reglab/statecodes huggingface dataset:
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-20 - Retroactive rate, program, and policy changes and clarifications

Current through Register Vol. 43, No. 28, July 11, 2024
A claim shall not be deemed to be an unpaid claim if a
				retroactive rate, program, or policy change creates an unpaid balance on a
				claim that the managed care organization has previously paid.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-21 - Retroactive eligibility

Current through Register Vol. 43, No. 28, July 11, 2024
If a provider submits a request for payment to a managed care
				organization before the patient is determined by the state to be eligible for
				medicaid, then the request shall not be deemed a claim under the act until the
				date on which the managed care organization is notified by the state that the
				patient was medicaid-eligible on the date of service.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-65 - Filing limitations for medical claims

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each provider
			 shall submit all medical claims to the Kansas medical assistance program within
			 12 months from the date of service.
(b) Any provider may resubmit a denied claim
			 for payment to the Kansas medical assistance program if the resubmission meets
			 the following requirements:
(1) Is within 24
			 months from the date of service; and
(2) is in conformance with all billing
			 requirements of the medicaid/medikan program.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-78 - Scope of and reimbursement for home-and community-based services for persons with traumatic brain injury

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The
			 scope of allowable home- and community-based services (HCBS) for persons with
			 traumatic brain injury shall consist of those services authorized by the
			 applicable federally approved waiver to the Kansas medicaid state plan.
			 Recipients of services provided pursuant to this waiver shall be required to
			 show the capacity to make progress in their rehabilitation and independent
			 living skills.
(b) The need for
			 HCBS shall be determined by an individualized assessment of the prospective
			 recipient by a provider enrolled in the program. HCBS shall be provided only in
			 accordance with a plan of care written by a case manager.
(c) HCBS, which shall require prior
			 authorization by the Kansas medicaid HCBS program manager, may include one or
			 more of the following:
(1) Rehabilitation
			 therapies, which may consist of any of the following:
(A) Occupational therapy;
(B) physical therapy;
(C) speech-language therapy;
(D) cognitive rehabilitation; or
(E) behavioral therapy;
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-88 - Scope of physician services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Except as
			 specified in subsection (b), the program shall cover medically necessary
			 services recognized under Kansas law provided to program recipients by
			 physicians who are licensed to practice medicine and surgery in the
			 jurisdiction in which the service is provided.
(b) The following services shall be excluded
			 from coverage under the program:
(1) Visits.
			 The following types of visits shall be excluded:
(A) Office visits when the only service
			 provided is an injection or some other service for which a charge is not
			 usually made;
(B) psychotherapy
			 services when provided concurrently by the same provider with both targeted
			 case management services and partial hospitalization services;
(C) psychotherapy services exceeding an
			 average of 32 hours of individual therapy or 32 hours of group therapy or any
			 combination of these in a calendar year for each recipient, unless the
			 recipient is a Kan Be Healthy program participant and either of these
			 conditions is met:
(i) Psychotherapy services
			 do not exceed 40 hours in a calendar year for each Kan Be Healthy program
			 participant; or
(ii) psychotherapy
			 services are being rendered pursuant to a plan approved by the agency. The
			 provider of psychotherapy services shall obtain prior authorization for the
			 plan. The plan shall not exceed a two-year period and shall be subject to a
			 reimbursement limit established by the agency. Quarterly progress reports shall
			 be submitted to the division of medical programs;
(D) inpatient hospital visits in excess of
			 those allowable days for which the hospital is paid or would be paid if there
			 were no spend-down requirements; and
(E) nursing home visits in excess of one each
			 month, unless the service provider documents medical necessity.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-108 - Scope of services for durable medical equipment, medical supplies, orthotics, and prosthetics

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Selected
			 durable medical equipment (DME) shall be available to each beneficiary, with
			 the following limitations:
(1) The DME shall
			 be the most economical to meet the beneficiary's need.
(2) The least expensive and most appropriate
			 method of delivery shall be used. If round-trip delivery is over 100 miles,
			 prior authorization shall be required.
(3) Used equipment with a warranty specified
			 by the agency shall be used if available.
(4) Certain DME designated by the agency
			 shall be the property of the agency.
(5) Educational, environmental control, and
			 convenience items shall not be covered.
(6) DME shall be covered for only the
			 following types of beneficiaries:
(A)
			 Participants in the Kan Be Healthy program;
(B) beneficiaries who require the DME for
			 life support;
(C) beneficiaries
			 who require the DME for employment; and
(D) beneficiaries who would require more
			 expensive care if the DME was not provided.
(7) DME services provided for the parenteral
			 administration of total nutritional replacements and intravenous medication in
			 the beneficiary's home shall require the provision of services by a local home
			 health agency, physician, advanced registered nurse practitioner, physician
			 assistant, or pharmacist.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-118 - Scope of federally qualified health center services

Current through Register Vol. 43, No. 28, July 11, 2024
For purposes of this regulation, a federally qualified health
				center shall mean a community health center, federally qualified health center
				(FQHC) look-alike, or an urban Indian organization receiving funds under the
				Indian health care improvement act that is accepted by the centers for medicare
				and medicaid to furnish federally qualified health center services for
				participation under medicare and medicaid. An FQHC look-alike shall mean an
				organization that meets all of the eligibility requirements of an organization
				that receives a public health service (PHS) section 330 grant but does not
				receive grant funding.
(a) The
			 services provided by the following health care professionals shall be billable
			 as federally qualified health center services:
(1) Physician and physician assistant
			 pursuant to K.A.R. 129-5-88 ;
(2)
			 advanced registered nurse practitioner pursuant to K.A.R. 30-5-113 ;
(3) dentist and dental hygienist pursuant to
			 K.A.R. 30-5-100 ;
(4) licensed
			 mental health practitioner pursuant to K.A.R. 30-5-104 ;
(5) clinical social worker pursuant to K.A.R.
			 30-5-86 ;
(6) visiting nurse
			 pursuant to K.A.R. 30-5-89 ; and
(7) for kan be healthy nursing assessments
			 only, registered nurse pursuant to K.A.R. 30-5-87 .
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-118a - Reimbursement for federally qualified health center services

Current through Register Vol. 43, No. 28, July 11, 2024
Reimbursement shall not exceed the reasonable cost of federally
				qualified health center services and other ambulatory services covered under
				the Kansas medical assistance program. "Reasonable cost" shall consist of the
				necessary and proper cost incurred by the provider in furnishing covered
				services to program beneficiaries, subject to the cost principles and limits
				specified in
				K.A.R.
				129-5-118a(c)(1) and
				K.A.R.
				129-5-118b.
(a) Reimbursement method. An interim per
			 visit rate shall be paid to each federally qualified health center provider,
			 with a retroactive cost settlement for each facility fiscal year.
(1) Interim reimbursement rate. The source
			 and the method of determination of interim rate shall depend on whether the
			 federally qualified health center is a new en-rollee of the Kansas medical
			 assistance program or is a previously enrolled provider. Under special
			 circumstances, the interim rate may be negotiated between the agency and the
			 provider.
(A) Newly enrolled facility. If the
			 facility is an already-established federally qualified health center with an
			 available medicare cost report, an all-inclusive rate derived from the cost
			 report may be used for setting the initial medicaid interim payment rate. If
			 the facility is an already-established federally qualified health center
			 opening a new service location, then the rate from the already-established
			 federally qualified health center shall be used for the new service location.
			 If the facility converted from a rural health clinic to a federally qualified
			 health center, then the rate from the rural health clinic shall be used for the
			 new federally qualified health center. For all other circumstances, the initial
			 payment rate shall be based on the average of the current reimbursement rates
			 for previously enrolled federally qualified health center providers.
(B) Previously enrolled facility. After the
			 facility submits a federally qualified health center cost report, the agency
			 shall determine the maximum allowable medicaid rate per visit as specified in
			 subsection (c). If a significant change of scope of services or a significant
			 capital project has been implemented, the federally qualified health center
			 shall submit an interim cost report if the center wants a change to the
			 existing rate. The agency and the federally qualified health center shall use
			 the interim cost report to negotiate a new interim rate.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 5 - PROVIDER PARTICIPATION, SCOPE OF SERVICES, AND REIMBURSEMENTS FOR THE MEDICAID (MEDICAL ASSISTANCE) PROGRAM › Section 129-5-118b - Cost reimbursement principles for federally qualified health center services and other ambulatory services

Current through Register Vol. 43, No. 28, July 11, 2024
The medicare cost reimbursement principles contained in 42
				C.F.R. part 413, as revised on October 1, 2005 and hereby adopted by reference,
				and the cost principles, standards, and limits discussed in this regulation and
				in K.A.R.
				30-5-118a shall be applicable to the
				financial and statistical data reported by the federally qualified health
				center for the determination of reasonable cost of providing covered services.
(a) Nonreimbursable costs. Each cost
			 that is not related to patient care and is not necessary for the efficient
			 delivery of covered federally qualified health center services and other
			 ambulatory services shall be excluded from the medicaid rate determination. In
			 addition, the following expenses shall be considered nonreimbursable:
(1) Salaries and fees paid to nonworking
			 directors and officers;
(2)
			 uncollectible debts;
(3) donations
			 and contributions;
(4)
			 fund-raising expenses;
(5) taxes
			 including the following:
(A) Those from which
			 the provider is entitled to obtain exemption;
(B) those on property not used in providing
			 covered services; and
(C) those
			 levied against a patient and remitted by the provider;
(6) life insurance premiums for directors,
			 officers, and owners;
(7) the
			 imputed value of in-kind services rendered by nonpaid workers and volunteers;
(8) the cost of social, fraternal,
			 civic, and other organizations associated with activities unrelated to patient
			 care;
(9) all expenses related to
			 vending machines;
(10) board of
			 director costs;
(11) the cost of
			 advertising for promoting the services offered by the facility to attract more
			 patients;
(12) public relations
			 and public information expenses;
(13) penalties, fines, and late charges,
			 including interest paid on state and federal payroll taxes;
(14) the cost of items or services provided
			 only to non-Kansas medical assistance program patients and reimbursed by third
			 party payers;
(15) all expenses
			 associated with the ownership, lease, or charter of airplanes;
(16) bank overdraft charges and other
			 penalties;
(17) the cost
			 associated with group health education classes, activities, and mass
			 information programs including media productions, brochures, and other
			 publications;
(18) expense items
			 without indication of their nature or purpose including "other,"
			 "miscellaneous," and "consultation";
(19) non-arm's-length transactions;
(20) legal and other costs
			 associated with litigation between a provider and state or federal agencies,
			 unless litigation is decided in the provider's favor; and
(21) legal expenses not related to patient
			 care.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-30 - Implementation of provisions specific to the ACA

Current through Register Vol. 43, No. 28, July 11, 2024
The definitions in
				K.A.R.
				129-6-34 and the provisions of
				K.A.R.
				129-6-41,
				129-6-42,
				129-6-53,
				129-6-54,
				129-6-103,
				129-6-106(e),
				129-6-110(a) and
				(b),
				129-6-111(a) and
				(b),
				129-6-112, and
				129-6-113 shall apply to all
				eligibility determinations completed on and after November 1,
				2013.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-35 - Application process

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
(1) An
			 application for medical assistance shall be submitted by an applicant, an adult who
			 is in the applicant's household or family, or another person authorized to act on
			 the applicant's behalf.
(2) Each
			 application on behalf of a deceased applicant shall be submitted by one of the
			 following individuals:
(A) A parent of the decedent
			 if the decedent is a minor;
(B) the
			 surviving spouse of the decedent;
(C) an
			 adult child of the decedent;
(D) an
			 adult in the decedent's tax household; or
(E) an executor or administrator, including
			 temporary, of the decedent's estate.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-36 - Redetermination of eligibility process

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each recipient shall provide the
			 department with information on the recipient's current situation and have an
			 opportunity to review the eligibility factors so that the department can
			 redetermine the recipient's continuing eligibility for medical
			 assistance.
(b) Each recipient
			 shall complete the redetermination process by either of the following:
(1) Reviewing and, if necessary, responding
			 to information provided from the department's records, including information
			 obtained through electronic data matching with other state or federal agencies;
			 or
(2) completing and returning
			 information on the individual's current situation requested by the
			 department.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-39 - Responsibilities of applicants and recipients

Current through Register Vol. 43, No. 28, July 11, 2024
Each applicant or recipient shall perform the following:
(a) Submit an application for medical
			 assistance on a department-approved form. Any applicant may withdraw the
			 application between the date the application is submitted and the date of the
			 notice of the department's decision;
(b) supply information essential to the
			 establishment of eligibility, to the extent that the applicant or recipient is
			 able to do so;
(c) give written
			 permission for the release of information regarding resources, when
			 needed;
(d) report any change in
			 circumstances within 10 calendar days of the change or as otherwise required by
			 the program. Changes to be reported shall include changes to income, living
			 arrangement, household size, family group members, residency, alienage status,
			 health insurance coverage, and employment;
(e) meet that individual's own medical needs
			 to the extent that the individual is capable of doing so;
(f) take all necessary actions to obtain
			 income or resources due the person or any other person for whom the individual
			 is applying or who is receiving medical assistance; and
(g) except for persons for whom a
			 determination under presumptive medical assistance as defined in K.A.R.
			 129-6-151 has been made, request a fair hearing in writing if the individual is
			 dissatisfied with any department decision or lack of action in regard to the
			 application for or the receipt of assistance.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-41 - Assistance planning for MAGI-based coverage groups

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The assistance plan for the groups
			 described in K.A.R. 129-6-34(c)(1) shall consist of those persons in the
			 household as determined in subsections (b) through (f).
(b) For each person who is not claimed as a
			 tax dependent by any other taxpayer and is expected to file a tax return, the
			 household shall consist of the person and all of the person's tax dependents,
			 except as noted in subsection (e). If a taxpayer cannot reasonably establish
			 that another individual is a tax dependent of the taxpayer for the tax year in
			 which assistance is determined, the inclusion of the individual in the
			 household of the taxpayer shall be determined in accordance with subsections
			 (d) and (e).
(c) For each person
			 claimed as a tax dependent by another taxpayer, the household shall consist of
			 that taxpayer and the taxpayer's dependents, except as noted in subsection
			 (e).
(d) For each person who
			 neither files a tax return nor is claimed as a tax dependent, the household
			 shall consist of the person and, if living with the person, the following:
(1) The person's spouse;
(2) the person's natural children, adopted
			 children, and stepchildren under the age of 21;
(3) the person's natural parents, adoptive
			 parents, and stepparents, if the person is under the age of 21; and
(4) the person's natural siblings, adopted
			 siblings, and stepsiblings under the age of 21, if the person is under the age
			 of 21.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-42 - Assistance planning for MAGI-excepted coverage groups

Current through Register Vol. 43, No. 28, July 11, 2024
(a) In independent living arrangements for
			 the groups described in K.A.R. 129-6-34(c)(2), the following requirements shall
			 apply:
(1) For any child who is not blind or
			 disabled, the assistance plan shall consist of all children in the family group
			 and the legally responsible relatives of the children, if living
			 together.
(2) For any child who is
			 not living with a legally responsible relative, a separate assistance plan
			 shall be applicable and shall include the siblings of the child if in the
			 family group.
(3) For SSI
			 recipients, a separate assistance plan shall be applicable and shall include
			 only the SSI recipient.
(4) For all
			 other persons, the assistance plan shall consist of those members of the family
			 group for whom assistance is requested and eligibility is determined.
(5) For any deceased person for whom an
			 application is made, the assistance plan shall be determined as if the person
			 were living.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-50 - Determined eligibles; general eligibility factors

Current through Register Vol. 43, No. 28, July 11, 2024
The general eligibility requirements in
				K.A.R.
				129-6-51 through
				129-6-60 and in
				K.A.R.
				129-6-63 shall be eligibility factors
				applicable to determined eligibles, except as specified in those regulations.
				Certain eligibility requirements may be waived by the secretary and additional
				eligibility requirements may be adopted by the secretary for all, or designated
				areas, of the state for the purpose of utilizing special project funds or
				grants or for the purpose of conducting special demonstration or research
				projects.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-51 - General eligibility requirements

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Eligibility process. The determination of
			 eligibility shall be based upon information provided by the applicant or
			 recipient, or on behalf of the applicant or recipient, as well as electronic
			 data matches with other state and federal databases, including the social
			 security administration, department of homeland security, department of labor,
			 and the department's office of vital statistics. If the information is unclear,
			 incomplete, conflicting, or questionable, a further review, including contact
			 with third parties, may be required.
(b) Eligibility for medical assistance. Each
			 applicant or recipient shall be eligible for medical assistance only if all
			 applicable eligibility requirements have been met.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-52 - Act on own behalf

Current through Register Vol. 43, No. 28, July 11, 2024
(a) For
			 purposes of this regulation, each of the following terms shall have the meaning
			 specified in this subsection:
(1) "Emancipated
			 minor" means either of the following:
(A) A
			 person who is aged 16 or 17 and who is or has been married; or
(B) a person who is under the age of 18 and
			 who has been given or has acquired the rights of majority through court
			 action.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-53 - Financial eligibility for MAGI-based coverage groups

Current through Register Vol. 43, No. 28, July 11, 2024
This regulation shall apply to all groups described in
				K.A.R.
				129-6-34(c)(1).
(a) Definitions. For purposes of this
			 regulation, each of the following terms shall have the meaning specified in
			 this regulation.
(1) "Household income" means
			 the sum of the MAGI-based income of every individual included in the
			 individual's household minus an amount equivalent to five percentage points of
			 the federal poverty level for the applicable family size, for purposes of
			 determining the individual's eligibility under the highest income standard for
			 which the individual is eligible.
(2) "MAGI-based income" means income
			 calculated using the same financial methodologies used to determine MAGI as
			 defined in 26 U.S.C. 36B(d), with the following exceptions:
(A) An amount received as a lump sum shall be
			 counted as income only in the month received;
(B) scholarships, awards, or fellowship
			 grants used for education purposes and not for living expenses shall be
			 excluded from income; and
(C) for
			 American Indian and Alaska native funds, the following shall be excluded from
			 income:
(i) Distributions from Alaska native
			 corporations and settlement trusts;
(ii) distributions from any property held in
			 trust, subject to federal restrictions, located within the most recent
			 boundaries of a prior federal reservation or otherwise under the supervision of
			 the secretary of the interior;
(iii) distributions and payments from rents,
			 leases, rights-of-way, royalties, usage rights, or natural resource extraction
			 and harvest from rights of ownership or possession in any lands described in
			 this paragraph or federally protected rights regarding off-reservation hunting,
			 fishing, gathering, or usage of natural resources;
(iv) distributions either resulting from real
			 property ownership interests related to natural resources and improvement
			 located on or near a reservation or within the most recent boundaries of a
			 prior federal reservation or resulting from the exercise of federally protected
			 rights relating to these real property ownership interests;
(v) payments resulting from ownership
			 interests in or usage rights to items that have unique religious, spiritual,
			 traditional, or cultural significance or rights that support subsistence or a
			 traditional lifestyle according to applicable tribal law or custom;
			 and
(vi) student financial
			 assistance provided under the bureau of Indian affairs education
			 programs.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-54 - Financial eligibility for MAGI-excepted coverage groups

Current through Register Vol. 43, No. 28, July 11, 2024
This regulation shall apply to all groups described in
				K.A.R.
				129-6-34(c)(2), except that
				subsections (c) and (d) of this regulation shall not apply to any medicare
				beneficiary who meets the requirements of
				K.A.R.
				129-6-86 or to any working disabled
				individual who meets the requirements of
				K.A.R.
				129-6-87.
(a) Definitions. For purposes of this
			 regulation, each of the following terms shall have the meaning specified in
			 this regulation:
(1) "Client obligation" means
			 the amount that the individual is required to pay towards the cost of care that
			 the individual receives in a long-term care arrangement. Client obligation
			 shall be based on the amount of applicable income that exceeds the income
			 standard in the eligibility base period.
(2) "Eligibility base period" means the
			 length of time used in the determination of financial eligibility. The length
			 of the eligibility base period varies from one month to six months as specified
			 in subsection (b).
(3) "Spenddown"
			 means the amount of applicable income that exceeds the protected income level
			 in the eligibility base period and that is available to meet medical
			 costs.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-55 - Residence, citizenship, and alienage

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Residence. Each applicant or recipient
			 shall be a resident of Kansas. Temporary absence from a state with subsequent
			 return to the state, or intent to return when the purposes of the absence have
			 been accomplished, shall not be considered to interrupt continuity of
			 residence. Residence shall be considered to be retained until abandoned or
			 established in another state. Residency shall be established as specified in
			 this subsection.
(1) Individuals aged 21 and
			 over.
(A) For each individual not residing in
			 an institution, the individual shall choose the state of residence, based on
			 one of the following:
(i) The state in which
			 the individual is living and intends to reside, including without a permanent
			 address;
(ii) the state that the
			 individual has entered with a job commitment or for seeking employment, whether
			 or not the individual is currently employed; or
(iii) the state in which the individual is
			 living, if the individual is not capable of stating intent.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-56 - Cooperation

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Establishment
			 of eligibility. Each applicant or recipient shall cooperate with the department
			 in the establishment of the applicant's or recipient's eligibility by providing
			 all information necessary to determine eligibility as specified in K.A.R.
			 129-6-39. Failure to provide all information necessary shall render members of
			 the assistance plan, as defined in K.A.R. 129-6-41 or 129-6-42, ineligible for
			 medical assistance.
(b) Potential
			 resources. Each adult applicant or recipient shall cooperate with the
			 department by obtaining any resources, including income, due the adult or any
			 other person for whom assistance is claimed. In applicable situations, this
			 cooperation shall include claiming an inheritance due the applicant or
			 recipient and taking a share of an estate due the applicant or recipient as a
			 surviving spouse. Failure to cooperate without good cause shall render the
			 adult ineligible for medical assistance. Good cause shall include failure to
			 pursue a potential resource when the cost of legal action would be greater than
			 the value of the resource and, for pregnant women, failure to pursue
			 unemployment benefits.
(c) Social
			 security number. Except as noted in this subsection, each applicant or
			 recipient shall cooperate by providing the department with the applicant's or
			 recipient's social security number. Failure to provide the number, or failure
			 to apply for a number if the applicant or recipient has not previously been
			 issued a social security number, shall render the applicant or recipient
			 ineligible for medical assistance. The following individuals shall be exempt
			 from this requirement:
(1) Any individual who
			 is not eligible to receive a social security number;
(2) any individual who does not have a social
			 security number and can be issued a number only for a valid non-work reason;
			 and
(3) any individual who refuses
			 to obtain a social security number because of well-established religious
			 objections.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-57 - Transfer of assets

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Definitions. For purposes of this regulation, each of the following terms shall
			 have the meaning specified in this regulation:
(1) "Assets" means all income and resources
			 of the individual and the individual's spouse, including any income or
			 resources that the individual or the individual's spouse is entitled to but
			 does not receive because of action by any of the following:
(A) The individual or the individual's
			 spouse;
(B) a person, including a
			 court or administrative body, with legal authority to act in place of or on
			 behalf of the individual or the individual's spouse; or
(C) any person, including any court or
			 administrative body, acting at the direction or upon the request of the
			 individual or the individual's spouse.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-60 - Public institutions

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 Definitions. For purposes of this regulation, each of the following terms shall
			 have the meaning specified in this subsection:
(1) "Institution" means an establishment that
			 furnishes food, shelter, and some form of treatment or services to four or more
			 persons who are unrelated to the proprietor.
(2) "Public institution" means any
			 institution that is the responsibility of a governmental unit or over which a
			 governmental unit exercises administrative control.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-63 - Assignment of rights to support or other third-party payments

Current through Register Vol. 43, No. 28, July 11, 2024
Each applicant or recipient shall assign to the secretary any
				accrued, present, or future rights to the following:
(a) Medical support payments received for any
			 individual for whom medical assistance is claimed; and
(b) third-party payments for medical care
			 that the individual could receive on the individual's own behalf or on behalf
			 of any other family member who is or would be in the individual's assistance
			 plan.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-65 - Automatic eligibles

Current through Register Vol. 43, No. 28, July 11, 2024
Each of the following individuals shall be automatically
				eligible for medical assistance without meeting any additional requirements,
				except that the individual shall meet the general eligibility requirements of
				K.A.R.
				129-6-50 and
				129-6-109(c)(2):
(a) A person who is legally entitled to and
			 receiving supplemental security income (SSI) benefits and who is in compliance
			 with the residence requirements of K.A.R. 129-6-55;
(b) a person who is legally entitled to and
			 receiving state supplemental payments from Kansas related to SSI;
(c) a person who is determined by the social
			 security administration to retain recipient status, although the person is not
			 currently receiving an SSI benefit;
(d) a person who is mandated to receive
			 inpatient treatment for tuberculosis;
(e) a child born to a mother who is eligible
			 for and receiving medicaid at the time of birth, including receiving medical
			 assistance under K.A.R. 129-6-97, for up to one year, if the mother remains
			 eligible for medicaid or would be eligible for medicaid if still pregnant.
			 Eligibility for the child shall continue, unless the child dies or is no longer
			 a resident of the state or action is taken to voluntarily terminate
			 coverage;
(f) a child receiving
			 foster care payments in an out-of-home placement, regardless of the state
			 making the payments;
(g) a child
			 for whom an adoption assistance agreement under title IV-E is in effect, even
			 if adoption assistance payments are not being made or the adoption assistance
			 agreement was entered into with another state. Eligibility shall begin when the
			 child is placed for adoption, even if an interlocutory decree of adoption or a
			 judicial decree of adoption has not been issued;
(h) a child for whom a non-title IV-E
			 adoption assistance agreement is in effect between the state and the adoptive
			 parents and who cannot be placed without medical assistance because the child
			 has special needs for medical or rehabilitative care; and
(i) a child receiving title IV-E guardianship
			 care payments.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-70 - Medicaid determined eligibles; eligibility factors specific to qualifying families

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each
			 applicant or recipient shall meet the general eligibility requirements of
			 K.A.R. 129-6-50 and the specific eligibility requirements in this
			 regulation.
(b) Each family shall
			 include a caretaker and the children of the caretaker who are under 19 years of
			 age. Any family may also include a pregnant woman and her unborn child or
			 children.
(c) Household income as
			 determined under K.A.R. 129-6-53 shall not exceed the income standard specified
			 in K.A.R. 129-6-103(a)(3).
(d)
			 Eligibility for medical assistance under this regulation shall continue for
			 each person who receives medical assistance under this regulation for at least
			 three of the six months immediately before the month in which the person became
			 ineligible for medical assistance under this regulation as a result, in whole
			 or in part, of collection or increased collection of spousal support.
			 Eligibility for medical assistance shall continue for the four months
			 immediately after the last month in which the person was eligible and legally
			 entitled to receive medical assistance under this regulation if the person
			 remains ineligible for medical assistance under this regulation due to
			 collection or increased collection of spousal support.
(e) Eligibility for medical assistance under
			 this regulation shall continue for each person who is included in the
			 assistance plan of a family that has received medical assistance under this
			 regulation in three of the six months immediately before the first month in
			 which the family has lost eligibility for medical assistance under this
			 regulation due solely to increased earned income or hours of employment of the
			 caretaker, including an increase in the amount paid for hours of work.
Assistance shall be provided for a period not to exceed 12
				months. Eligibility shall end for any individual who leaves the family and for
				any child who no longer meets the age requirements of subsection
				(b).
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-71 - Medicaid determined eligibles; poverty-level pregnant women

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each applicant
			 or recipient shall meet the general eligibility requirements of K.A.R. 129-6-50
			 and the specific eligibility requirements in this regulation.
(b) Each eligible woman shall be pregnant.
			 Assistance under this regulation shall continue for two calendar months
			 following the month in which the pregnancy terminates.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-72 - Medicaid determined eligibles; poverty-level children

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each applicant or recipient shall meet
			 the general eligibility requirements of K.A.R. 129-6-50 and the specific
			 eligibility requirements in this regulation.
(b) For infants, each eligible infant shall
			 be under one year of age. Medical assistance under this regulation shall
			 continue according to either of the following:
(1) Through the month in which the child
			 reaches the age of one; or
(2) if
			 receiving inpatient services in the month in which the child reaches the age of
			 one, according to the earlier of the following:
(A) Through the calendar month in which the
			 inpatient care ends; or
(B) through
			 the calendar month following the month in which the inpatient care begins. If
			 the inpatient care will exceed this time period, eligibility for the child
			 under this regulation shall end on the last day of the calendar month in which
			 the child reaches the age of one.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-73 - Medicaid determined eligibles; eligibility factors specific to pregnant women

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each
			 pregnant applicant or recipient shall meet the general eligibility requirements
			 of K.A.R. 129-6-50. In addition, the applicant or recipient shall not be
			 eligible for medical assistance under K.A.R. 129-6-71.
(b) Financial eligibility under this
			 regulation shall be determined for each month as if the unborn child were
			 already born and living with the applicant or recipient and shall be based on
			 the number of children that the applicant or recipient is expected to
			 deliver.
(c) Assistance under this
			 regulation shall continue for the two calendar months following the month in
			 which the pregnancy terminates.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-74 - Medicaid determined eligibles; eligibility factors specific to children

Current through Register Vol. 43, No. 28, July 11, 2024
Each child shall meet the applicable general eligibility
				requirements of
				K.A.R.
				129-6-50 and the following
				requirements:
(a) The child shall be
			 under 19 years of age.
(b) The
			 child shall not be eligible for medical assistance under K.A.R.
			 129-6-72.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-80 - Medicaid determined eligibles; eligibility factors specific to children in foster care

Current through Register Vol. 43, No. 28, July 11, 2024
To be eligible for participation in the medical assistance
				program related to foster care, each child shall meet the following
				requirements:
(a) Meet the general
			 eligibility requirements of K.A.R. 129-6-50;
(b) be under the age of 18 or be a full-time
			 elementary or secondary school student who is qualified to receive foster care
			 maintenance payments under title IV-E of the social security act, 42 U.S.C. 670
			 et seq.;
(c) be placed in a living
			 arrangement approved by the secretary, including a foster family home, a
			 private nonprofit child care facility, a medicaid-approved medical facility, a
			 medicaid-accredited psychiatric hospital, or an intermediate care facility;
			 and
(d) have a written order issued
			 by a court giving care, custody, and control of the child to one of the
			 following:
(1) The secretary of the department
			 for children and families;
(2) in
			 the case of an Indian child as defined by the federal Indian child welfare act,
			 the four tribes social services child-placing agency; or
(3) the secretary of the department of
			 corrections.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-81 - Medicaid determined eligibles; eligibility factors specific to children living in medicaid-accredited psychiatric hospitals, intermediate care facilities, or residential treatment facilities

Current through Register Vol. 43, No. 28, July 11, 2024
To be eligible for participation in the medical assistance
				program under this regulation, each child shall meet the following
				requirements:
(a) Meet the general
			 eligibility requirements of K.A.R. 129-6-50; and
(b) be under the age of 21 or, if receiving
			 inpatient psychiatric care on the person's 21st birthday and currently
			 receiving inpatient care in either of the following, be under the age of 22:
(1) A state institution that has been
			 approved as a medicaid-accredited psychiatric hospital or intermediate care
			 facility; or
(2) a psychiatric
			 residential treatment facility as defined in K.A.R. 28-4-1200.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-82 - Medicaid determined eligibles; eligibility factors specific to HCBS

Current through Register Vol. 43, No. 28, July 11, 2024
(a) To be eligible
			 for participation in the medical assistance program under this regulation, each
			 person shall meet the following requirements:
(1) Meet the general eligibility requirements
			 of K.A.R. 129-6-50;
(2) be assessed
			 as in need of long-term care services in an institutional setting pursuant to
			 K.S.A.
			 39-968, and amendments thereto, and choose to
			 receive HCBS if these services are available; and
(3) be in an approved waiver under 42 U.S.C.
			 1315 or 1396n, or both.
Kansas Administrative Regulations › Agency 129 - KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT-DIVISION OF HEALTH CARE FINANCE › Article 6 - MEDICAL ASSISTANCE PROGRAM-CLIENTS' ELIGIBILITY FOR PARTICIPATION › Section 129-6-83 - Medicaid determined eligibles; eligibility factors specific to PACE

Current through Register Vol. 43, No. 28, July 11, 2024
(a) To be eligible
			 for participation in the medical assistance program under this regulation, each
			 person shall meet the following requirements:
(1) Meet the general eligibility requirements
			 of K.A.R. 129-6-50;
(2) be assessed
			 as in need of long-term care services in an institutional setting;
(3) be 55 years of age or older and residing
			 in a PACE service area as authorized by the secretary; and
(4) meet the disability criteria of K.A.R.
			 129-6-85(b) or (c) if aged 55 through 64.