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EES Program Administrators
All Assistant Regional Directors


March 31, 2008


Tim T Schroeder, E & D Medical Eligibility Policy Manager


Implementation Instructions for the HCBS PRTF-CBA Waiver

This memo provides implementation instructions and information for the new Home and Community Based Services (HCBS) Psychiatric Residential Treatment Facility – Community Based Alternative (PRTF-CBA) Waiver.  The PRTF-CBA (HCBS/PR) Waiver is being implemented effective April 1, 2008.

  1. Background – More than 2,400 children and adolescents were served through the level of
    care provided in a PRTF for the most recent fiscal year.  Available data indicated that only
    one in three of these individuals had access to mental health services prior to admission. 
    These children and adolescents may have potentially avoided a more restrictive setting if they had the opportunity to access mental health services in their community.

    In December 2006, the Centers for Medicare & Medicaid Services (CMS) awarded the
    Kansas Department of Social and Rehabilitation Services (SRS) a five year demonstration grant to allow the state to use Medicaid funds to provide home and community based services (HCBS) to children and adolescents as an alternative to serving those individuals in a PRTF.  The goal of the waiver is to divert children and adolescents at risk of placement in a PRTF and to transition those individuals currently residing in a PRTF back into the community.

    It is anticipated that the total number of individuals served under this waiver will be
              Year 1  -     189
              Year 2  -     523
              Year 3  -     662
              Year 4  -     840
              Year 5  -  1,067

  2. Target Population – The PRTF-CBA Waiver will serve children and adolescents meeting the following criteria:

    1. Diagnosis – The individual must have a diagnosis of mental disorder and be determined by a Qualified Mental Health Professional to have a serious emotional disturbance. Those served by this waiver will generally not meet the more restrictive clinical eligibility criteria of the Severe Emotional Disturbance (SED) Waiver.

    2. Age – The individual must be between the ages of 4 and 18 years old. An exception may be requested for a child under the age of 4 experiencing a serious emotional disturbance who demonstrates a substantial need for services. Individuals over 18 may also remain on or become eligible for the waiver through age 21 provided they have received specialized community based services any time in the 6 months prior to turning 18. It is the responsibility of the HCBS case manager to make this determination.

    3. Institutionalization – The individual must be determined as likely to need placement in a PRTF in the absence of waiver services. Those served by this waiver will not need the level of care provided in a state psychiatric hospital but will have chronic mental health or behavior issues that require treatment in a residential setting.

  3. Eligibility Process – The eligibility process in the new PRTF-CBA waiver is very similar to
          the process in the existing waivers.

    1. Referral – An individual seeking services under the waiver must have a referral sent
      from the Community Mental Health Center (CMHC) to the HCBS Program Manager at SRS/Mental Health. The referral process may be initiated by the individual’s family, the service provider or the local SRS office by contacting the CMHC.

    2. Assessment – The individual must have a mental health diagnosis and be determined to be experiencing severe emotional disturbance. This clinical eligibility will be established via the Certification of Need process. Kansas Health Solutions, the Medicaid managed care organization for mental health services, will review and authorize plans of care for each individual accessing services under the waiver.

      Once the individual has been determined clinically eligible, the family will be given a
      choice between placement in a PRTF or community based services. The choice date is the effective date of services for this waiver.

    3. Financial – Financial eligibility for the individual shall be based on the individual’s
      own income and resources and shall follow the HCBS budgeting methodology. It is
      possible that the individual may have a monthly client obligation if countable income
      exceeds the protected income limit. The client obligation is entered on the LOTC screen.
    4. LOTC Coding – The Living Arrangement (LA) and Level of Care (LOC) coding for the PRTF-CBA Waiver is HC/PR. As mentioned previously, the payment effective date for this waiver is the choice date. The LA/LOC and client obligation along with the effective date shall be entered on the LOTC screen.

    5. Communication – All communication between the HCBS Case Manager and the EES Eligibility Worker will be via the existing ES-3160/ES-3161 forms. The forms should be sent by fax to expedite delivery.

Should you have any questions about this memo or the PRTF-CBA waiver, please contact Tim Schroeder at (785) 296-1144 or