SHPBN-2017-030 Valid Level of Care Required for Long Term Care Services
Date: 08/29/17
Effective June 1, 2017, reimbursement for Long Term Care Services (institutional, HCBS and MFP) will be limited to beneficiaries with a valid level of care.
- HCBS = Home and Community Based Services
- MFP = Money Follows the Person
Beneficiaries with a level of care on file have been determined to meet all requirements for LTC reimbursement.
The level of care must correspond to the facility/entity providing the service for the requested dates of service.
Long term care services provided for beneficiaries who have not been authorized through a level of care will not be reimbursed.
Please see below valid levels of care as defined by MMIS (Medicaid Management Information System):
| MMIS LOC | DESCRIPTION | Allowable Provider Type for this LOC |
|---|---|---|
| 000 | NO LIVING ARRANGEMENT OR INDEPENDENT LIVING | No Payment |
| 010 | HOME AND COMMUNITY BASED INTELLECTUAL/DEVELOPMENTALLY DISABLED SERVICES | HCBS-IDD |
| 011 | TEMPORARY CARE HOME AND COMMUNITY BASED INTELLECTUAL/DEVELOPMENTALLY DISABLED SERVICES | HCBS-DD, ICF-IDD, Swing Bed Facility |
| 020 | HOME AND COMMUNITY BASED HEAD INJURED SERVICES | HCBS-HI |
| 021 | TEMPORARY CARE HOME AND COMMUNITY BASED HEAD INJURED SERVICES | HCBS-HI and Nursing Facility, Head Injury (TBIRF), Swing Bed Facility |
| 030 | HOME AND COMMUNITY BASED SERVICES PHYSICALLY DISABLED | HCBS-PD |
| 031 | TEMPORARY CARE HOME AND COMMUNITY BASED SERVICES PHYSICALLY DISABLED | HCBS-PD and Nursing Facility, Swing Bed Facility, Head Injury (TBIRF) |
| 040 | HOME AND COMMUNITY BASED TECHNOLOGY ASSISTED SERVICES | HCBS-TA |
| 041 | TEMPORARY CARE HOME AND COMMUNITY BASED TECHNOLOGY ASSISTED SERVICES | HCBS-TA and hospital, general, acute, Swing Bed Facility |
| 050 | WORK SERVICES | WORK |
| 070 | HOME AND COMMUNITY BASED SERVICES AUTISM WAIVER | HCBS-AU |
| 071 | TEMPORARY CARE HOME AND COMMUNITY BASED SERVICES AUTISM WAIVER | HCBS-AU and hospital - psych speciality |
| 100 | PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY | PRTF |
| 110 | NURSING FACILITY HEAD INJURY | Nursing Facility - Head Injury (TBIRF) |
| 120 | NURSING FACILITY SWING BED | Hospital - general, acute |
| 130 | NURSING FACILITY SKILLED NURSING | Nursing Facility |
| 131 | TEMPORARY CARE NURSING FACILITY SKILLED NURSING | Nursing Facility |
| 140 | NURSING FACILITY SPECIALIZED SERVICES/IDD | ICF-IDD |
| 141 | TEMPORARY CARE NURSING FACILITY SPECIALIZED SERVICES/IDD | ICF-IDD |
| 170 | STATE HOSPITAL MENTAL HEALTH (Ages under 22 and over 64) | State Institution - MH |
| 171 | TEMPORARY CARE STATE HOSPITAL MENTAL HEALTH (Ages under 22 and over 64) | State Institution - MH |
| 180 | HOME AND COMMUNITY BASED SERVICES FRAIL ELDERLY | HCBS FE |
| 181 | TEMPORARY CARE HOME AND COMMUNITY BASED SERVICES FRAIL ELDERLY | HCBS-FE, Nursing Facility, Swing Bed Facility |
| 231 | TEMPORARY CARE NURSING FACILITY MENTAL HEALTH | NF MH |
| 250 | HOME AND COMMUNITY BASED SERVICES SEVERE EMOTIONAL DISTURBANCE | HCBS SED |
| 251 | TEMPORARY CARE HOME AND COMMUNITY BASED SERVICES SEVERE EMOTIONAL DISTURBANCE | HCBS-SED, PRTF, IMD, Swing Bed Facility |
| 300 | MONEY FOLLOWS THE PERSON HEAD INJURY | MFP HI |
| 301 | TEMPORARY CARE MONEY FOLLOWS THE PERSON HEAD INJURY | MFP HI and Nursing Facility - Head Injury |
| 310 | MONEY FOLLOWS THE PERSON INTELLECTUAL/DEVELOPMENTALLY DISABLED | MFP IDD |
| 311 | TEMPORARY CARE MONEY FOLLOWS THE PERSON INTELLECTUAL/DEVELOPMENTALLY DISABLED | MFP DD, ICF-IDD |
| 320 | MONEY FOLLOWS THE PERSON FRAIL ELDERLY | MFP FE |
| 321 | TEMPORARY CARE MONEY FOLLOWS THE PERSON FRAIL ELDERLY | MFP FE, Nursing Facility |
| 330 | MONEY FOLLOWS THE PERSON PHYSICALLY DISABLED | MFP PD |
| 331 | TEMPORARY CARE MONEY FOLLOWS THE PERSON PHYSICALLY DISABLED | MFP PD, Nursing Facility |
Review level of care on KMAP
A beneficiary's level of care can be reviewed by logging into the KMAP (Kansas Medical Assistance Program) secure website.
If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.