Kan. Admin. Regs. § 129-7-8

Current through Register Vol. 44, No. 2, January 9, 2025

Section 129-7-8 - Notices to applicants and beneficiaries; applicability

This regulation shall apply to adequate and timely notices of approval sent by the secretary to applicants and beneficiaries regarding approval of eligibility or approval of an FFS covered service authorization request.

(a) An adequate notice of approval shall be sent by the secretary to an applicant for medical assistance when the secretary approves an applicant's claim for eligibility, or to a beneficiary of medical assistance when the secretary fully or partially approves an FFS covered service authorization request, and to an applicant or a beneficiary following a decision by a presiding officer that reverses the secretary's action. Each adequate notice of approval shall include the following:

(1) The date of the adequate notice of approval;

(2) the approved eligibility, including the basis of the eligibility;

(3) the effective date and, if applicable, the end date of the approved eligibility or approved FFS covered service authorization request. If no effective date is specified, the effective date shall be the date of the adequate notice of approval;

(4) the circumstances under which the applicant or beneficiary must report, and procedures for reporting, any changes that could affect the applicant's or beneficiary's eligibility;

(5) if applicable, the amount of medical expenses, if any, that must be incurred to establish eligibility for a medically needy applicant or beneficiary under a spend-down program, including the following:

(A) The budget period used to determine the spend-down amount;

(B) medical expenses, if any, applied toward the spend-down amount; and

(C) types of medical expenses allowed against any remaining spend-down amount; and

(6) basic information on the level of benefits and services available based on the applicant's or beneficiary's eligibility, including the following, if applicable:

(A) A description of any premiums and cost sharing required;

(B) an explanation of how to receive additional detailed information on benefits and financial responsibilities; and

(C) an explanation of any right to appeal the eligibility status or level of benefits and services approved.

(b) A timely notice of approval shall be sent by the secretary to the applicant or beneficiary within the time frames specified in paragraphs (b)(1) and (b)(2). A timely notice of approval shall include the contents of an adequate notice of approval as specified in subsection (a).

(1) An adequate notice of approval shall be sent by the secretary to an applicant or beneficiary no later than one business day following the date upon which the secretary makes the eligibility or FFS covered service authorization approval decision that is the subject of the adequate notice of approval.

(2) An adequate notice of approval shall be sent by the secretary to an applicant or beneficiary no later than one business day following the date upon which notice of the presiding officer's reversal of the secretary's action is received by the secretary. If a petition for review to SAC is filed by the secretary, the adequate notice of approval shall be delayed until notice of the SAC decision affirming the presiding officer's reversal of the secretary's action is received by the secretary.

Kan. Admin. Regs. § 129-7-8

Authorized by and implementing K.S.A. 65-1,254 and 75-7403; adopted by Kansas Register Volume 43, No. 50; effective 12/27/2024.