Special Assistance Administrative Letters

Administrative Letter No. DAAS-05-09 Special Assistance Basic Adult Care Home Rate Change – Oct 2005 (Obsolete 02/20/07, Change Notice 01-07)

Division of Aging and Adult Services
Adult Services Section

Date: September 1, 2005

Subject: Special Assistance Basic Adult Care Home Rate Change

Distribution: County Directors and Special Assistance Supervisors

Effective Date: October 1, 2005

I. Background and Content of Change

Session Law 2005-276 was ratified on August 13, 2005. The law contains a provision to increase the maximum basic Adult Care Home facility rate for State/County Special Assistance for Adults. This change is effective October 1, 2005.

Maximum Basic Adult Care Home Rate Change

The maximum rate for Special Assistance recipients with Ambulation Capacity Code “B” will increase from $1,084 to $1,118.

There is no change in the personal needs allowance, which is $46 for all Special Assistance recipients, including the disenfranchised groups.

The Basic SA/ACH Maintenance Amount for those with Ambulation Capacity Code “B” will increase from $1,130 to $1,164 ($1,118 + $46).

Disenfranchised Groups, Ambulation Capacity Code “D”, “A”, or “S”

1. There is no change in the SA facility rate or the SA/ACH Maintenance Amount for disenfranchised recipients with Ambulation Capacity ‘D’. For this group, the maximum rate is $1,091 and the maintenance amount is $1,137. As of August 2005, there are only 7 Ambulation Capacity ‘D’ recipients. They are receiving SA benefits from Cabarrus, Forsyth, Guilford, Moore, Rowan, and Wake counties.

However, due to the increase in the SA/ACH Maintenance Amount for basic SA adult care homes, all cases in the ‘D’ disenfranchised group must be manually changed by the county DSS SA caseworker to the new basic SA/ACH, Ambulation Capacity ‘B’ rate. This is because the new rate is higher than the disenfranchised “D” rate. Once these changes are completed by the counties there will no longer be a ‘D’ disenfranchised group.

Disenfranchised recipients with Ambulation Capacity Code “D” are those individuals who met the following requirements:

a. The application was taken prior to October 1, 2003, and

b. The recipient resided in an adult care home and was eligible for SA on September 30, 2003, and

c. The recipient’s countable income is less than $1,136.50.

2. There is no change in the 1995 disenfranchised group, Ambulation Capacity Codes “A” and ‘S’. The domiciliary rate for this group is $1,231 and the maintenance amount is $1,277.

Note: Disenfranchised group recipients ‘A’, ‘S’ or ‘D’ recipients may be eligible for the new ACH Special Care Unit (SCU) rate effective October 1, 2005 (Ambulation Capacity code ‘C’). See Administrative Letter 05-08 for instructions.

Automated Update for Ongoing Cases

On the night of August 26, 2005, EIS automatically updated active SAA and SAD cases with an Ambulation Capacity code “B” to reflect the new basic SA/ACH rate and the new maintenance allowances effective October 1, 2005. Do not send a notice for the October checks. A notice will be mailed with the September checks. A copy of the notice is attached in Figure 1.

Active Case Records with Ambulation Capacity Code “B”

1. For each active SAA or SAD case in EIS with an Ambulation Capacity of “B” and Total Countable Income of $1,163.50 or less, EIS will:

Change the Domiciliary Rate to $1,118.

Change the Maintenance Amount to $1,164.

EIS will update the Monthly Payment Amount by subtracting Total Countable Monthly Income from the new Maintenance Amount of $1,164 (minus any Grant Recoupment) and rounding the difference to a whole dollar. The Payment Effective Date will change to October 1, 2005.

A case profile will be mailed for each case updated.

Updates for all other active SA/ACH Cases

A. Active Case Records with Ambulation Capacity Code “D”

1. EIS will not update active SAA or SAD case in EIS with an Ambulation Capacity of “D”. Beginning August 30, review these cases manually to determine any increase in the SA payment effective October 1, 2005 and ongoing when calculated at the new ‘B’ rate.

a. Recalculate the Monthly SA Payment Amount by subtracting Total Countable monthly income from the new Maintenance Amount of $1,164 (minus any Grant Recoupment) and rounding to the nearest whole dollar.

b. Change the SA payment amount to the new ‘B’ payment amount, and with the payment effective date of October 1, 2005.

c. Change the Domiciliary Rate to $1,118.

d. Change the Maintenance Amount to $1,164.

e. Change the Ambulation Capacity Code “D” to “B”.

f. Send a DSS-8110/DSS-8110s Adequate Notice, Change in Benefits notifying the recipient of the increased SA payment amount.

Active Case Records With Ambulation Capacity Codes ‘A’, or ‘S’

EIS will not update cases with Ambulation Capacity ‘A’, or ‘S’. Review these cases manually to determine any change. As of August 2005, there is only 1 Ambulation Capacity ‘A’ recipient, receiving benefits from Durham County. There are only 5 Ambulation Capacity ‘S’ recipients. They are receiving SA benefits from Avery, Buncombe, Columbus, Johnston, and Sampson counties.

EIS will create a report to identify disenfranchised cases. DHREJA SA RATE INCR-A&S DISEN CA identifies case records with Ambulation Capacity ‘A’ or ‘S’.

Cases with Ambulation Capacity ‘A’ or ‘S’ cannot be changed. Contact the SA Program Coordinator for assistance if there is a change in income that affects ambulation capacity for this disenfranchised group.

III. Applications

Application Pending on October 1, 2005 - Effective Date Prior to October 1

For applications pending on October 1, 2005 with an effective date prior to October 1, approve the application with a Payment Effective Date of October 1, 2005.

If Total Countable Monthly Income is $1,163.50 or less, approve the case as Ambulation Capacity Code ‘B’ with a Maintenance Amount of $1,164 and a Domiciliary Rate of $1,118.

Authorize months prior to October 2005 in the Retro 1 and 2 fields, using the 2004 SA/ACH maintenance amount of $1,130.00.

Application Pending on October 1, 2005 - Effective Date of October 1 or Later

For applications pending on October 1, 2005 with an effective date of October 1 or later, approve the case as Ambulation Capacity Code ‘B’ only if income is $1,163.50 or less. Do not approve applications with income greater than $1,163.50.

Applications Taken On or After October 1, 2005

Use the new Basic SA/ACH Maintenance Amount and Domiciliary Rate for all applications taken on or after October 1, 2005.

IV. Reports

The following reports will be available in NCXPTR on August 27, 2005. Follow the instructions below for each report. Reports are sorted by county and by district number within the county. Recipients in each district number are listed in alphabetical order by last name with case ID and county case number.

A. Audit Report (DHREJA SA RATE INCR–AUDIT REPORT)

There will be a list of those cases that were correct and were automatically updated by EIS. The report includes the old and new payment amounts and the old and new Total Countable Monthly Income. Review the cases to ensure the revised payment is correct.

If the payment is incorrect (usually because changes occurred that were not keyed prior to August 26 or it was too late to follow “pull check” procedures), recalculate the payment following budgeting procedures. Notify the recipient of any change using the appropriate notice.

B. Case Profiles (DHREJA SA RATE INCR–CASE PROFILE)

In addition to paper profiles, a case profile will be in NCXPTR for each case updated by EIS.

C. Error Report - Cases Not Updated (DHREJA SA RATE INCR–ERROR REPORT)

The cases listed on the error report were not updated by EIS. Review each case on the error report and manually compute the payment for October and ongoing months. Follow the budgeting procedures in SA-3220. Update the case and send the appropriate notice for any changes.

The following is a description of the error messages:

AMB CAP NOT ‘B’, ‘D’, ‘A’, ‘S’, or ‘H’: These are cases without a correct SA Ambulation Capacity Code in EIS. When updating these cases, ensure that the correct Ambulation Capacity Code is entered.

MAINT NOT $1,130: These are cases with Ambulation Capacity ‘B’ and the Maintenance Amount does not equal $1,112.

MAINT NOT $1,137: These are cases with Ambulation Capacity ‘D’ and the Maintenance Amount does not equal $1,137.

MAINT NOT $1,277: These are cases with Ambulation Capacity ‘A’ or ‘S’ and the Maintenance Amount does not equal $1,277.

DOM RATE NOT $1,084: These are cases with Ambulation Capacity ‘B’ and the Domiciliary Rate does not equal $1,066.

DOM RATE NOT $1,091: These are cases with Ambulation Capacity ‘D’ and the Domiciliary Rate does not equal $1,091.

DOM RATE NOT $1,231: These are cases with Ambulation Capacity ‘A’ or ‘S’ and the Domiciliary Rate does not equal $1,231.

PAYMT NOT EQUAL DIFF: These are cases where the Payment Amount does not equal Maintenance Amount minus Total Countable Monthly Income minus Grant Recoupment Amount.

TOT MO INC NOT BAL: These are cases where the total of the RSDI, SSI, and Other Unearned Income amounts do not equal the Total Countable Monthly Income plus $20.

UNEARN INC = ZERO: There is no entry for Unearned Income in EIS.

SSI AND RSDI = ZERO: There are no entries for SSI and RSDI income.

CASES PENDING: These are cases that contain a pending DSS-8125.

Disenfranchised Cases With Ambulation Capacity Code ‘A’ or ‘S’

(DHREJA SA RATE INCR-A&S DISEN CA)

This is a list of cases with Ambulation Capacity Code “A” or “S” after the update. Once the window for changing Ambulation Capacity has closed, the report will show the cases remaining with Ambulation Capacity Code “A” or “S”.

Disenfranchised Cases With Ambulation Capacity Code ‘D’

(DHREJA SA RATE INCR-D DISEN CASE)

This is a list of cases with Ambulation Capacity Code ‘D’ after the update.

Listing of Potential Zero Pay Cases (DHREJA SA RATE INCR–POTE ZERO PA)

As a result of the rate change, some current recipients may become zero pay cases (cases with a Payment Amount of $1.00, $2.00, $3.00 or $4.00). These cases are not automatically updated in EIS. Manually compute the new payment for October and ongoing months following budgeting procedures in SA-3220. Update the case and send the appropriate notice.

If you have any questions regarding this information, please contact your Adult Programs Representative or either Brenda Porter, Special Assistance Program Coordinator, or Geoff Santoliquido, Special Assistance Program Administrator, at 919-733-3818.

Sincerely,

Karen E. Gottovi

Director

IMPORTANT NOTICE TO

RECIPIENTS OF SPECIAL ASSISTANCE FOR ADULTS (SA) IN ADULT CARE HOMES

The 2005 session of the North Carolina General Assembly approved a change in the rate for Adult Care Homes for most recipients of Special Assistance. Beginning October 1, 2005, the rate that you pay the facility each month is increased from $1,084 to $1,118. Your SA check may be increased beginning in October 2005 because of the increase in the rate you pay the facility.

Exception: If you have been paying the facility $1,091 per month, your rate will increase to $1,118 if your countable monthly income is less than $1,164. If the rate you pay the facility decreases, your SA check will also decrease.

Hearing Rights: If you disagree with this decision, you have a right to ask for a hearing. To ask for a hearing, call or write your caseworker within sixty (60) days, that is by November 1, 2004. If you do not ask for a hearing by that date, you cannot have a hearing. A local hearing will be held within 5 days of your request unless you ask for it to be postponed for good reason for an additional 10 days. The hearing will establish whether this action was correct. Then, if you think the decision in the local hearing was wrong, call or write your caseworker within 15 days of the local hearing to ask for a second hearing before a state hearing officer.

You may have someone speak for you at your hearing, such as a relative or an attorney obtained at your expense. Free legal services may be available in your community. Contact your caseworker for information on free legal services.

If you ask, your caseworker will show you and the person speaking for you your eligibility record before your hearing. You may ask to see other information used at the hearing.

DAAS Administrative Letter 04-11

Figure 1

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