Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 8/10/2020

07000 >>> 07400

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07400 Client Requirements for Timeliness - Reviews -

7410 Review Form - As indicated in 7331, households subject to a pre-populated review shall be given a minimum of 30 days to return a required review form. The review form shall be mailed to the individual on or about the 15th of the next to last month of the review period. To be considered timely received, the review form must be returned to the agency by the 14th of the last month of the review period. If the review form is not timely received, coverage will be automatically discontinued the evening of the 15th with an effective date of the last day of the last month of the review period (see 7431).

7410.01 Using an Application Form as a Review - An application form shall be used as the review in the following circumstances:
- Received within two months prior to the Review Due month
- Received any month after the Review Due month through the current month when the Review Discontinuance Batch has not been run.
The application is used to complete the review when all members of the household are listed on the application. The application must be reviewed for consistency with the known case information. If additional information is needed to process the review, it shall be requested from the consumer, but another application form or review form is not required.

7410.02 Continuation of Coverage Pending Completion of Review - When a review form is timely received (see 7331) and registered before the change processing deadline, eligibility at current levels will continue automatically until the review process is completed. If the review is timely received, but not registered before the change processing deadline, coverage will be automatically discontinued. In that instance, the discontinuance shall be rescinded and coverage reinstated while the review is pending. Note that if an untimely review is received during the review reconsideration period (see 7431), the discontinuance shall be rescinded but coverage shall not be reinstated pending the completion of the review.

Due to this process, if a timely received review is not timely processed by the agency, as defined in 7420, the current level of coverage for the household may continue past the end of the review period for one or more months [extended month(s)]. The date the timely review is received will determine if those months are subject to correction.

1. If the review is received before the 1st day of the last month of the review period, it is anticipated
that the review will be completed prior to the change processing deadline in the last month of the
review period (see 7420). Therefore, there should be no extended months of coverage. However,
if the review is not processed timely, resulting in extended coverage month(s), those months are
subject to correction, if necessary. Understated eligibility shall be restored, and an agency error
claim shall be created for any overstated eligibility (see 8312) for those month(s).

2. If the review is received on or after the 1st day of the last month of the review period, correction is
required beginning with the second extended month. The first extended month is only subject to
correction when the new benefit level is greater than the previous coverage. In that instance, the
extended month shall be corrected to reflect the new benefit level for that month. If the new
benefit level is less than the previous coverage, no correction of the extended month is required.


Correction is required for all months beginning with the second extended month.

Note: If the review is not timely processed, as noted above, eligibility will continue at the current level until some intervening action, automated or manual, is taken to either change or discontinue coverage. If the ultimate action taken on the case is adverse, timely and adequate notice of the action is required (see 1422).

7411 Information/Verification - All information and/or verification shall be provided by the requested date. Clients must submit any required verification or additional information within 12 days from the date of the initial request in order to ensure the rights to uninterrupted benefits. However, if the requested information is provided after adverse action is taken, but during the review reconsideration period, as described in 7431, the adverse action may be rescinded and the review reinstated for processing.
Follow the verification requirements at initial application, except that non-citizen status, providing an SSN, residency, and identity, do not have to be reverified unless a change has been reported or it is questionable.

7420 Agency Action on Timely Review - If the review form is timely filed and all review requirements have been met, the agency shall promptly process the review to ensure correct and timely coverage is provided. Timely processing shall be defined as follows:

1. A review form received before the 1st day of the last month of the review period shall be processed by the change processing deadline in the last month of the review period.

2. A review form received on or after the 1st day of the last month of the review period shall be processed by the change processing deadline in the month after the last month of the review period. Whenever possible, the agency, though not required, shall still attempt to process the review by the change processing deadline in the last month of the review period.

This process may result in an extended month of coverage. Any extended month of coverage provided under this process is subject to adjustment as indicated in 7410.02(2) if understated eligibility has occurred. However, in no instance shall a claim subject to recovery be created for the extended month (see 8321.02)).

3. Due to the nature of the program, all Medically Needy (MDN) reviews, regardless of when received, shall be processed by the change processing deadline in the last month of the review period. This will ensure that a new 6 month eligibility base period is properly established beginning with the month after the month the review period ends. See also 1410.01(2).
All households shall be notified of the appropriate reporting requirements upon review approval. See 7120.

7421 Passive Review Responses - After being passively reviewed, the consumer is required to contact the agency (either orally or in writing) if any of the information used in the passive review needs to be updated. Reaction to this change is based on when the change occurred, when it was reported, and the type of eligibility being received.
- If the change occurred on or before the 15th of the last month of the old review period, the change is processed as a Passive Review Response.
- If the change occurred after the 15th of the last month of the old review period, the change is not considered a passive review response. It is treated like any other change that is reported outside of the review process.
To process the Passive Review Response, staff update the case with the changes and redetermine eligibility for the first unpaid month. The reported change can result in a change in coverage and/or premium. If the passive review response includes a request for medical assistance for a new individual, the change to add the individual is processed for the month of request but coverage for existing members is protected for any paid months by continuous eligibility rules. When a premium is involved, if a positive change, the change is made for the month after the month of report.

7430 Failure to Act -

7431 Household Failure to Act Timely - A household which timely submits a review form but submits all verification in an untimely manner shall lose the right to a prompt review of eligibility (see 7420) untimely verification is provided.

If the review form is not returned by the end of the current review period, the individual has a three month reconsideration period to return the review form. Individuals will have until the end of the third month after the end of the previous review period to return the form for processing. The reconsideration period also applies to information requested in order to process the review. An application received after that period is treated like a new application, including any request for prior medical assistance. If the requested information is provided after the reconsideration period expires, a new application may be required.

A review reconsideration period is not applicable to an individual who is approved at review or is denied at review for not meeting eligibility criteria. Any application for review not submitted in a timely manner shall be treated as an initial application. The timeliness provisions of 1407 and subsections apply.

When eligibility has been discontinued for failure to provide requested verification, and the verification is later provided within the review reconsideration period described above, eligibility shall not be reinstated pending completion of the review. The discontinuance shall be rescinded, but no coverage past the end of the review period shall be provided, unless and until the review is fully processed.

7431 Household Failure to Act Timely - A household which timely submits a review form but submits all verification in an untimely manner shall lose the right to a prompt review of eligibility (see 7420) untimely verification is provided.

If the review form is not returned by the end of the current review period, the individual has a three month reconsideration period to return the review form. Individuals will have until the end of the third month after the end of the previous review period to return the form for processing. The reconsideration period also applies to information requested in order to process the review. An application received after that period is treated like a new application, including any request for prior medical assistance. If the requested information is provided after the reconsideration period expires, a new application may be required.

A review reconsideration period is not applicable to an individual who is approved at review or is denied at review for not meeting eligibility criteria. Any application for review not submitted in a timely manner shall be treated as an initial application. The timeliness provisions of 1407 and subsections apply.

When eligibility has been discontinued for failure to provide requested verification, and the verification is later provided within the review reconsideration period described above, eligibility shall not be reinstated pending completion of the review. The discontinuance shall be rescinded, but no coverage past the end of the review period shall be provided, unless and until the review is fully processed.

7432 Agency Failure to Act Timely - If the agency fails to timely process a timely received review form, an administrative processing error may have occurred. Eligibility will continue with coverage at the current level while the review is pending. This may result in one or more months of coverage past the end of the review period before the review is processed [extended month(s)]. Once the review is processed, the extended months of coverage resulting from the delay shall be reevaluated as follows:

1. If the new level of coverage determined by the untimely agency review is the same as the previous coverage, no adjustment to the extended month(s) is required. No administrative error, other than delayed processing, has occurred.

2. If the new level of coverage determined by the untimely agency review is greater than the previous coverage, the extended month(s) must be adjusted accordingly. Coverage for those extended month(s) shall be enhanced to match the newly determined coverage. The agency shall promptly update the coverage and notify the household of the change.

3. If the new level of coverage determined by the untimely agency review is less than the previous coverage, including discontinuance of coverage, an agency error overstated eligibility has occurred for the extended month(s). Agency action must be taken to determine the amount of the overstated eligibility and establish a claim according to 8300 and subsections.

7440 Frequency of Reviews -

7441 Frequency of Reviews - All medical cases shall be reviewed once every 12 months.

7441.01 - For all MAGI programs, the review period should usually correspond to the end of the shortest continuous eligibility period that exists on the case.

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