Children's Waiver Oversight and Monitoring of K-codes and Assessments

  • Notice is also available in Portable Document Format (PDF)

To: Health Homes Serving Children and C-Yes
Date: Effective: Immediately (12/6/2024), UPDATED April 30, 2025

UDPATE: The following is to clarify when and what needs to be reported to the Department of Health, Capacity Management Team as well as updated language surrounding Fair Hearings as noted below. Updates are highlighted in yellow.

To reduce duplication, there are several instances when the Health Home care manager no longer needs to report to Capacity Management Team, however this does not negate the Health Homes/C-YES responsibility to notify the Capacity Management Team of ALL discharges using the prescribed excel format, also known as the discharge list, submitted on a regular cadence (weekly, bi-weekly, monthly). C-YES must continue to notify Capacity Management via SFT.

Health Homes and CYES must ensure that their network Care Management Agencies/Care Managers are following the Health Homes & Home and Community Based Services (HCBS) Notices and Fair Hearings Policy HH0004.

The Department of Health, Capacity Management Team will be taking the following oversight and monitoring steps to ensure appropriate HCBS Children's Waiver enrollment and Restriction Exception (R/E) Coding, if not otherwise notified by the Health Home or CYES:

  1. Any child that does not have active Medicaid will have their R/RE HCBS Children's Waiver "K -codes" ended 90 days after the Medicaid has expired.
  2. Any child that was found HCBS "Ineligible" will have their K-codes ended 30 15 days following the ineligible determination if no Fair Hearing with Aid to Continue (Removed Language: Information has been entered within UAS (or MAPP HHTS once live) or requested by the HH/CMA) has been requested by the child/family.
  3. Any child that has an expired HCBS Eligibility Determination assessment will have their K- codes ended 15 days following the expiration date if no Fair Hearing with Aid to Continue has been requested. Please note previous announcement, new K-codes will automatically have 365 days expiration date from the previous HCBS Eligibility outcome date.

PLEASE NOTE that a Health Home and CYES may be reached out to by the Capacity Management Team if either of the below occur:

  1. Children have a duplicate record within UAS
    • ALL assessments conducted within UAS (especially reassessments) MUST have a search of the child's information (Name, Date of Birth, CIN) prior to creating a new child's record withing UAS. The Capacity Management Team receives information from the UAS and can see when a new child record is created within UAS as a duplicate record.
  2. Information for two (2) different children are on the same record within UAS
    • All UAS assessment should also be reviewed prior to completion to ensure that the assessment was conducted for the correct child. The Capacity Management Team receives information from the UAS and can see when an incorrect child's name or CIN is entered on another child's UAS record.