Sunflower HCBS POC Monthly Calculations

Hayden Parker

SUNFLOWER’S HCBS POC MONTHLY CALCULATIONS

This announcement does not apply to I/DD HCBS

Beginning June 1, 2014, Sunflower Health Plan will use a more accurate calculation for monthly Plans of Care (POC) in Home and Community Based Services. The new calculation will use 4.5 weeks in each month instead of 5 weeks per month. The change does not apply to I/DD HCBS.

This scheduled change does not impact the member’s weekly service units. The new equation will contain a more accurate number for averaging the weeks in a month.

For example: John Smith will continue to receive 10 units of personal care weekly as noted on his Needs Assessment. The new calculation for the monthly personal care units will be: 10 units per week x 4.5 weeks = 45 units per month. In comparison, this has previously been calculated as: 10 units per week X 5 weeks = 50 units per month.

The State’s fee-for-service system previously used 5 weeks for every month of the year. The new 4.5 weeks per month will give us a number closer to the intended amount based on the weekly allocation. Please note that a 31-day month is still only 4.3 weeks (less than the 4.5 weeks we will be calculating).

The new Sunflower HCBS POC multiplier is consistent with the calculation used by one other KanCare health plan (Amerigroup).

Providers in Sunflower will use the new 4.5-week multiplier in non-I/DD HCBS needs assessments beginning June 1, 2014.

This change is not an appealable event as a POC or service reduction, as it is only a change in the method to more accurately calculate weekly units of service into a monthly total allocation.

For more information, call the Sunflower Provider Service Center at 1-877-644-4623