Funding and/or Service Reductions/ Terminations B-06

PURPOSE:

The purpose of this policy is to identify the procedures and circumstances in which an individual may have their funding and/or services reduced or terminated.

POLICY:

Sedgwick County Developmental Disability Organization (SCDDO) will ensure intellectual and/or developmental disability (IDD) eligible individuals and community service providers (CSP) are given adequate notice prior to funding and/or service reductions and terminations.

PROCEDURES:

Funding and/or services may be reduced or terminated voluntarily, involuntarily or upon death. Voluntary reductions or terminations can only be initiated by the individual/guardian. Involuntary reductions or terminations may be initiated by the Kansas Department for Aging and Disability Services (KDADS), SCDDO, CSP, or Managed Care Organization (MCO).

1. Voluntarily reductions or terminations to an individual’s funding and/or services may be initiated when they exercise his/her right to formally withdraw from services. The targeted case management provider (TCM) should have the individual/guardian sign the Funding for Services – Requests and Terminations form and submit to SCDDO. If the signature cannot be obtained, the provider should include an explanation of why the signature was not included.

2. Involuntary reductions or terminations to an individual’s funding may be initiated for the following reasons:
   1. Failure to maintain/renew Medicaid: An individual, receiving State Aid funded Day/Residential or HCBS IDD Program funded service(s), does not complete the Medicaid application/renewal. Notification should be submitted to SCDDO per funding committee guidelines.
   2. Failure to use services: services have not been accessed for 15 consecutive days and/or utilization is at less than 75% of the allocation for three consecutive months. Notification should be submitted to SCDDO per funding committee guidelines.
   3. Failure to Complete Functional Assessment: Individuals who have failed to complete the required functional assessment per KDADS policy.
   4. Funding source has been withdrawn or
   5. Eligibility: Individuals who fail to complete an eligibility redetermination or are determined ineligible.
   6. Alternative Placement: Individuals who are incarcerated, institutionalized, or placed in a nursing facility for a period of time that exceeds the limits of a “temporary stay.” A “temporary stay” is defined by the month of entrance and the following two Notification should be submitted to SCDDO per funding committee guidelines.
   7. Medicaid fraud, abuse, neglect or exploitation has been substantiated; contiuned access of funding will be directed by State authority.
3. Involuntary reductions or terminations to an individual’s services may be initiated for the following reasons:
   1. Inappropriate Community Placement: The Secretary of KDADS has determined participation in community services is not appropriate because the individual is presently likely to cause harm to self or others.
   2. Failure to pay or meet monthly IDD Program services client obligation.
   3. Failure to pay or meet financial agreements with chosen CSP.
   4. Failure to maintain contact: Individuals who cannot be contacted despite reasonable attempts, such as failure to respond to a registered letter, made by the CSP or SCDDO.
4. TCM or CSP will submit the Funding for Services – Requests and Terminations form, unless otherwise noted,to SCDDO within five business days of being made aware of the circumstances listed above. Information submitted should include documentation of the CSP’s efforts to work with the individual/guardian to resolve these situations.
5. SCDDO will notify the individual at least 15 business days prior to the reduction or termination of funding advising of the action and appeal rights in writing.
6. If a dispute is filed, no reduction or termination will occur until the dispute resolution and/or the State administrative hearing processes have been completed.

Office of Administrative Hearings

1020 S. Kansas Avenue

Topeka, Kansas 66612-1311

7. If SCDDO determines a reduction or termination should occur, the recommendation will be communicated in writing to KDADS and/or other affected parties. SCDDO will follow State policies and guidelines regarding reduction or termination of funding and services.