Since medical continues when a child moves from HCBS to foster care or adoption assistance, the user needs to add a Requested Medical Type of PPS beginning the first of the month following the month HCBS ends.
Access the case through Person Search or enter the Case Number in the quick search field from Task Navigation and click Go. The Case Summary page displays.
Select Eligibility from Global Navigation. The Case Summary page displays.
Click the View Details button in the Medical Programs block. The Medical Program Detail page displays.
Click the Edit button. The Medical Program Detail page redisplays with edit capabilities.
Click the Edit button in the Program Persons section. The Medical Person Detail page displays.
Click the Add button in the Requested Medical Type section. The Requested Medical Type Detail page displays.
Select PPS from the Requested Medical Type drop-down menu.
Enter the month following the month HCBS ends in the Begin Month field using the <mm/yyyy> format or the calendar icon.
Click the Save and Return button. The Medical Person Detail page displays.
Click the Save and Return button. The Medical Program Detail page displays.
Click the Save and Return button. The Case Summary page displays.
Select Customer Information from Local Navigation. The Contact Summary page displays. Select LTC Data from Task Navigation. The LTC Data List page displays.
Click the Edit button for the HCBS record that is ending. The LTC Data Detail page displays.
Enter the date following HCBS Ends Effective on the ES-3161 in the Termination Effective Date field using the <mm/dd/yyyy> format or the calendar icon.
Click the Save and Return button. The LTC Data List displays.
Select Run EDBC from Task Navigation. The Run EDBC page displays.
Select the month HCBS ends from the Benefit Month drop-down menu. Then click the Select button.
Select the check box for the Medical program. If the month is prior to the come-up month:
Select Yes from the Timely Notice Exception drop-down menu.
Select LTC Late Change from the Reason drop-down menu.
Click the Run EDBC button. The EDBC List page displays with Status of ‘Not Accepted’.
Click the Medical hyperlink for the benefit month and Review the Eligible Budgets section:
Test: Foster Care Medical/Adoption Support Medical
Results: Pass
FPL %: 0%
Premium/LTC Liability/Spenddown: $0.00
Aid Code: FCM/XX/N/N or ASM/CH/N/N
LTC Detail: HC/HC/waiver type
Members Tested: child’s name
Role: Mem
Click the Medical hyperlink located in the Medical Summary block. The Requested Medicaid EDBC – Medical page displays. Review the LTC Details block to verify the Start Date and End Date are correct.
Name: Child’s name
Type: HC
Living Arrangement: HC
Waiver: Waiver type
Start Date: First day of the month or the date chosen to start HCBS services
End Date: HCBS termination date
If the information is correct, click the Close button and continue to STEP 22.
If the information is incorrect, click the Close button. Click Cancel on the EDBC Summary page and correct the LTC Data Detail page.
Click the Accept button if the EDBC results are correct. The EDBC List page displays with a Run Status of ‘Accepted-Not Saved’.
Click the Save and Continue button. The Distributed Documents page displays with the Notice of Action (NOA) generated.
Select the check box for the NOA. Click the Delete button. The NOA is removed from the Distributed Documents page.
Update the appropriate form and forward to the Managed Care Provider (MCO) per PPS Policy. See Forms for more information.
NOTE: HCBS forms are not in KEES. Once the form is produced off system, it will need to be imaged to the appropriate case in KEES. See Imaging for more information.
Select Journal from Utility Navigation. Record all actions taken on the case. See Journal for more information about journaling functionality.