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Adult Medicaid Manual MA-2530 BLindness M-SB

II. SAB Authorization (DSB-7209)

A. Verification of Receipt of SAB

1. When an SAB payment or payment revision is authorized, the DSB sends the DSB-7209 with a copy of the SAB Budget DSB-7207 to the county department of social services for the county director’s signature.

2. After the county director has signed the DSB-7209, the white and yellow copies of the DSB-7209 are returned to DSB. The pink copy and the DSB-7209 are to be routed to the county income maintenance director or supervisor for action and must be filed in the eligibility record as verification of receipt of SAB.

3. DSB often authorizes a blind individual for a one-time SAB payment to pay for a specific service; i.e., a hearing aid for an individual over age 21 in an NF. Payments are authorized on the DSB-7209. A note is written at the top of the DSB-7209 stating, "one-time payment only".

REVISED 05/01/05 – CHANGE NO. 16-05

(II.A.3.)

Individuals receiving this type of SAB payment are not automatically eligible for Medicaid because they will not receive SAB on an ongoing basis.

4. DSB authorizations are not completed for change in payment resulting from legislative increases for rest home rate change and COLA increases for Social Security (SSA) and Supplemental Security Income (SSI.) The payee is notified by letter.

B. SAB Check Register

Each month DSB sends an SAB Paper Check Register to the county. The check register lists each SAB payment made to residents of that county and is mailed for receipt by the first week of the month for which the payments listed are issued. The check register gives the following information:

1.	Name of Recipient
2.	Address
3.	Social Security Number
4.	SAB review date
5.	Amount of SAB payment - Listed in the column labeled, "ST. SSA."
6.	Amount of Social Security payment
7.	Amount of SSI payment
8.	Code for living arrangement:
		In own home or rental quarters		01
		In household of another		02
		In medical institution:
			Mental Hospital	21
			Chronic Disease Hospital	22
			Skilled Nursing Home	23
			Intermediate Care Facility	24
			Other Medical Institution	25

In Non-medical institution:
	Room and Board Facility	31
	Foster Care Home	32
	Domiciliary Care Facility	33
	Other Institution	34
In group quarters containing 5 or more persons unrelated to person in charge		99

REVISED 05/01/05 – CHANGE NO. 16-05

(II.)

C. Documentation of Receipt of SAB

Document receipt of SAB as follows:

1. Enter on the DMA-5008/5007 the method used to verify the SAB payment.

2. File a copy of the DSB-7209 in the eligibility case record.