Kan. Admin. Regs. § 28-4-411

Current through Register Vol. 43, No. 49, December 5, 2024

Section 28-4-411 - Responsibilities of individuals who apply for or who receive assistance

(a) Each applicant shall fulfill these requirements:

(1) supply financial, insurance and family information essential to the establishment of eligibility within 30 days of the request for service, on forms approved by the secretary;

(2) submit written permission on forms prescribed by the secretary for release of information needed to determine medical and financial eligibility; and

(3) report to the secretary changes in any of the following circumstances;

(A) eligible person's address;

(B) the number of persons living in the home;

(C) marital status of the eligible person, parents, or legal guardians;

(D) custody of the eligible person;

(E) medical insurance coverage for the eligible person;

(F) medicaid eligibility or supplemental security income eligibility for the eligible person;

(G) family income or cash assets of more than $500.00 per year; or

(H) other circumstances that affect the special health care needs of the eligible person.

(b) Each eligible person who is enrolled in the department of social and rehabilitation services managed care arrangements shall, within 10 working days of enrolling, report the following information:

(1) the eligible person's medical number;

(2) the name of the managed care provider; and

(3) the name of the eligible person's primary care network physician at the time of application or subsequent enrollment in the managed care arrangement.

(c) Each eligible person under 21 years of age enrolled in medicaid shall participate in the kan-be-healthy program.

(d) Each eligible person enrolled in a managed care arrangement under the medicaid program or an insurance policy shall obtain referrals for care as required by the managed care provider.

(e) Each eligible person shall fulfill these requirements:

(1) obtain prior authorization for services;

(2) apply for insurance, medicaid coverage, supplemental security income or benefits from other sources, when requested;

(3) assign the insurance benefits to hospitals and other providers of service for any medical treatment;

(4) apply the benefits of any non-assignable insurance by making payments to hospitals or other providers of service for items ordered by the attending physician; and

(5) reimburse the secretary for any insurance proceeds sent directly to the recipient if the insurance payment is made for medical treatment provided by the hemophilia program.

(f) Each eligible person shall obtain from one of the comprehensive centers initial and annual evaluations of medical eligibility for the hemophilia program.

(g) Each eligible person shall submit any bills received for prior authorized services to the secretary within six months of the date of service.

(h) Each eligible person shall obtain from one of the comprehensive centers a written prescription for blood products or other efficacious agents and shall provide a copy of the current prescription to the secretary.

Kan. Admin. Regs. § 28-4-411

Authorized by and implementing K.S.A. 65-1,132; effective, T-85-41, Dec. 19, 1984; effective May 1, 1985; amended Dec. 26, 1989; amended Sept. 12, 1997.