1323 Information Known to the Agency-
The agency is required to act on information when it becomes known. The phrase ’Known To The Agency' establishes the point in time that the agency is made aware of information in order to act upon such information for purposes of eligibility determination/redetermination. These policies do not negate the consumer’s responsibility to report information (see Medical KEESM 9100), but are meant to provide required parameters when reacting to new information.
See 9121.1 for processing changes.
1323.1 Definition of Agency
Agency means the single state Medicaid/CHIP agency as well as any contractors or other state agency units authorized to determine eligibility for medical assistance or provide direct support of the medical assistance eligibility determination process. Currently, this means the KanCare Clearinghouse, KDHE Outstationed Workers, KDHE Central Office – Eligibility Unit and DCF PPS workers who make medical determinations. It also includes automated systems that determine medical assistance eligibility to the extent the information is used in the medical assistance determination.
1323.2 Date Information is Known
The date information is considered known to the Agency establishes the date by which information must be acted upon. This date is determined by the source/channel of the information:
1. 1. Information reported directly to the Agency by a consumer or third party, by any channel, is considered known on the date it is reported. Examples:
· The date of a phone call from the consumer reporting a change in income
· The date of receipt of written correspondence
· The date a Nursing Home reports a change in living arrangement
· The date a new application is received, whether for a new household or an existing household reporting a change or a new member
2. 2. Information that originally becomes known to another state agency but is communicated to the Agency as part of an approved business process is considered known on the date the information was reported to the Agency. Examples:
· The date DCF creates a task notifying KDHE of a new medical condition that a mutual client originally reported to DCF
· The date DCF creates a task notifying KDHE of a change in health insurance premium amount.
3. 3. Information obtained through an interface used by the medical assistance programs which populates information directly into KEES is considered known on the date the information is added to KEES. Examples:
· The date a TBQ adds new Medicare entitlement to the Medicare Information page
· The date an SDX task is created from a Social Security interface telling KDHE that SSI has ended
4. 4. Information originally obtained through another program through any channel that was not directly reported to the Agency, is considered known based on the type of information received.
a. Information received through a shared data field in KEES and is immediately used for case processing through an automated process is known on the date the information is added to KEES. Example:
· The date a DCF updates an address in KEES for a mutual client.
b. Information received through a shared data field in KEES is considered known on the earlier of the date the information is used for processing or the date it is viewed by a person considered part of the Agency. Example:
· DCF updates health insurance premium at the end of the day. The review batch runs that evening and uses the health insurance premium in the new determination. DCF notifies KDHE of the change the following day. The information is considered known on the date of the review batch, because the information was used to redetermine medical benefits.
c. Information available only through a non-shared data field in KEES is considered known on the date it is viewed by someone considered part of the Agency. Example:
· The date a KDHE staff person views a DCF income record.