PPS Medical to HCBS

The following steps are required to establish HCBS for a child receiving foster care medical.

Complete the following

1. 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.

2. Click the View Details button in the Medical Programs block.  The Medical Program Detail page displays.

3. Click the Edit button.  The Medical Program Detail page redisplays with edit capabilities.

4. Click the Edit button in the Program Persons section.  The Medical Person Detail page displays.

5. Click the Add button in the Requested Medical Type section.  The Requested Medical Type Detail page displays.

6. Select LTC from the Requested Medical Type drop-down menu.

7. Enter the Begin Month for HCBS using the <mm/yyyy> format or calendar icon.

   NOTE:  LTC must be the Requested Medical Type (RMT) for the entire month in which services are provided.

8. Click the Save and Return button.  The Medical Person Detail page displays.

9. Click the Save and Return button.  The Medical Program Detail page displays.

10. Click the Save and Return button.  The Case Summary page displays.

11. Select Eligibility from Global Navigation. Select Customer Information from Local Navigation.  Select LTC Data from Task Navigation. The LTC Data List page displays.

12. Click the Add button.  The LTC Data Detail page displays.

13. Select the child’s Name from the drop-down menu.

14. Select HCBS from the LTC Type drop-down menu.

15. Enter the date the information is being entered for the Recorded Date using the <mm/dd/yyyy> format or calendar icon.

16. Click the Select button under Agency in the HCBS Information section.  The Select Provider Resource page displays.

17. Enter the Name of the MCO, select Active from the Status drop-down, and click the Search button.  The Select Provider Resource results page displays.

    NOTE: A misspelled name may incorrectly limit results.

18. Click the radio button of the desired MCO provider.

    NOTE: If the resource Name is not found on the first search, try entering a portion of the resource name to search again.  If the resource Name is still not found or needs to be updated, see Requesting an Addition or Change to the Resource Databank.

19. Click the Select button.  The LTC Data Detail page displays with Agency information populated.

20. Complete the required fields using Form ES-3160 Notification of Medical/HCBS Services Referral/Initial Eligibility/Assessment/Services Information.

21. Click the Save and Return button. The LTC Data List page displays.

22. Select Run EDBC from Task Navigation.  The Run EDBC page displays.

23. Select the month HCBS begins from the Benefit Month drop-down menu. Then click the Select button.

24. Select the check box to the left of Medical program. If the Benefit Month precedes the come-up month

    • Select Yes from the Timely Notice Exception drop-down menu

    • Select LTC Late Change from the Reason drop-down menu

25. Click the Run EDBC button.  The EDBC List page displays with Run Status of Not Accepted.

26. Click the Medical hyperlink for the benefit month run.  The Medical EDBC Summary page displays.  

27. Review the information in the Eligible Budgets section for accuracy:

    • Test: Foster Care Medical/Adoption Assistance Medical

    • Result: Pass

    • FPL%: 0%

    • Premium/LTC/Liability Spenddown: $0.00

    • Aid Code = FCM/XX/N/N or ASM/HC/N/N

    • LTC Details: HC/HC/SE (or the specific waiver chosen on the LTC Data Details page)

    • Members Tested: Child’s name

    • Role: MEM

28. Click the Foster Care Medical hyperlink located in the Medical Summary block. The Requested Medicaid EDBC – Foster Care 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: Date chosen to start HCBS

    • End Date: HCBS termination date or last date of the month

    • • If the information is correct, click the Close button and continue to STEP 29.

      • If the information is incorrect, click the Close button. Click Cancel on the EDBC Summary page and correct the LTC Data Detail page.

29. Click the Accept button if the EDBC results are correct. The EDBC List page displays with a Run Status of ‘Accepted-Not Saved’.

30. Click the Save and Continue button.  The Distributed Documents page displays with the Notice of Action (NOA) generated.

31. Select the check box for the NOA. Click the Delete button. The NOA is removed from the Distributed Documents page.

32. Update the appropriate form and forward to the HCBS provider.

    NOTE:  HCBS forms are not in KEES.  Once the form is produced off system, it needs to be imaged to the appropriate case in KEES.  See Imaging for more information.

33. Select Journal from Utility Navigation.  Record all actions taken on the case.  See Journal for more information about journaling functionality.