Kansas Family Medical Assistance
Manual (KFMAM)
Eligibility Policy - 4/26/2024
1211
1212 Responsibilities of the Agency - Upon request, the agency must explain the rights and responsibilities of clients and the following requirements placed on the agency.
1212.01 Periodic Reviews - The agency is required to make periodic reviews of eligibility if the application is approved.
When a formal review is required, the agency shall notify the client of the expiration of the review period and shall send the client a new application prior to the last month of the review period.
When the family qualifies for a Passive Review, a new application is not required and therefore not mailed to the client.
1212.02 Fraud - The agency is required to investigate and refer for legal action any alleged fraud related to the receipt of assistance.
1212.03 Responsibility to Accept an Identifiable Application - The agency shall accept an application containing a legible name and address (unless homeless) and which has been signed. See 1401.
1212.04 Responsibility to Review Recipients Timely - The agency has the responsibility to process all subsequent applications timely so there will be no break in the benefits the client is eligible to receive.
1212.05 Responsibility to Establish Claims of Overpayment - The agency is responsible for establishing claims for overpayment (either fraud, client, or agency error).
1212.06 Responsibility to Restore Lost Benefits - The agency shall restore benefits to the client if benefits were wrongfully denied, delayed, or terminated.
1212.07 Responsibility for Giving Notice of Action - The agency is responsible for giving adequate and/or timely notice of action when appropriate.
1212.08 Case File Documentation - The agency has the responsibility to ensure that case file documentation supports the decision to provide, deny or change eligibility, benefits, or services.
1212.09 Cost-Effective Service Provision - Services shall be provided in the most cost-effective manner in order to provide the client with the appropriate services within the resources allowed.