Enter the following information based on the ES-3160 or ES-3161.
1. Complete the HCBS Information section.
1. Click the Select button for the Agency. The Select Provider Resource page displays.
2. Enter the Provider ID for the appropriate MCO in the ID field. Use the following ID numbers when selecting a provider:
|
Provider |
ID Numbers |
|
Healthy Blue |
2316692 |
|
United Healthcare |
1066186 |
|
Sunflower Health Plan |
1066236 |
NOTE: If an MCO was not selected and the consumer was not able to be reached to select one, the system is to automatically select the MCO. Use Provider ID 1246712 HCBS MCO PLACEHOLDER in the data details record for the MCO Agency. This will cause the system to select the MCO automatically in MMIS within 24-48 hours. Return to the case after the selection has been made in MMIS and update the Provider ID from 1246712 HCBS MCO PLACEHOLDER to the one that is now displayed in MMIS.
3. Click the Search button.
4. Select the radio button next to the appropriate MCO.
5. Click the Select button. This will display the MCO on the LTC Data Detail page.
6. Choose the HCBS Waiver Type from the drop-down menu.
7. Select an option from the Waiver/LOC Threshold Met drop-down menu.
8. If the consumer is on a waiting list:
a. Select Yes from the Placed on Waiting List drop-down menu.
b. Enter the date they were placed on the waiting list
c. If they are not on a waiting list, leave these fields blank.
9. Select Yes in the Choose HCBS drop down menu,
10. Enter the Date they chose HCBS based on the ES-3160.
NOTE: For AU, BI, and TA waivers enter the effective date in the both the choice date and effective date fields.
11. Enter the Estimated Monthly Cost of Care.
a. If income is at or below 300% of the SSI one-person standard, enter $9,999.
b. If income is more than 300% of the SSI one-person standard, enter the Estimated Monthly Cost of Care from the ES-3160 or ES-3161.
12. Enter the Effective Date of HCBS Services.
13. If the consumer’s HCBS has ended, fill in the following fields. Otherwise, leave these blank.
a. If they are ending HCBS due to an institutional Care Stay enter the Nursing Facility Admission Date and Anticipated Length of Stay.
b. Select Yes in the HCBS Terminated drop-down menu.
c. Enter or select the Termination Effective Date.
d. Enter a short description for the Termination Reason.
3. If allocating income, click the Add button to complete the Dependents of LTC/Applicant/Member or Dependents of Spouse block. See Income Allocation for more information.
4. If appropriate, enter or edit the Temporary Care Admission section.
1. Click the Add button to create a new record if needed.
2. Enter or select the Temporary Care Admission Date.
3. If the Temp Stay has ended, enter or select the Temporary Care Discharge Date.
4. Click the Save and Return button.
5. If additional Temp Stays are needed, click the Add button additional times for each entry.