COMMONWEALTH OF KENTUCKY

Cabinet for Health and Family Services

Department for Community Based Services

Frankfort, Kentucky

Operation Manual

Transmittal Letter No. 267

September 1, 2005

To: All Field Staff

Subject: Various Medicaid Revisions

Volume I

The Table of Contents is revised to delete MS 0418, KenPAC MAID Card, which is obsoleted with the incorporation of KYHealth card procedures. The Table of Contents is also revised to re-name MS 0352, as KYHealth Card and Managed Care Card and MS 0450 as KYHealth Card. The Table of Contents is further revised to rename MS 0456 “Non-Receipt of KYHealth Cards”.

Manual sections 0097, 0352, 0419, 0450, 0456 and 0457 are revised to delete cross-references to OM Upd. No. 05-17, MS 99701, 5/1/05, and to incorporate procedures for the permanent, plastic KYHealth card, which replaces the former monthly MAID card. OM Upd. No. 05-17 is now obsolete.

MS 0097 is further revised to delete cross-references to OM Pol. Upd. 02-20, MS 99591, 8/1/02; OM Pol. Upd. 02-30, MS 99601, 12/1/02; and OM Pol. Upd. 03-17, MS 99622, 5/1/03, as co-pay procedures are incorporated into this section. OM Pol. Upds. 02-20, 02-30 and 03-17 are now obsolete.

MS 0352 is also revised to change the title to “KYHealth Card and Managed Care Card”.

MS 0418 is obsoleted with the implementation of the permanent KYHealth Card.

MS 0419 is also revised for re-numbering and to delete references to the monthly KenPAC MAID card.

MS 0450 is retitled “KYHealth Card”. MS 0450 is further revised to delete the cross-reference to OM Pol. Upd. 03-20, MS 99627, 5/1/03, as Spend Down procedures are incorporated in this section.

MS 0456 is retitled “Non-Receipt of KYHealth Cards”.

MS 0457 is also revised to delete references to the monthly MAID card and to update contact information for the Department for Medicaid Services (DMS).

Volume IV

The Table of Contents is revised to delete MS 4240, MAID, which is obsolete with incorporation of KYHealth card procedures. MS 2894, P7 Case Processing, is added.MS 1050, MS 2892 and MS 3050 are revised to delete cross-references to OM Upd. 05-17, MS 99701, 5/1/05, and to incorporate procedures for the permanent, plastic KYHealth card, which replaces the former monthly MAID card. MS 1050 is further revised to delete cross-references to OM Upd. 05-21, MS 99705, 6/1/05, and OM Pol. Upd. 03-24, MS 99632, 7/1/03, as Medicare Part D prescription drug coverage and caretaker relative restrictions are incorporated in the definitions. OM Updates 03-24 and 05-21 are now obsolete.

MS 1050 is also revised to remove the statement, “This amount may be decreased by loans” from the definition of Face Value (FV) of life insurance as the statement is incorrect.

MS 2650 is revised to add the following states to the list of Interstate Compact on Adoption and Medical Assistance (ICAMA) states:

· District of Columbia;

· Florida;

· Michigan; and

· New Jersey.

MS 2650 is also revised to delete the cross-references to OM Upd. 04-27, MS 99681, 11/1/04, and OM Upd. 05-05, MS 99689, 2/1/05 which listed states previously added to the ICAMA participation list. OM Upd. 04-27 and OM Upd. 05-05 are now obsolete.

MS 2670 is revised to instruct field staff that eligibility determination for “U” children is the responsibility of Central Office. It is also revised to state that eligibility only exists in the “U” category if the child is not eligible in any other category of Medicaid. The child must have been hospitalized for over 30 days for eligibility to exist.

MS 2892 is also revised to delete the cross-references to OM Pol. Upd. 02-15, MS 99586, 7/1/02, OM Pol. Upd. 03-39, MS 99648, 11/1/03, and OM Pol. Upd. 04-06, MS 99658, 1/1/04, as face-to-face application and co-pay requirements are incorporated into this section.

MS 2894 is created to incorporate premium payment procedures issued via OM Upd. 03-39, MS 99648, 11/1/03 and OM Upd. 04-06, MS 99658, 1/1/04. OM Upd. 03-39 and OM Upd. 04-06 are now obsolete.

MS 3130 is revised to state that a special category of assistance is available to children hospitalized in a psychiatric facility, Institute for Mental Diseases (IMD) or Psychiatric Residential Treatment Facility (PRTF), if not eligible under any other category of Medicaid and the child has been hospitalized for over 30 days. The cross-reference to OM Upd. No. 01-23, MS 99571, 12/1/01, is removed as it is now obsolete.

MS 3990 is obsolete as Central Office has responsibility for the determination of eligibility for “U” cases.

MS 4100 is revised to delete the cross-reference to OM Upd. 02-06, MS 99577, 5/1/02. The acronym “DSI” is changed to “DFS”, and "AFDC-Related MA Recipients" is added to the list of individuals under age 21 eligible for EPSDT services.

MS 4170 is revised to remove the cross-reference to OM Upd. 02-06, MS 99577, 5/1/02, and OM Upd. 04-28, MS 99682, 11/1/04, as they are incorporated into this manual section. The reference to “U Child” and “U Case” in item A.3 is removed. Item 4 is revised to state that eligible Medicaid recipients under age 21 can receive EPSDT LTC services with the exception of recipients of KCHIP3. Categories H, HP and KP are added to item 4. “DMS” is changed to “provider” in item E. A link is added to MS 2670 in item F.2. In item G.4 the reference to “U Case” is changed to “hospital”. “Operations Support Branch” is changed to “Medical Support and Benefits Branch”. OM Updates 02-06 and 04-28 are now obsolete.

MS 4240 is obsolete as KenPAC MAID card procedures for dually eligible recipients are superseded by the implementation of the permanent, plastic KYHealth card.

Volume IVA

The Table of Contents is revised to delete MS 4520, QMB and MAID Cards, which is obsolete with the incorporation of KYHealth Card procedures.

MS 1010, MS 1280, MS 1430 and MS 4720 are revised to delete cross-references to OM Upd. 05-17, MS 99701, 5/1/05, and to incorporate procedures for the implementation of the permanent, plastic KYHealth card which replaces the monthly MAID card. OM Upd. 05-17 is now obsolete. MS 1010 is further revised to delete the cross-reference to OM Upd. 05-21, MS 99705, 6/1/05, as Medicare Part D prescription drug coverage is incorporated in the definitions.

MS 1430 is also revised to state Spend Down applications cannot be approved on the PA-62 system.

MS 1760 is revised to incorporate new standards effective July 1, 2005, and to remove the cross-reference to OM Upd. 05-23, MS 99707, 7/1/05, as it is now obsolete.

MS 3710 is revised to update the address for the Health Services Administrative Hearings Branch.

MS 4520 is deleted in its entirety as QMB and MAID card procedures are obsoleted by the implementation of the permanent, plastic KYHealth card.

MS 4550 is revised to remove the statement that SLMB dual eligibility does not apply to SSP and Pass Through recipients. It is also revised to remove the statement concerning annotation of the MAID card.

MS 4575 is revised to add SSP and Pass Through to SLMB dual eligible cases.

MS 4720 is further revised to add determination of SSI eligibility for individuals in a managed care county that are exempt from managed care requirements. MS 4720 is also revised to include program codes F, G, H or Z as a basis for MA application upon discontinuance of SSI.

MS 4770 and MS 4820 are revised to include instructions for conversion recertifications to convert A, B or D Exparte cases on the PA-62 system to F, G, H, J, K, M, or Z cases on KAMES. MS 4770 and MS 4820 are also revised to delete the cross-reference to OM Upd. 05-20, MS 99704, 6/1/05, as it is now incorporated into these manual sections.

Volume VI

MS 4340 is revised to remove the cross-reference to OM Upd. 05-20, MS 99704, 6/1/05, as it is not applicable.

Volume X

The Table of Contents is revised to delete the following OM Updates as they are now obsolete due to being incorporated into the Operations Manual: 01-23, MS 99571, 12/1/01; 02-06, MS 99577, 5/1/02; 02-20, MS 99591, 8/1/02; 02-30, MS 99601, 12/1/02; 03-17, MS 99622, 5/1/03; 03-39, MS 99648, 11/1/03; 04-06, MS 99658, 1/1/04; 04-27, MS 99681, 11/1/04; 04-28, MS 99682, 11/1/04; 05-05, MS 99689, 2/1/05; 05-17, MS 99701, 5/1/05; 05-20, MS 99704, 6/1/05; and 05-23, MS 99707, 7/1/05.

The following OM Updates are now obsolete as they are incorporated into the Operations Manual: 01-23, MS 99571, 12/1/01; 02-06, MS 99577, 5/1/02; 02-20, MS 99591, 8/1/02; 02-30, MS 99601, 12/1/02; 03-17, MS 99622, 5/1/03; 03-39, MS 99648, 11/1/03; 04-06, MS 99658, 1/1/04; 04-27, MS 99681, 11/1/04; 04-28, MS 99682, 11/1/04; 05-05, MS 99689, 2/1/05; 05-17, MS 99701, 5/1/05; 05-20, MS 99704, 6/1/05; and 05-23, MS 99707, 7/1/05.

OM Pol. Upd. 02-15, MS 99586, 7/1/02, is revised to delete the cross-reference to Vol. IV, Page 2892, MS 2892 as face-to-face application procedures are incorporated into the manual.

OM Upd. 03-20, MS 99627, 5/1/03, is revised to delete the cross-reference to Vol. I, Page 0450-0456, MS 0450 as Spend Down procedures for the KYHealth card are incorporated into the manual.

OM Upd. 03-24, MS 99632, 7/1/03 is revised to delete the cross-reference to Vol. IV, Page 1050, MS 1050 as caretaker/specified relative restrictions are incorporated into the definitions.

OM Upd. 05-21, MS 99705, 6/1/05 is revised to remove the cross-references to Vol. IV, MS 1050 and Vol. IVA, MS 1010 as Medicare Part D prescription drug coverage is incorporated into the Medicare Program definitions.

Tom Emberton, Jr., Commissioner