Kan. Admin. Regs. § 28-4-401 - Responsibilities of individuals who apply for or who receive services
(a) Each applicant
shall fulfill the following requirements:
(1)
Supply financial, insurance, and family information essential to the
establishment of eligibility within 30 days of the request for service, on
forms prescribed 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) the eligible
person's address;
(B) the number
of persons living in the home;
(C)
marital status of 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 report, within 10 working days of enrolling, the following
information:
(1) The eligible person's
medicaid 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 to the managed care provider or at the time of subsequent
enrollment or change in enrollment in the managed care provider arrangement.
(c) Each eligible
person 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
perform the following actions:
(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;
(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 services for children with special health
care needs program; and
(6) submit
any bills received for prior-authorized services to the secretary within six
months of the date of service.
Notes
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