Does the member have KHS qualifying AXIS I diagnosis and meet SED determination & have qualifying CAFAS/PECFAS & CBCL scores?

The member is eligible to receive Community Based Services.

Does the Client meet the age criteria? If age exception denied, not eligible.If NO, submit exception to SRS. If approved, go to STEP 3.

Complete Financials and 3161 and submit to SRS. Submit a new ePOC to KHS.

PRTF approved or alternative services are O�ered.

PRTF CBS Waiver Flowchart- Accessing & Continuation of Services -

Note: Contact SRS for exceptions to the above process.

The Wrap Around Team meets for the Annual Evaluation (before the one year anniversary date of the Family Choice Date from STEP 6 to evaluate if the member continues to meet Clinical Eligibility requirements. The clinician completes the Annual Evaluation of Level of Care form to determine Continued eligibility.

WAF will complete the Quarterly Reviews of the POC every 90 days. WAF will make any amendments/changes to the POC if applicable. A new monthly budget must be submitted on the ePOC to re�ect such changes.

WAF will submit the Electronic Plan of Care (ePOC) to the identi�ed agency (KHS/SRS) within 60 days of the family signing the Family Choice Assurance Document also known as the Family Choice Date.

Has CBST been completed? Has PRTF screen been completed? Is criteria met for PRTF?

Has PRTF screen been Requested? Submit Access Form to verify availability and bookmark slot.

Has the family chosen the PRTF CBS Waiver over PRTF treatment?

If No, does not qualify.

YES

Wrap Around Facilitator (WAF) from the CMHC meets with the family and treatment team to develop POC. Ensure that PRTF Specialized Waiver services are in place and available. (Must include Wrap Around Facilitation) Team will meet as needed to amend PO

Does the member continue to meet Clinical Eligibility?

NO

YES

YES

YES

NO

NO

NO

NO Turn in the 3161 to SRS with the result of the Annual Review.

YES

- Complete PRTF Clinical/Finance Eligibility. Submit 3160 to SRS.- Has the parent/guardian signed the Family Choice Assurance Document?- Wrap around facilitator to develop interim budget from CBSP.

1

2

3

4

5

6

7

10

8

9

Does the member have KHS qualifying AXIS I diagnosis and meet SED determination & have qualifying CAFAS/PECFAS & CBCL scores?

The member is eligible to receive Community Based Services.

Does the Client meet the age criteria? If age exception denied, not eligible.If NO, submit exception to SRS. If approved, go to STEP 3.

Complete Financials and 3161 and submit to SRS. Submit a new ePOC to KHS.

PRTF approved or alternative services are O�ered.

PRTF CBS Waiver Flowchart- Accessing & Continuation of Services -

Note: Contact SRS for exceptions to the above process.

The Wrap Around Team meets for the Annual Evaluation (before the one year anniversary date of the Family Choice Date from STEP 6 to evaluate if the member continues to meet Clinical Eligibility requirements. The clinician completes the Annual Evaluation of Level of Care form to determine Continued eligibility.

WAF will complete the Quarterly Reviews of the POC every 90 days. WAF will make any amendments/changes to the POC if applicable. A new monthly budget must be submitted on the ePOC to re�ect such changes.

WAF will submit the Electronic Plan of Care (ePOC) to the identi�ed agency (KHS/SRS) within 60 days of the family signing the Family Choice Assurance Document also known as the Family Choice Date.

Has CBST been completed? Has PRTF screen been completed? Is criteria met for PRTF?

Has PRTF screen been Requested? Submit Access Form to verify availability and bookmark slot.

Has the family chosen the PRTF CBS Waiver over PRTF treatment?

If No, does not qualify.

YES

Wrap Around Facilitator (WAF) from the CMHC meets with the family and treatment team to develop POC. Ensure that PRTF Specialized Waiver services are in place and available. (Must include Wrap Around Facilitation) Team will meet as needed to amend PO

Does the member continue to meet Clinical Eligibility?

Kansas Health Solu t ions

NO

YES

YES

YES

NO

NO

NO

NO Turn in the 3161 to SRS with the result of the Annual Review.

YES

- Complete PRTF Clinical/Finance Eligibility. Submit 3160 to SRS.- Has the parent/guardian signed the Family Choice Assurance Document?- Wrap around facilitator to develop interim budget from CBSP.

1

2

3

4

5

6

7

10

8

9

Has the family chosen the PRTF CBS Waiver over PRTF treatment?5

4 Has CBST been completed? Has PRTF screen been completed? Is criteria met for PRTF?

Turn in the 3161 to SRS with the result of the Annual Review.

Complete Financials and 3161 and submit to SRS. Submit a new ePOC to KHS.

Does the member continue to meet Clinical Eligibility?10The Wrap-Around Team meets for the Annual Evaluation (before the

one year anniversary date of the Family Choice Date from ) to evaluate if the member continues to meet Clinical Eligibility requirements. The clinician completes the Annual Evaluation of Level of Care form to determine Continued Eligibility.

9

WAF will complete the Quarterly Reviews of the POC every 90 days. WAF will make any amendments/changes to the POC if applicable. A new monthly budget must be submitted on the ePOC to re�lect such changes.8

WAF will submit the Electronic Plan of Care (ePOC) to the identi�ied agency (KHS/SRS) within 60 days of the family signing the Family Choice Assurance Document also known as the Family Choice Date.

7

If age exception denied, NOT eligible.

If NO, submit exception to SRS. If approved, go to

PRTF CBS Waiver FlowchartAccessing & Continuation of Services

Does the member have KHS qualifying AXIS I diagnosis and meet SED determination & have qualifying CAFAS/PECFAS & CBCL scores?1

Does the Client meet the age criteria?2

Kansas Health Solu t ions

The member is eligible to receive Community-Based Services.

YES

If NO, does not qualify.

YES

YES

Note: Contact SRS for exceptions to the above process.

Complete PRTF Clinical/Finance Eligibility. Submit 3160 to SRS.Has the parent / guardian signed the Family Choice Assurance Document?Wrap-Around Facilitator to develop interim budget from CBSP.

NO PRTF approved or alternative services are offered.

3

Has PRTF screen been requested? Submit Access Form to verify availability and bookmark slot.3

NO

Wrap-Around Facilitator (WAF) from the CMHC meets with the family and treatment team to develop POC.

Ensure that PRTF Specialized Waiver services are in place and available. (Must include Wrap Around Facilitation) Team will meet as needed to amend POC.

6

NOYES

6

If No, does not qualify.

PRTF CBS Waiver FlowchartAccessing & Continuation of Services Kansas Health

Solu t ions

1Does the member have KHS qualifying AXIS I diagnosis and meet SED determination & have qualifying CAFAS/PECFAS & CBCL scores?

Has PRTF screen been Requested? Submit Access Form to verify availability and bookmark slot. 3

Has CBST been completed? Has PRTF screen been completed? Is criteria met for PRTF? 4

Wrap Around Facilitator (WAF) from the CMHC meets with the family and treatment team to develop POC.

Ensure that PRTF Specialized Waiver services are in place and available. (Must include Wrap Around Facilitation) Team will meet as needed to amend POC.6

WAF will submit the Electronic Plan of Care (ePOC) to the identified agency (KHS/SRS) within 60 days of the family signing the Family Choice Assurance Document also known as the Family Choice Date. 7

WAF will complete the Quarterly Reviews of the POC every 90 days. WAF will make any amendments/changes to the POC if applicable. A new monthly budget must be submitted on the ePOC to reflect such changes. 8

The Wrap Around Team meets for the Annual Evaluation (before the one year anniversary date of the Family Choice Date from to evaluate if the member continues to meet Clinical Eligibility requirements. The clinician completes the Annual Evaluation of Level of Care form to determine Continued eligibility. 9

Does the member continue to meet Clinical Eligibility?

10

Complete PRTF Clinical/Finance Eligibility. Submit 3160 to SRS.Has the parent/guardian signed the Family Choice Assurance Document?Wrap around facilitator to develop interim budget from CBSP.

YES

NO

YES

Does the Client meet the age criteria?

2 If age exception denied, Not eligible.

If NO, submit exception to SRS. If approved, go to 33

Turn in the 3161 to SRS with the result of the Annual Review.

Complete Financials and 3161 and submit to SRS. Submit a new ePOC to KHS.

NO PRTF approved or alternative services are Offered.

Has the family chosen the PRTF CBS Waiver over PRTF treatment?

5

NO

Note: Contact SRS for exceptions to the above process.

YESThe member is eligible to receive Community Based Services.