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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.