households to switch between actual and the
SUA at the time of the mid point contact.
Changes contained in this revision that are based on federal law are a result of the
recently passed food stamp reauthorization legislation, the Agriculture, Conservation, and
Rural Enhancement Act of 2002, Public Law 107-171 (also known as the Farm Bill). These
changes mandate that the standard deduction be determined based on household size, and
that the higher resource limit of $3,000 apply to households in which at least one member
is disabled and that food stamp eligibility be restored to legal immigrants who are
disabled regardless of when they entered the country. Several changes are mandated by USDA
clarification including the exemption of Ricky Ray Hemophilia Relief Act payments, that
the drug related provisions of 2183 take precedence over categorical eligibility, and the
fact that medical ID bracelets and necklaces are not allowable medical expenses for food
stamps, but that pagers needed for a person awaiting an organ transplant are allowable.
Clarifications included as a result of staff questions and input include modifications
to the alcohol and drug treatment section, a new section describing eligibility for
residents of halfway houses, income clarifications regarding VISTA and Americorps,
clarifications regarding case closure for failure to submit the monthly report form, and a
clarification that only one interview needs to be scheduled by the agency at the time of
review. Several cross references have also been added for clarification purposes.
Lastly, this revision implements the annual federally mandated increases in the Food
Stamp Program's maximum benefits, maximum excess shelter deduction and gross and net
income limits effective October 2002.
Medical Programs - A new Medicaid service, Program of All-Inclusive Care for the
Elderly (PACE), is being implemented with this revision. Under this Medicaid option a
person age 55 or older who meets the nursing facility level of care threshold may enroll
in a PACE program. PACE will provide medical care through a network of medical providers.
Once enrolled, a monthly capitated rate is paid to the PACE provider by both Medicaid and
Medicare, and fee for service claims are no longer paid. The only PACE provider in Kansas
is Via Christi HOPE, serving only residents of Sedgwick county. PACE enrollment begin
September 1, 2002.
Estate Recovery - This revision is also implementing a new law passed by the
2002 Kansas Legislature. Substitute for Senate Bill 513, which amended K.S.A. 16-304,
provides the agency the right to recover excess funds from prearranged funeral agreements,
contracts and plans. The new law specifically requires the company holding the prearranged
funeral or burial plan to forward funds remaining after payment of reasonable funeral or
burial expenses for a person who received medical assistance, or the spouse of a former
recipient, to SRS. This is applicable regardless of whether the plan is financed by a bank
account, certificate of deposit, trust fund, life insurance or other financial vehicle.
All funds are to be sent to the Estate Recovery Unit for tracking and monitoring.
Companies failing to comply with this new law could face monetary penalties. The new law
went into effect July 1, 2002.
Work Program Changes - Marshall and Nemaha counties have been added as counties
which offer Food Stamp Employment and Training (E & T) services.
The recently passed Farm Bill removed the $25 cap on Food Stamp E & T transportation
payments. The Food Stamp E & T transportation policy is being changed in this revision
to be more consistent with TAF transportation policies. Flexible transportation may be
authorized. FS E & T clients who are participating in more than one component may be
eligible for transportation for each component.
Other - Other technical corrections and clarification to policy and procedure
have also been incorporated. JTPA terminology has been converted to WIA. References to
Applicant Job Search (AJS) have been replaced with the more generic job search
terminology.
CHANGES AND REQUIRED ACTIONS
- KEESM 1211.3 - Right to Information - This
section has been modified to provide that if the applicant is applying for TAF or GA, the
applicant has a right to know that the time limits of those programs do not apply to
receipt of food stamp benefits. In addition, food stamp households have a right to know
that they may still qualify for food stamps if they have been terminated from receiving
TAF or GA due to the time limits, begun working or for other reasons.
- KEESM 1213.8 - Consumer Education - This
section has been revised to state that the agency is responsible to notify consumers that
the time limits of the TAF or GA programs do not apply to the Food Stamp Program and that
those that have been terminated from the TAF or GA program because they have reached a
time limit, begun working, or for other reasons may still qualify for food stamps.
- KEESM 1322.1 - Mandatory Verification That Affects
Eligibility for Program Benefits - A new item, (8) Hours Worked by an ABAWD, has been
added to this section to provide that the hours worked by an ABAWD who is satisfying the
ABAWD work requirement by working 20 hours per week (averaged monthly) must be verified.
- KEESM 1411.1 - How to Apply - Applicable to All
Programs - This section has been modified to provide that applying for food stamp
benefits should be encouraged if the applicant expresses concerns which indicates that the
household does not have any, or enough, food.
- KEESM 1411.2 - Application Date - This section
has been revised to clarify that if the application is mailed or left at the wrong county
office, the office shall mail the application to the appropriate office on the same day,
or forward it the next day by any means possible to insure the application arrives the day
it is forwarded (such as FAX).
- KEESM 1412.1 - Face-to-Face Interview - This
section has been modified to clarify that the agency is responsible for scheduling an
interview for each applicant that is not interviewed on the day the application is
submitted.
- KEESM 1630 - Civil Rights Complaints - This
section has been modified to change the reference to the FP-1600 to the ES-1600. The form
has been updated and revised. Also see item 1 of the Forms Section.
- KEESM 1725.3 - Filing of Claims by Estate Recovery
Unit - This section has been modified to reflect a new Kansas law requiring any entity
providing funeral or burial services through a prearranged funeral agreement to a medical
assistance recipient, or surviving spouse of a recipient, to forward any funds remaining
in such agreement after payment of reasonable burial or funeral expenses to the Estate
Recovery Unit (ERU). This requirement is applicable regardless of the vehicle used to fund
the funeral agreement , including bank accounts, trusts, burial insurance and life
insurance. The funeral home and/or insurance company is required to remit any such excess
funds if the individual, or the individual's spouse, ever received medical assistance This
requirement does not apply to other resources not specifically assigned for payment of
funeral expenses, such as life insurance policies payable to another beneficiary. It also
does not apply if the decedent has a living spouse or minor or disabled children.
This
provision is applicable for any deaths occurring on or after July 1, 2002.
In addition, the new law also incorporates two new notification requirements. First, all
recipients of medical assistance are now required to notify the agency of the existence of
any prearranged funeral agreement upon entering into such an agreement. Second, persons
receiving medical assistance are also required to notify the funeral home of the plan when
entering into the funeral agreement.
Additional implementation instructions regarding both new rules will be issued in a
separate memo.
- KEESM 2124 - Potential Resources - This section
is being modified to include information regarding a potential resource for medical
assistance recipients who are or have been married. State law allows a surviving spouse to
claim a portion of assets owned by the deceased spouse upon his or her death. These rights
are also called the ‘spousal elective share'. The potential amount of the spousal
elective share is based on the ‘augmented estate' of the deceased spouse. Assets used
to determine the augmented estate include joint tenancy property but can also include
assets obtained prior to the marriage that have been solely owned by the newly deceased
spouse and assets assigned to other persons through payable on death (POD) provisions.
Property regarded as a homestead is not included. The portion of assets in which the
surviving spouse has rights to claim is dependent upon a number of factors, including the
length of the marriage. For example, a person married 15 years or more has a right to 50%
of the augmented estate. In order to lay claim to assets which were passed to persons
other than the surviving spouse, the surviving spouse must initiate probate action within
6 months from the date the spouse died. If action is not taken by this date, spousal
elective share rights are forfeited. All medical assistance recipients are expected to
fully exercise spousal elective share rights as a potential resource. Failure to pursue
these potential resources shall result in ineligibility. Assistance shall remain in place,
provided all other eligibility factors have been met, if the client or persons acting on
behalf of the client continue to cooperate in pursuing these potential resources.
Legal
staff in the Estate Recovery Unit (ERU) shall provide assistance to staff when potential
spousal elective share rights are identified. Upon notification of the death of spouse of
medical assistance recipient, the EES Specialist shall inform ERU of the situation. EES
should also request information regarding potential rights to the spousal elective share
from the client. A special notice has been created for this purpose. The request will
specifically ask the recipient spouse to provide information regarding any action he/she
has taken to ensure spousal rights have been protected. Failure to respond to this request
will result in ineligibility. However, it is important to ensure the client is capable of
acting in his/her own behalf, or has a medical representative capable of doing so, prior
to taking action.
If it is discovered that the surviving recipient spouse has given up her rights by
consenting to a will or to a POD assignment, and has thus forfeited her spousal elective
share rights, a transfer or property penalty must be considered. The date of death is
considered the transfer date in these situations.
Several formatting changes are also included in this revision. Clarification has been
added that persons are also required to pursue potential income sources, with the
exception of MA CM programs.
- KEESM 2140 and Subsections - Citizenship and
Non-citizen Status (Not Applicable to Social Services Child Care) - This section has
been modified to better describe the current qualifying non-citizen statuses for the cash,
medical, food stamp, and child care programs. Specifically the cash, medical, and child
care provisions have been separated from food stamp provisions creating two new sections,
2142 and 2143. Both subsections better reflect which non-citizens are eligible without
regard to time limitations vs. those subject to the 5 year bar or 7 year benefit
limitation.
The cash, medical, and child care section incorporates a new qualifying
status regarding non-citizens who have been battered or subject to extreme cruelty by a
U.S. citizen or lawful permanent resident spouse. In addition, this section also notes
that persons who were in the United States on or before August 22, 1996 who have since
obtained a qualifying status are eligible for benefits provided other criteria have been
met. This is true regardless of their status on 08-22-96. If the individual can
demonstrate residence in the country on that date and they have since obtained Legal
Permanent Resident status, been granted conditional entry, proven battery or extreme
cruelty as defined in this material, or granted parole status, they are regarded as
qualified aliens not subject to the 5 year bar for cash, medical and child care purposes.
Section 2143, now contains the qualifying non-citizen statuses for the Food Stamp
Program. Subsection 2143.2 (c) contains a policy change mandated by the Farm Bill that is
effective October 1, 2002. This change restores food stamp benefits to otherwise eligible
non-citizens receiving blindness or disability payments regardless of their date of entry
into the country. Prior to this revision, the non-citizen receiving blindness or
disability had to be a lawfully residing in the U.S. on 8/22/96.
- KEESM 2243 - Guidelines for Closing TAF Hardship
Cases Following the Loss of Hardship Status - Clarification has been added to this
section to address the impact on the food stamp work related requirement penalty count in
situations where the TAF cash case has exceeded 60 months and hardship status has ended.
- KEESM 2510
- Categorically Eligible Households - A cross reference in item
(1) in this section is being corrected.
- KEESM 2514 - Persons Not to
be Included in a Household Which is Otherwise Categorically Eligible
- A new item (6) has been added to this section to clarify that
the drug-related conviction provisions of 2183 take precedence over
categorical eligibility.
- KEESM 2520 - Able-bodied Adults
Without Dependents (ABAWD) - Item (1) of this section has been
modified to clarify that if an individual would have worked an average
of 20 hours a week, but missed some work for good cause, the individual
shall be considered to have met the work requirement if the absence
from work is temporary and the individual retains his or her job.
Good cause shall include circumstances beyond the individual's control,
such as, but not limited to illness, illness of another household
member requiring the presence of the member, a household emergency
or the unavailability of transportation.
- KEESM 2541 - Alcohol and Drug Treatment and
Rehabilitation Centers - This section has been modified to clarify that the SRS entity
licensing alcohol and drug treatment and rehabilitation centers in Kansas is the SRS
office of Substance Abuse Treatment and Recovery (SATR). Furthermore, the section
clarifies that if SATR has licensed a facility to provide substance abuse treatment and
rehabilitation, the facility is considered "authorized under Part B of Title XIX of
the Public Health Service Act" and it's residents are therefore eligible to apply for
participation in the food stamp program following the provisions of this section.
- KEESM 2541.4 - Treatment Center Responsibilities -
Item (4) of this section which discusses responsibility for overpayments has been revised
to provide instructions when an overpayment is calculated and determined to be the
responsibility of the facility. In these instances, the claim shall be established on the
system, however, a repayment plan shall not be entered for the claim to prevent collection
from the recipient either through benefit reduction or the Treasury Offset Program. A
notice of repayment must be sent to the facility explaining the overpayment and requesting
repayment. A collateral notice will be available to send in these situations.
- KEESM 2550 - Comparable Treatment for
Disqualifications - This section, and accompanying subsections, has been substantially
revised to provide that the comparable treatment for disqualification provision only
applies when a penalty is assessed on an ongoing TAF recipient, not when assistance is
denied when the individual is an applicant. The individual must be a recipient of TAF and
food stamps at the time the disqualification in the TAF program is assessed to be
disqualified from the Food Stamp Program.
In addition, this
section has been revised to provide that when a person is disqualified for food stamps
based on the comparable provisions, they shall be treated as an excluded household member
(SEPA code DI), instead of as a disqualified member (SEPA code DF). Also see item 30 of
this letter.
Item (1) of 2552, has been revised to provide clearer policy on treatment of the case when
a first time penalty is assessed. And last, a new item (4) has been added to provide that
the maximum length of time a person can be penalized under these provisions is one year.
If at the end of one year they have still not cooperated with the TAF work
program or CSE requirement, they shall be reinstated.
Additional instructions regarding this change will be
provided in the Implementation Memo.
- KEESM 2551 - Comparable
Treatment of Disqualifications; KEESM 4310 - Assistance Planning; and KEESM 5430 - Exempt
Personal Property - The NOTE in 2551, the second paragraph in 4310 and item (18) in
5430 have all had a reference corrected. Previously, the reference was to KEESM 2622, Medical
Only for TAF Caretakers (MA CM). That section was "reserved" in KEESM
Revision No.4 in January 2001 and the information was put into section 2621, Family
Medical Coverage (AM Associated with TAF and MA CM).
- KEESM 2672.2 -
Expanded LMB - This section has been clarified to state that persons attempting to
gain Medicaid eligibility are not eligible for Expanded LMB. The material previously
appeared to only prohibit regular Medicaid if it came by way of spenddown.
- KEESM 2691- Emergency
Medical for Non-Citizens - This section has been changed to state that non-citizens
granted stay in the United States for temporary purposes only are not eligible for
emergency medical coverage under SOBRA because they do not meet state residency
requirements. State residence is establish by intent to remain in Kansas indefinitely. A
person entering the country under a temporary status has agreed to leave the United States
after a certain period of time, and will not be remaining in Kansas. Such persons are not
Medicaid eligible. Examples include foreign visitors, tourists, diplomats, or students in
the country on temporary visas.
- KEESM 2793 - Newborn
Coverage - This section is being modified to indicate the appropriate policy for
enrolling a newborn into Title XXI when the child was not born to a Title XXI mother. A
determination must be made for a newborn not born to a Title XXI mother. If the child is
determined to be Title XXI, no retroactive coverage is available for that child,
regardless of whether there are other eligible children on the plan. Coverage for the
newborn will begin effective with the date of enrollment, approximately one business day
after the child is added to the plan.
- KEESM 2795 - Child
Support Enforcement - There is no requirement to refer a child eligible for HealthWave
to CSE or that the family cooperate in establishing paternity and support on behalf of the
child. A family can voluntarily pursue paternity and support for any HealthWave child
where there are no Medicaid eligible siblings and should be directed to the local CSE
staff if such request is made. In these instances, a system generated referral shall not
be used.
- KEESM 2833 - SS (Social
Service) Child Care - Item 3 regarding SSI children is being removed from this
section. This policy change helps clarify appropriate use of Social Service child care
subtype. KEESM 4420 will be modified to correspond with this policy change. Policies for
SSI children will be aligned with existing policies for TAF children. Since both of these
categories of children are seen as receiving "public assistance", policies
should be the same.
- KEESM 3100 - Work
Related Requirements - This section has been revised to provide that food stamp
work-related requirements are not to be applied to food stamp applicants. Requirements
will only be applied to recipients. This change is being made to be consistent with the
change described in item 16 that does not allow the state agency to apply the comparable
penalty provisions to applicants. The only work related requirement that can be imposed on
food stamp applicants is the potential employment provisions of 3540. This section has
also been modified to add two additional counties to the list of counties participating in
the federally mandated FS employment and training program. These counties are Marshall and
Nemaha. Corresponding changes have also been made to 3310.2, Job Search Components.
- KEESM 3310.4 (4)
Employment Assessment Process - This section has been modified to clarify that this
component is available for food stamp recipients in Food Stamp Employment and Training
counties but it is not available to food stamp applicants.
- KEESM 3411.1 -
Transportation - The third paragraph of this section has been revised to add a final
sentence explaining that payment for expenses associated with vehicle purchase, repairs,
etc., shall be made using the Special Services Allowance. This sentence had previously
been a part of this section but was accidentally removed in the January, 2002 revision.
- KEESM 3120 - Initial
Interview - This section has been modified to clarify that food stamp applicants
should not be assigned to job search activities.
- KEESM 3421-
Transportation - The Food Stamp E & T transportation section has been modified to
be more consistent with TAF transportation policies and allow more flexibility in
determining the amount of the transportation payment.
- KEESM 3500 - Failure to
Meet Work Related Requirements - Wording in this section and subsections has been
modified to incorporate the change noted in items 16 and 22. Any reference to a denial of
assistance due to failure to cooperate with work requirements has been removed.
3511.1 Effect on Cash and Food Stamp Eligibility for Non-Recipients, item (2) for food
stamps, has been modified to clarify again that for food stamp applicants, the only work
related provision that applies is potential employment. Several references to an
ineligible food stamp person being "disqualified" has been changed to
"excluded". Also see item 30.
- KEESM 3522 -
Re-Establishing Eligibility (For Cash and Food Stamps) - Item (2) for food stamps, has
been modified to clarify policy and reduce confusion. When re-establishing eligibility,
normally the person is added back onto the food stamp case the month following the month
they cooperate in accordance with the change rules of 9211.3 or 9311.1. The only exception
to this, is when the person cooperates in the month following the month in which action
was taken the remove (code DI) the person from the food stamp case. This means that if
they cooperate in the first month removed from the case, there is no break in
participation and they shall be added back onto the FS case (code IN) effective the first
day of the month in which the cooperation is established.
- KEESM 4212.2 -
Excluded Household Members - This section has been modified as previously noted.
Persons determined ineligible due to the comparable provisions are to be treated as
excluded household members (SEPA code DI) instead of disqualified (SEPA code DF). In
addition, persons found ineligible for noncompliance with food stamp work-related
requirements, including potential employment, shall be treated as excluded household
members instead of disqualified. Corresponding changes have been made to 4212.3,
Disqualified Household Members.
Additional
information for converting ongoing cases will be provided in the Implementation Memo.
- KEESM 4250 - Residents
of Halfway Houses - This new section has been added to clarify that residents of
halfway houses are eligible to participate in the Food Stamp Program (if otherwise
eligible), even if meals are provided to residents. Halfway houses are temporary
accommodations, usually for persons just released from prison. Residents are considered
homeless (see definition of homeless in Appendix item 78), and thus are eligible to
participate. Residents may apply on their own behalf and are not required to apply by use
of an authorized representative of the facility.
- KEESM 4420 - Exceptions
to the Child Care Assistance Planning - Item 3 referencing the use of the SS subtype
for children who receive SSI is being removed with this revision. Item 2 is being revised
to apply to both TAF and SSI children.
- KEESM 5120 - Maximum
Allowable Resource Limits - Food Stamps - This section has been revised to provide
that the $3,000 resource limit now also applies to households with at least one member who
is considered disabled (see definition of disabled in the Appendix) for purposes of the
Food Stamp Program.
Additional information about the
system implementation of this change will be provided in the Implementation Memo.
- KEESM 5722 - Transfer of
Assets to Trusts/Disclaimers of Inheritance - This section has been modified to
include a waiver of spousal elective share rights by an applicant/recipient spouse as a
potential transfer of property. Waiver of rights is viewed as any action which forfeits
the spouses right to the elective share, such as consenting to a will or POD clause on
property owned by the spouse. Kansas law allows a spouse to waive spousal elective share
rights, entirely or partially, before or after marriage. However, such a waiver is only
valid if the spouse is capable of consent (e.g. have decision making capacity). The
Medicaid program views spousal elective share as a potential resource and
applicants/recipients are expected to take any necessary action to ensure their rights are
protected. However, if internal legal opinion and/or court action determines any waiver of
spousal share was executed in accordance with the law and the spouse does not have rights
to the property, the action is viewed as a disclaimer of inheritance rights and therefore,
subject to transfer of property provisions. The date of death of the spouse is viewed as
the date of transfer in these situations. Referral to legal staff in ERU shall be made on
a case by case basis for additional guidance.
- KEESM 6410 - Income
Exempt as Income Only and Income Exempt as Income and a Resource - A cross reference
to item (62), VISTA income has been added to item (5) Americorps. Item 34, JTPA, has been
removed as JTPA has been replaced by the Workforce Investment Act (WIA). All references to
JTPA in the KEESM have been changed to WIA as a result of this change. Item 35 through 47
have been renumbered, 34 through 46 as a result. In item (62) wording has been added to
explain that VISTA is an Americorps program with special income treatment rules. A new
item, (47) has been added to provide that payments made pursuant to the Ricky Ray
Hemophilia Relief Fund Act are exempt as income and as a resource for all programs.
Interest earned on the funds that exceeds $50 is not exempt per 6410(29).
- KEESM 7131 -
Intermittent Income - This section has been clarified to show that intermittent income
received prior to the first eligibility period shall not be considered.
- KEESM 7132.1 - Income
Producing Cost Deduction - This section has been modified to clarify that capital
gains are countable self employment income. Capital gains are realized when business
property is sold at a profit over the purchase price or other ‘basis' for the
property. The basis includes the purchase price plus improvements made to the property.
The total amount of gain is determined by subtracting the basis from the sales price.
Because depreciation is not considered as an allowable expense for self employment
enterprises, it does not impact the basis or capital gain. Certain sales expenses (such as
realtor fees and advertising expenses) can also be counted toward the basis thus reducing
the total capital gain. The full amount of capital gain is countable and are included and
averaged with the other self employment income. Losses from sales of business property do
not reduce earnings from the ongoing enterprise or other earned or unearned income.
- KEESM 7222 - Standard
Deduction - This section has been modified to provide that effective October 1, 2002,
the standard deduction used in calculating benefits for the Food Stamp Program shall be
determined based on household size. Household sizes of 1-4 will still be the current
amount of $134. Household sizes of 5 will have a standard deduction of $147. Household
sizes of 6 or more will have a deduction of $168. The KAECSES system has been modified to
determine the appropriate standard deduction. Further information about this change will
be provided in the Implementation Memo.
- KEESM 7226.3 -
Utilities - Item (3), Standard Utility Allowance, has been modified to provide that
households certified for 24 months in accordance with KEESM 9772(4) may switch between
actual utility costs and the standard utility allowance at the time of the mid-point
contact.
- KEESM 7420 - Food Stamp
Standards - A sentence has been added to this section that was inadvertently omitted
when the combined manual was implemented. This sentence provides that households that
include at least one member who is elderly or disabled do not need to meet the gross
income test.
- KEESM 8300 - Program of
All-Inclusive Care for the Elderly (PACE) - This new section has been added to reflect
a new long term care option for persons age 55 and older and residents of Sedgwick County.
PACE is a program designed to provide a complete and total care package for the frail
elderly. Services are delivered primarily in an adult day home environment but can extend
to the community, inpatient setting or long term NF arrangement. PACE relies on a team of
medical professionals called an interdisciplinary team, to establish a detailed plan of
care for the enrollee to provide for all medical needs. The interdisciplinary team
includes persons involved in the clients day-to-day care, such as the physician, various
therapists, dietician, nurses, social workers and other attendants, such as van drivers
and aides.
Because PACE is only available to
residents of the service area, persons living outside of Sedgwick County do not have the
option of PACE.
PACE providers are reimbursed through a capitated rate
structure. There are no fee-for-service claims for PACE enrollees, with the exception of
Medicare buy-in. Capitated Medicare reimbursement is also applicable for persons enrolled
in Medicare. Once a client is enrolled into PACE, the PACE entity is obligated to provide
for all of the patients medical needs for the single capitated payment amount. Any
services received outside of the PACE program, are the clients responsibility. Further,
these expenses are not allowable to reduce the participant obligation as are not
considered medically necessary. The only appropriate participant obligation reductions are
the cost of due and owing bills and health insurance premiums.
Providers wishing to become PACE sites must have an
approved application from the Centers for Medicare and Medicaid Services. Currently, Via
Christi HOPE is only approved PACE entity in Kansas.
Assignment to PACE begins September 1, 2002. Separate
detailed implementation instructions have been provided for Wichita area staff. Four
additional subsections have also been added to support the PACE program.
- KEESM 8310 - General
Eligibility - This new section has been added to set forth the general eligibility
guidelines for PACE participants. Persons must be age 55 or older and meet the NF LTC
threshold (currently a score of 26). For couples, spousal impoverishment applies.
Referrals for PACE will be made to the PACE entity.
- KEESM 8320 - Financial
Eligibility - This new item provides information regarding the financial eligibility
requirements of the PACE program. In general, HCBS income and budgeting methodologies are
applicable with the HCBS protected income standard applicable beginning the month of
enrollment. For persons moving to an institutional arrangement, the NF protected income
standard of $30.00 is applicable beginning the month following the month of the move
unless the planned brief stay provisions of 8114 apply.
- KEESM 8330 - Effective
Date of Coverage - This new item provides information regarding the coverage date for
the PACE program. Coverage under PACE is always prospective. Eligibility must be
determined and appropriate codes entered onto the KAECSES system by the first medical card
cutoff for the month. This is necessary for the client to be correctly assigned to the
PACE organization, to ensure that the appropriate capitated rate is paid to the PACE
provider but also to ensure that no fee-for-service claims are paid.
A new living arrangement code of PC has been developed for the
KAECSES LOTC screen. The PC code is used in combination with the NA level of care code to
denote PACE and provide for assignment. Once assigned, monthly medical cards will no
longer be generated for the beneficiary. Co-payments do not apply either.
Persons may be served under an appropriate HCBS waiver
while awaiting enrollment into PACE.
- KEESM 8340 - Changes and
Disenrollment - This new item provides information regarding changes and disenrollment
from the PACE program. Persons may only disenroll from PACE effective the last day of the
month. Persons are also required to report all changes.
- KEESM 9213 -
Termination/Pending of Benefits - Item (2) of this section has been clarified to
provide that a household's cash or food stamp case shall not be closed when the household
fails to file a monthly report and the benefits for the issuance month are to be
determined by prospective budgeting. This would occur when the household is being
converted from monthly reporting to nonmonthly reporting.
- KEESM 9310 -
Responsibility after Approval for Nonmonthly Reporting Households - This section has
been modified to strengthen the requirement that a Change Report Form (either the hard
copy form or the KAECSES notice V834) be provided to all nonmonthly reporting households
at the time of initial approval and at each review, and whenever the household reports a
change using the Change Report Form. Use of the form will allow staff to enter the amount
of income the agency is currently budgeting on the case at hand so the consumer will have
a guide to know when and what they are required to report. This is critical in our efforts
to reduce errors for failure to report required changes.
- KEESM 9732 - Interview
(Cash and Food Stamps Only) - This section has been modified to clarify that at the
time of review, the agency is responsible for scheduling one interview - either
face-to-face or telephone.
- KEESM 10032 -
Requirements to Approve Regulated Providers - Reference to the Attendance Record
ES-1604 has been removed from the chart. The ES-1604 should be provided as a sample but is
not necessarily a "required" form for enrollment. Attendance records continue to
be a provider responsibility. This form is included in Appendix Item #22, Child Care
Provider Handbook.
- KEESM 10033 -
Requirements to Approve Unregulated Legally Exempt Providers (Excluding In-Home) -
Reference to the Attendance Record ES-1604 has been removed from the chart. The ES-1604
should be provided as a sample but is not necessarily a "required" form for
enrollment. Attendance records continue to be a provider responsibility. This form is
included in Appendix Item #22, Child Care Provider Handbook.
- KEESM 10035.1 -
Maintaining Provider Files - Reference to the need for staff to provide copies of
enrollment documents to child care providers has been added.
- KEESM 10036 - In-Home
Child Care Enrollment and Monitoring Procedures - Reference to the Attendance Record
ES-1604 has been removed from the chart. The ES-1604 should be provided as a sample but is
not necessarily a "required" form for enrollment. Attendance records continue to
be a provider responsibility. This form is included in Appendix Item #21, In-Home Child
Care Handbook.
- KEESM 12150 -
Definitions - The term, "Vulnerable Adult" has been replaced with
"Adult at Risk". The APS statutes do not use "vulnerable". The other
definitions added to this section are from the re-codification of the
Guardianship/Conservatorship Act, effective July 1, 2002. The former definitions relating
to the previous Guardianship/Conservatorship statute have been replaced.
- KEESM 12350 - Death of
Alleged Victim Before Being Interviewed (Not Receiving Services from CDDO/Affiliate) -
Criteria for continuing with an investigation when the alleged victim dies before being
interviewed has been added .
- KEESM 12700 -
GUARDIANSHIP AND CONSERVATORSHIP SERVICES - This section relates to
Guardianship/Conservatorship and has been revised to incorporate changes necessitated by
the statutory revision.
FORMS
- The ES-1011,
Guardianship/Conservatorship Referral / Notification, form now includes the statement:
"Date sent to KGP".
- The ES-1600, Civil Rights
Complaint, has been revised and updated with KEESM references. The basic content and
use of the form is unchanged. Due to the low usage of this form, the form shall be
reproduced locally and completed as needed.
- The ES-2004, Protective
Services for Vulnerable Adults brochure has been revised to reflect recent legislative
changes and is being placed into the KEESM.
- The ES-3166,
Notification of PACE Information, has been developed to support communication of PACE
information. The form is used much like the current ES-3160 and ES-3161 forms to
communicate information between EES and the PACE provider. Copies of the form are to be
made locally.
APPENDIX
- With the changes to Section 2140, the Immigrant
Status/Program Qualification Chart, Item 1, has been
modified and expanded to include all appropriate documentation requirements for each
category of non-citizen eligibility. Non-citizen documentation information is no longer
contained in the body of the manual.
- With the annual adjustments to the Food Stamp Program's
maximum excess shelter deduction and gross and net income limits, the Food
Stamp Program Standards Chart, Item 49, and the Food
Stamp Program Benefit Tables Chart, Item 50,
have been revised effective October 1, 2002. These adjustments will be implemented to
ongoing FS cases via mass change with rollover that occurs in August 2002 effective for
October 1, 2002. All affected households will be notified via a mass change notice.
- Item 84, Medically Necessary
Items Which Are Allowable Deductions for Food Stamps or Can be Applied Toward a Spenddown,
has been revised to provide that medical ID bracelets and necklaces are not allowable
expenses for food stamp purposes. However, another provision has been added to provide
that for food stamps, a pager medically necessary for a person awaiting an organ
transplant is an allowable expense for food stamps. These are federally mandated changes.
The item has been clarified to include motorized wheelchairs or
scooters as allowable items if used in lieu of a standard chair. It has also been modified
to allow some home health services, including non-medical attendant costs, for persons on
an HCBS or PACE waiting list. The need for these services must be substantiated through an
ADL/IADL on the screening assessment.
- Item
96 - Adding TANF Months from Other States, 10-02, was modified to reflect a change
in the e-mail address. Prior versions of this form have been removed from the electronic
version of the KEESM as they contained an incorrect fax number and the now incorrect
e-mail address.
EFFECT ON LOCAL STAFF
Most of the mandated Food Stamp Program changes contained
in this manual revision will have a minimal impact on staff as they have been incorporated
into the KAECSES system and will require no manual procedures. The change in the treatment
of income for persons penalized for an FS or TAF comparable work program failure from
disqualified to excluded, will have an impact initially as affected persons are converted
from one SEPA code to another for November 2002. Other FS policy changes and
clarifications will have a minimal impact on staff. The change to implement the new
Medicaid service, PACE, will only affect Sedgwick county and will have a minimal impact on
staff in that office.
COORDINATION EFFORTS
The material in this letter, manual revision and
accompanying Implementation Memos have been coordinated with staff in the Economic and
Employment Support Section, Children and Family Policy Section, Kansas Department on
Aging, Health Care Policy-Community Supports and Services, Medical Policy, Vocational
Rehabilitation Services, Office of Public Affairs, and EES Chiefs.
Sincerely,
Sandra C. Hazlett, Director
Economic and Employment Support
SCH:MW:jmm
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