HCBS Waiver Considerations

Outside the Age Limits for the Requested Waiver

Individuals outside the age limits for a requested HCBS waiver cannot be considered for services, unless the HCBS waiver allows for an age exception AND the worker has received Waiver Manager approval.

NOTE: For the PD Waiver, workers do not need to complete the below process and can authorize HCBS services as normal.

Process for Authorizing Waivers Outside the Age Limits

This process assumes workers have received Waiver Manager approval and are ready to run EDBC to authorize the HCBS waiver for an individual outside the age limits prior to completing the steps below.

1. On the LTC Data Detail page change the HCBS Waiver type to TA then click the Save and Return button.

2. Run EDBC for the appropriate benefit month.

3. On the EDBC List page, select the Medical hyperlink.

4. On the Medical EDBC Summary page select the Override Medical Summary button at the bottom right corner.

5. On the Medical EDBC Override List page, select the Override button for the Medically Needy or SSI Test Category.

6. On the Medical EDBC Override Detail page, select the Edit button in the LTC Details block.

7. On the Medical EDBC LTC Override Detail page, select SE or AU from the Level of Care drop-down menu.

8. Click the Save and Return button.

9. On the Medical EDBC Override Detail page enter the Start Date as the first day of the EDBC benefit month.

10. Enter an End Date as the last day of the EDBC Benefit Month.

11. Click the Save and Return button.

NOTE: Although the LTC Details were updated, the original LTC Details will display on the Medical Override EDBC List page.

12. On the Medical EDBC Override List page, select the EDBC Override Reason of Administrative Decision. Click the check box next to the overridden budget. Then click the Save and Return button.

13. On the Medical EDBC Summary page the updated information shows in the Eligible Budgets. Click the Accept button if the result is correct.

14. On the EDBC List page select the Save and Continue button.

15. If necessary, repeat these steps through the come-up month.

16. Return to the LTC Data Detail page and set the Waiver Type back to SED or AU.

17. Send Notices and HCBS forms (ES-3160/ES-3161) as appropriate. See Manual NOA Generation for detailed steps on sending the notifications.

18. Create a Journal entry documenting the changes. Include that the steps in the KEES User Manual were followed to authorize the SED or AU waiver per valid exception.