SHPBN-2015-010 HCBS Services: Change in Monthly Unit Calculations

Date: 04/15/15

Home and Community Based Services (HCBS) Unit Calculations

Effective June 1, 2015, Sunflower Health Plan will use the actual number of days in each month to calculate and authorize the number of HCBS service units for its members. This plan of care (POC) calculation change does not reduce or increase service units; it is only a change in the monthly calculation methodology.

This new calculation methodology will apply to the Frail/Elderly, Traumatic Brain Injury, Physical Disability, Technology Assistance, and Intellectual/Developmental Disability HCBS programs.

The number of units of HCBS services approved will continue to be determined through the Member Needs Assessment. The weekly number of service units needed will be divided by 7 and then multiplied by the actual number of days within the month. The calculation will take into consideration: members who have an established weekly direct care schedule, members who utilize a different number of units each day of the week, and months when there are more of the high utilization days.

Prior to the effective date, Sunflower Health Plan will notify members about these changes by sending a letter to all members receiving these services. Sunflower's case managers will then attempt to contact each member or legal guardian by phone to make sure the letter was received, answer any questions, and to recalculate the POC.

Copies of the new POCs will be sent to the member or legal guardian as well as the provider(s). For members with I/DD, the POC will also be sent to the Targeted Case Manager and the CDDO. Authorization letters will be sent to the providers.

If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call our Customer Service Center at 1-877-644-4623.