8200 - Home and Community-Based Services (HCBS)
This section sets forth the guidelines regarding persons who receive home care services through the State's approved home-and-community based services waivers. Such services may be provided in either a non-institutional (e.g., own home) or institutional (e.g., assisted living or residential health care facility) setting and may be either medical and/or non-medical in nature. Services are designed to provide eligible persons with the least intensive level of care which maintains or improves the overall physical or mental condition of customers who may otherwise be placed in a nursing facility, hospital, or intermediate care facility for the mentally retarded.
8200.1 General Requirements - To receive HCBS, individuals must be eligible for medical assistance. Categorical as well as financial and nonfinancial requirements must be met. Categories for individuals age 18 and under include SI, MS, and MA CM programs. For individuals age 19 and older, categories are limited to MA CM, SI and MS. HCBS is not available to persons covered under the Breast and Cervical Cancer group, Working Healthy or MediKan recipients. For persons between the ages of 19 and 65 a disability determination is required except for those ages 19-21 in the HCBS TA and SED waivers.
8200.2 HCBS Effective Date - The HCBS effective date establishes the date an individual is considered an HCBS recipient. A person is an HCBS recipient if he or she has been assessed, found in need of long term care services, chooses to receive HCBS services and those services are available, and services have been scheduled to begin.
For the FE, PD, MRDD, and SED waivers, the effective date is the date the client chooses HCBS if regular HCBS services are expected to begin by the following month. If services are expected to begin the second month following the month of choice or later, the date services actually begin is considered the HCBS effective date. For the TA and waiver, the effective date of the waiver is the assessment date. For the AU waiver, the effective date is the actual date eligibility staff take action to approve coverage. For the TBI waiver, the Program Manager in at KDADS will determine the effective date. For persons placed on a waiting list, HCBS is not effective until such time that funding becomes available to serve the individual on the waiver.
8200.3 HCBS Plan of Care/Cost of Care - Persons receiving HCBS must have an approved plan of care (POC). The POC outlines the services the individual will receive, the provider authorized to provide the services and the rate at which the services will be reimbursed. POC development and approval is the responsibility of the appropriate case manager along with KDOA (FE waiver) and HCP. The total cost of the approved plan is included on the POC. This cost, less any standard amount included for acute care costs, is the HCBS cost of care.
8200.4 Communication with HCBS Entity - As part of the HCBS service package, the organization responsible for the administration of HCBS services for the applicant/recipient shall provide a designated individual to coordinate such services. Communication between the HCBS entity and the eligibility worker is essential to ensure that services are properly coordinated.
All pertinent events which impact eligibility or the HCBS plan must be communicated to the partner entity. Examples of pertinent events include establishment of initial eligibility, case closure, changes in client obligation, changes in address or living arrangement, significant changes in the cost of the HCBS plan and death. These events shall be communicated timely using an appropriate method of communication as defined in this section. The ES-3160 and ES-3161 have been specifically designed as communication tools between staff. The method used for communicating, such as fax, regular mail or e-mail, is determined locally by agreement of both entities involved. If e-mail is used, the appropriate form must be e-mailed, a general email describing the change is not sufficient.
The ES-3160, Notification of Medicaid/HCBS Services Referral/Initial Eligibility/Assessment/ Services Information. The ES-3160 shall be completed for each individual initially requesting HCBS. The form may be initiated by either the HCBS entity or the eligibility worker as a referral for services. When a decision is made regarding the availability and eligibility for HCBS, the HCBS entity completes necessary information, including the estimated cost of care and information related to the effective date, and sends the form to the appropriate eligibility worker. The eligibility worker will report eligibility information, including the start date and client obligation, to the HCBS entity, where the original form is kept. For new approvals, this form must be used to inform the other entity of HCBS eligibility. The version of the ES-3160 maintained as a KAECSES notice may also be used for initial referrals.
The ES-3160, Notification of Medicaid/HCBS/Working Healthy Services. The ES-3161 may be used to communicate ongoing changes between the entities. For example, a change in a client obligation. As with the ES-3160, a change report can be initiated by either party and must be sent promptly. The version of the ES-3161 maintained as a KAECSES notice may also be used.