| State of Kansas Department of Social
and Rehabilitation Services
Gary Daniels, Acting Secretary
Integrated Service Delivery - Candy Shively,
Deputy Secretary (785) 296-3271
Economic and Employment Support - Bobbi Mariani, Director
(785) 296-3349
MEMORANDUM
This memo provides implementation
instructions and information for the following January 1, 2005
KEESM changes:
• Adding New Household Member to a Pending Application -
KEESM 7401 (1)
•
Potential Employment - KEESM 3540
•
KLS Referrals - KEESM 1724 and 2315
•
Kansas Early Head Start and SRS Child Care Subsidy - KEESM
10021.1 (8) and 1114
•
Food Stamp Work Related Exemptions - KEESM 3230
•
Working Healthy - Medically Improved Group - KEESM 2665
•
Out of Home Relative Provider Rate Reduction - KEESM 10240
•
215 Hour Cap on Out of Home Relative Provider Child Care
Plans - KEESM 7600
•
Child Care Provider Purchasing Violation Option - KEESM 10037
•
In-Home Child Care Provider Case Files - KEESM 10036.4
- MULTIPLE PROGRAMS
Adding New Household Member to a Pending Application
-[See Summary of Changes, Item 1, B. (2) and KEESM
Section 7401(1)] Assistance
for the new household member is prorated from the date of application
when the new person enters a cash or food stamp household after
the application has been filed but during the month of application
and prior to case approval. If the new household member enters
a cash or food stamp household in the month following the month
of application, but prior to approval, assistance for the new
household member is effective the first day of the month the
person entered the home. The clarification will be incorporated
into the May KEESM revision.
Examples:
- Rosa applies for TAF and food stamps on
January 20, 2005. On February 4, Rosa reports
that another child, Sara, returned to
live with Rosa on February 2. Sara had
been living with her father. The application
is approved on February 11. Assistance is
prorated
for all household members except Sara
from January 20. Sara is added effective February
1, 2005.
- Fred, Ginger and their two children apply for
TAF and FS on January 4, 2005. On January
15, Ginger has a new baby and reports this
on January 17. The application is processed
and approved on January 24. All five individuals
have both TAF and FS assistance prorated from
January 4, the date of application.
- Sally applies for TAF and FS on January 20,
2005. On February 8, Sally reports that she
gave birth to twins on February 7. The application
is processed and approved on February 10.
TAF and FS are approved for just Sally effective
January 20. The twins needs are added to both
TAF and FS effective February 1, 2005.
- Ellen applies for TAF and food stamps on January
25, 2005. On February 10, Ellen reports that
her husband, Joe, returned to the home on
February 2. Joe had earnings during January
but lost his job and will not receive any
earned income during February. The application
is processed on February 14. Assistance is
prorated for all household members except
Joe from January 25. Joe is not considered
a household member in January and his income
is not counted. Joe is added to the assistance
plan effective February 1, 2005.
- Same situation as #4 except the application
is processed on March 4. The case action is
the same. Assistance is prorated for all household
members except Joe from January 25. Joe is
not considered a household member in January
and his income is not counted. Joe is added
to the assistance plan effective February
1, 2005.
- Ellen applies for TAF and food stamps on January
25, 2005. The application is processed on
February 14. On February 18, Ellen reports
that her husband, Joe, returned to the home
on February 16. Joe had earnings during January
but lost his job and will not receive any
earned income during February. Joe is added
to the assistance plan in March, the month
after the change is reported.
Potential Employment - [See Purpose, Background and
Reason for Change, third paragraph, last sentence and
KEESM Section 3540.] Please note that an individual item for this change was inadvertently
omitted from the Multiple Programs, Changes, section of the Summary
of Change. This change applies to both food and cash assistance.
This revision changes the potential employment provisions to
state that the potential employment penalty for reducing hours
of employment shall only be applied if the person voluntarily
reduces hours of employment from 30 or more per week to less
than 30 hours per week AND reduces monthly gross earnings to
less than 30 hours a week multiplied by the federal minimum wage
(currently $5.15 per hour). For example, under the new policy,
a person who without good cause, reduces hours of employment
from 40 hours a week to 25, but is paid $8 per hour would not
be penalized for reducing hours of employment. This new policy
applies to voluntary reductions in hours (without good cause)
being evaluated for a penalty or denial of assistance on or after
1/1/05.
- CASH ASSISTANCE
KLS Referrals - [See Summary of Changes, Item
III. A. 1 and KEESM Sections 1724 and 2315] GA applicants are to be referred to KLS
for services immediately upon application. This referral will
occur prior to approval of the application and prior to receipt
of the 3151 in most instances. The purpose of this policy change
is to allow for the earliest possible involvement of KLS in the
Social Security Disability process. KLS will be responsible for
making contact with Social Security on behalf of the consumer
and will be responsible for scheduling the initial interview.
- CHILD CARE ASSISTANCE
Kansas Early Head Start - [See
Summary of Changes, Item IV. A. 3 and KEESM
Sections 7600
- 7620]This
revision change makes it possible for Kansas
Early Head Start (KEHS) families
to access child care assistance for a limited
time and under specific criteria.
It is important for KEHS and SRS staff to use the
SRS Turnaround Communication Referral Form,
Appendix, Item #C-20 when families
enter and exit child care assistance. Usual application
processing policies and procedures will apply
to
the KEHS families taking
this option. The only exception is that plans should
not be set up for more than 10 months if the
family is found eligible. Staff
will be aware of these families through the Turnaround
form presented by the family with the application.
A new Reason for Child Care
code is being added to KsCares to help with tracking
at the Central Office level. The new code
is EH for Early Head Start. The EH
reason code should be used on CHCP when plans are
authorized. If staff have additional questions
as this option is
utilized, they should be directed to Mary
Weathers, Kansas Early Head Start
Program Manager.
215 Hour Cap on Out of Home Relative Provider
Child Care Plans - [See Summary of Changes,
Item IV. A. 3 and KEESM 7600] This
revision implements a cap on the number of hours of
care SRS will purchase per child from an Out
of Home Relative provider.
Child care plans (and payments) should not exceed 215
hours per month per child. There will not
be an edit added to KsCares to
specifically address this policy change for Out of Home
Relative providers. Only the existing 215
hour edit will be in place.
A printout will be made available to workers which will
indicate any plans with Out of Home Relative
providers that exceed 215
hours. These plans will need to be adjusted according
to the new policy. While doing the fiscal
analysis of this change, it
was found that only about 5% of Out of Home Relative
provider plans statewide have scheduled hours
over 215. The work involved
in adjusting plan hours according to this change should
be minimal. Providers and clients should be
notified of child care plan changes
through use of the C401 Change Notice on KsCares. An
example is attached to this memo. Child care
plan hours will need to
be adjusted and updated on CHCP (Pf12 to update) at
the same time the C401 is sent. The new plans
(Pf5 to print) will then
need to be sent to the client and provider. This shall
be done by 1/19/05 (adverse action deadline)
for plans beginning 2/1/05.
Staff are reminded that Policy Memo 04-03-02 Child Care
Plan Authorization - Sleep Time for Children
remains in effect.
Out of Home Relative Provider Rate Reduction
- [See Summary of Changes, Item V. A. 1 and
KEESM 10240] Processing will begin
January 3, 2005 to implement a rate reduction for Out
of Home Relative child care providers. Notifications
will begin January
3, 2005, with the new rate effective for the service
month of February 2005 which is paid in March
2005. All payments for the
February 2005 service month (paid in March) will reflect
the lower rate.
Staff are reminded of KsCares system changes made with the October
2004 revision. One of these changes was separating Out of Home
Relative provider rates from Registered provider rates on KsCares.
Since no rate change for Out of Home Relative providers was implemented
with the October 2004 system changes, many staff may not have
noticed the changes. These changes could be seen on the PRRA
(Provider Rate) screen on KsCares. With the January 2005 revision,
SRS will be utilizing these system modifications and implementing
a rate reduction for Out of Home Relative child care providers.
This rate change will NOT be like the In-Home rate changes that
were implemented in October 2004. With the In-Home rate change,
KsCares programming was completely changed. There were tables
added to KsCares and the way the system paid for In-Home care
was completely different. The In-Home transition resulted in
all payments keyed after the system migration was completed being
impacted (prior months included). This will NOT occur with the
Out of Home Relative rate change being implemented with the January
2005 revision. The Out of Home Relative provider rate change
will look similar to past provider rate adjustments. The KsCares
programming logic will be the same and the rate tables adjusted
by Central Office staff will have effective dates. Essentially,
once these tables are changed, the system will know what rate
to pay for which service month.
Staff should refer to the updated SRS Provider Rate Schedule
to see the new rates. As seen on the schedule, counties
remain grouped
according to current SRS county clusters. This new Out
of Home Relative provider rate represents 65% of the
Registered provider
rate for that county grouping. This is in keeping with
the approach taken by other states in regard to payment
for this type of care.
This new rate should be considered a standard rate to
be paid to any Out of Home Relative provider. There
is no need to process
the private pay rates indicated by the relative on the
ES-1653. The new Out of Home Relative rates should
be filled in by SRS
staff on the ES-1653 in the SRS rate section. This section
tells the provider what rate they will be receiving.
There is no need
for staff to enter these state rates for relatives on
PRRA after implementation of this change. By leaving
these fields blank,
the system will always pay the state rate that is indicated
on the rate table maintained by Central Office. Staff
will not need
to blank out existing rates on PRRA for existing Out
of Home Relative providers. Preliminary analysis indicates
that there
are only 3 relative providers statewide with a rate
on PRRA lower than the new standard rate. These particular
relative provider
rates will be blanked out by Central Office staff so
the provider receives the new standard rate. This will
mean that these few
providers will see a rate increase. Local staff will
be notified when this is done. The reason why existing
rates on PRRA do not
need to be blanked out across the board on PRRA is because
KsCares pays the rate on the table (controlled by Central
Office) or
the rate on PRRA, whichever is lower. If a provider’s rate
on PRRA is higher than the new rate, the system will pay the
new rate on the table. Since Out of Home Relative providers turn
over fairly quickly, open providers with rates entered on PRRA
will eventually phase out naturally. It is suggested that provider
enrollment staff cross out the section on the ES-1653 which asks
for the provider’s rate and fill in the SRS rate prior
to sending the document to the provider. This may save
time in processing the ES-1653. The ES-1653, as well as
all other provider
enrollment forms, will be revised prior to EBT CC implementation.
Drafts will come out shortly after the first of the
year.
Workers will not need to update child care plans (CHCP) in the
system in order for the new rate to be paid. Correct rates will
be paid in accordance with the table changes that will be made
on KsCares. (CHCP will need to be updated if the worker is reducing
the plan hours to 215 however. This is discussed further in another
section of this memo.) Current child care plans will automatically
begin using the new rates when payment is made on REPC for the
Payment Month of February 2005 (paid in March). Whenever new
plans are created, they will use the new rates for that provider.
Staff are reminded that wording on the child care plan indicates
that rates may change due to changes in SRS maximum reimbursement
rates. Out of Home Relative providers will also be notified of
the rate change separately as listed in the next paragraph.
A Provider Notice will be available on KsCares. The notice will
be P001 SRS Child Care Provider Rate Adjustment. This notice
should be sent by local staff to all active Out of Home Relative
providers by 1/19/05 (adverse action deadline). This will provide
adequate and timely notice of rate reduction for service month
of February 2005 (paid in March). Reports are available from
Central Office to assist with this task.
If a provider or client wishes to Appeal this rate reduction they
may do so. Normal procedures for processing Appeal requests and/or
requesting dismissal should be used. See KEESM 10514 or 1615.
Out of Home Relative providers should be informed that
becoming a Registered provider through the Health Department
is an option.
If an Out of Home Relative provider becomes Registered,
they would be eligible for the Registered provider
rate. Registered
providers are also eligible to participate in the Child
and Adult Care Food Program (CACFP) administered by
the Department of Education.
CACFP can provide reimbursement for food served to children
in care and CACFP staff also provide nutrition education
to the
provider. As a Registered provider, the relative would
still have control over who and how many children they "enroll".
Essentially, becoming Registered does not obligate the
provider to serve additional children.
Child Care Provider Purchasing Violation
Option - [See Summary of Changes, Item V. A. 4
and KEESM 10037]Child care provider
monitoring staff have expressed the desire to be able
to address purchasing violations with more flexibility.
An example is a
provider who is over capacity with KDHE. Staff would
like to address this issue without having to terminate
the provider completely.
This revision will allow staff the option to prevent
new child care plans from being written with a
particular provider without
having to disrupt current families with provider termination.
Staff will be able to write Corrective Action plans
with providers. New plans can prevented by putting
an "N" in the CC
Plan field on PRRA.
In-Home Child Care Provider Case Files
- [See Summary of Changes, Item V. A. 3 and KEESM
10036.4] If
not already in place, Regions should begin making
specific In-Home Child Care Provider files
maintained by provider enrollment monitoring staff.
It has been indicated that in some Regions, workers
maintain all of this
information in the client’s case file. With the pending
implementation of EBT CC, it will be necessary for local
staff to put the actual In-Home provider on the KsCares
system (now
the client is put on KsCares). It is the provider, not
the client, who will be sent to eFunds for enrollment
under EBT. It will
be the provider, not the client, who will need to be
able to receive payments through direct deposit into
a bank account.
Maintaining In-Home provider files centrally will help
when this transition comes.
-
FOOD ASSISTANCE
Food Stamp Work Related Exemptions - [See
Summary of Changes, item VI, A. (2) and KEESM
Section 3230] With this change in
policy, one work related exemption is being
modified and four new work
related exemptions are applicable to the Food Stamp
Program.
The exemption regarding employment is being modified to state that
a person employed or self employed and working a minimum of 30
hours weekly OR receiving weekly earnings at least equal to the
federal minimum wage multiplied by 30 hours is exempt. For example,
effective 1/1/05, a person working 20 hours a week and earning
$10 per hour is exempt from food stamp work related requirements.
In another example, a person who is self-employed and who works
30 hours a week, would also be exempt from food stamp work requirements.
(Use prudent person in making the decision whether a self-employed
person is exempt from work requirements or not.) When determining
if the amount of self-employment is equal to or more than 30
hours a week times minimum wage, consider the adjusted gross
self-employment income (after income producing costs or flat
25% deduction).
JOPR reason code is EM.
In regard to the four new exemptions, the following are suggested
guidelines for determining if the person is exempt from work
related requirements. The appropriate JOPR exemption code is
also listed below.
- A person subject to and complying with
TANF work requirements - This includes persons
receiving
TANF
cash assistance and cooperating
with TANF work requirements.
JOPR reason code is PA.
NOTE: Although exempt from FS work requirements, the comparable
treatment of disqualification policies of 2550 still apply.
NOTE: The PA reason code should only be used if it is the only
applicable exemption reason code for a TAF/FS recipient. For
example, if the TAF/FS person has a child under 6, the reason
code of CU-EX should be used instead of PA-EX.
- A person receiving unemployment
compensation - This
includes a person who
is receiving unemployment compensation, or
who
has
been approved for unemployment compensation,
but has not
yet received
the first benefit.
JOPR reason
code is UC.
- A regular participant in a drug addiction
or alcoholic treatment and rehabilitation
program -This includes all outpatient
drug or alcoholic treatment; cooperation with RADAC; and
cooperation with an individual drug or alcoholic
treatment plan. Some documentation
of participation in the program is required.
JOPR reason code
is AD.
- A student enrolled at least half-time
in any recognized school, training program
or institution of higher education -
This included on-line, virtual schools (half-time enrollment
as verified by the school). Documentation is required.
JOPR reason code is ST.
These new work related exemptions shall be applied to all applications
received or processed on or after January 1, 2005. For on-going
cases, any persons who are currently mandatory, but who should
be exempt under the new definitions, shall be converted to exempt
as identified, but no later than the time of the next review
or IR, whichever comes first.
NOTE: Until the KAECSES code cards are revised the above reason
codes need to be added to the JOPR code card, page 6, under Reason
Code as follows:
AD Alcohol/Drug Treatment (FS only)
PA Subject to and complying with TANF (FS only)
ST Student at least ½ time (FS only)
UC Receiving UC (FS only)
- MEDICAL ASSISTANCE
Working Healthy-Medically Improved Group - [See
Summary of Changes, Item VIII. A. 3 and KEESM
Sections 2664.2 and 2665] Coverage
under this new eligibility group will be effective Feb 1, 2005.
The Medically Improved group is an extension of the current Working
Healthy program. Persons covered are those who were covered under
the current Working Healthy group but lost eligibility due to
a medical improvement which resulted in a loss in disability
status with SSA.
Working Healthy Case Closure - The eligibility worker is responsible
for notifying the Benefits Specialist upon closure of all Working
Healthy cases. When the worker suspects a case has been closed
because of medical improvement, a special note shall be made
on the referral. Suspect cases can be identified by information
on EATSS and should be noted on the referral. When Social Security
terminates benefits for an individual a BENDEX or SDX record
will be generated. The change in payment status will prompt a
change alert to the eligibility worker. For terminations based
on medical improvement one of the following codes will be reflected:
- For SSI, a payment status of N07
- For Title II/SSDI, a payment status
code of T8
However, the presence of these codes do not always indicate a medical
improvement was the basis for closure. Social Security must must
verify the closure was based on medical improvement as complete
information is not available on EATSS. The eligibility worker
will identify suspect cases but the Benefits Specialist will
actually contact SSA and confirm the closure reason. The Benefits
Specialist will contact the beneficiary and discuss other options
as well, including appealing the termination with Social Security.
As with all medical assistance cases based on disability, if
the individual appeals the Social Security decision within 60
days of action, Medicaid coverage continues as long as the appeal
remains active. The Benefits Specialist will work through these
issues with the beneficiary and will provide the eligibility
worker with Social Security status information.
NOTE: In some cases persons may have been covered under another
category, but otherwise meet Working Healthy criteria (e.g.,
SI under 1619b). When a suspected termination for medical improvement
occurs for these individuals, the case is to be staffed with
the Benefits Specialist. In some cases, administrative action
to move the individual to the Working Healthy group for the sole
purpose of establishing coverage under the Medically Improved
group may be acceptable
Approval Process - If the individual does not exercise SSA appeal
rights or has exhausted them, he may elect to move to the Medically
Improved group. The individual must meet all criteria of the
Working Healthy program, with the exception of disability criteria.
In addition, persons must be employed a minimum of 40 hours per
month earning at least minimum wage. The individual must also
continue to have a documented severe impairment. A new application
is required prior to approving Medically Improved coverage.
Although all individuals must have previously enrolled in the Working
Healthy group, Medically Improved coverage may be established
following a break in such coverage. For example, Working Healthy
closed 05-04 due to a loss in disability status. The Benefits
Specialist confirms a medical improvement. Coverage under the
new group may be established effective 02-01-05 if all eligibility
criteria continue to be met.
All verification requirements of the Working Healthy
program apply to the Medically Improved group. In addition,
the employment
criteria of 40 hours a week at minimum wage level must
also be verified prior to approval.
Medically Improved cases are established on the MS program in
KAECSES and are specifically denoted by using a PICK code of
WM. The WH program subtype must also be used. Premiums are required
at the same level as Working Healthy. An individual may enter
into a repayment agreement as outlined in KEESM 2664.5 if necessary.
Ongoing Coverage - Changes are managed as in the current Working
Healthy program. A desk review shall be completed every 6 months
as with Working Healthy. Premiums are to be adjusted at this
time. A full redetermination is required annually. Verification
that the individual meets the 40 hour per month employment criteria
is required for both full reviews and 6 month desk reviews.
Medically Determinable Severe Impairment - The
individual must continue to have a documented medically
determinable severe impairment.
This must be documented annually, at the time of the
redetermination. The Benefits Specialist is responsible
for this determination.
At the same time the annual review is sent to the beneficiary,
a request shall be made to the Benefits Specialist for
impairment status. The Benefits Specialist will then
generate a request
for a medical statement to determine the status of the
condition. The form, The Statement Of Continuing Eligibility,
is attached.
The form must be completed by a medical professional
familiar with the beneficiary’s condition. Other
documentation may be requested if necessary. The level
of impairment shall be reported
to the eligibility worker, prior to completion of the
review. Completed forms and other verification used
to establish the
level of impairment shall be retained in the eligibility
case file. If it is established the individual no longer
has such
an impairment, coverage shall be terminated.
Notices - Several new notices have been developed to support the
new program.
N119 - WH - Medically Improved Approval - No Premium
N120 - WH - Medically Improved Approval - With Premium
N145 - WH - Medically Improved Review - No Premium
N146 - WH - Medically Improved Review - With Premium
N426 - WH - Medically Improved Closure - Other Reasons
BM:PG:jmm
Attachments - Statement
Of Continuing Eligibility
C401
Change Notice
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