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I. Background and Content of Change
II. Entering SAB Cases as SA into the Eligibility Information System (EIS)
IV. Manual Approval Notice Required for All SAB Transition Approvals
V. Applications On or After September 1, 2010
Division of Aging and Adult Services
Administrative Letter No. 10 – 15, Counties Receiving Special Assistance for the Blind Cases
N.C. Division of Aging and Adult Services, Adult Services Section
Date: |
August 10, 2010 |
Subject: |
Counties Receiving Special Assistance for the Blind Cases |
Distribution: |
County Directors Special Assistance Supervisors Adult Services Supervisors |
Effective Date: |
September 1, 2010 |
Alamance |
Cleveland |
Gaston |
Lee |
Orange |
Vance |
Alexander |
Craven |
Guilford |
Lincoln |
Pasquotank |
Wake |
Buncombe |
Cumberland |
Halifax |
Martin |
Pender |
Watauga |
Burke |
Durham |
Harnett |
Mecklenburg |
Person |
Wayne |
Cabarrus |
Franklin |
Haywood |
Moore |
Robeson |
Wilkes |
Catawba |
The Special Assistance for the Blind Program (SAB) is being consolidated with the State/County Special Assistance for Adults (SA) Program. Formerly administered by the Division of Services for the Blind (DSB), the SAB Program will now be administered by the Division of Aging and Adult Services (DAAS). This change, enacted by the North Carolina General Assembly in Session Law 2010-31 (Senate Bill 897), was ratified on
June 30, 2010. The consolidated SA Program name has been statutorily changed from State/County Special Assistance for Adults (SA) to State/County Special Assistance to include the eligibility of children under age 18 who are legally blind.
Effective September 1, 2010, DAAS will administer the SAB Program under the existing SA Program. Thirty-one county DSSs will be responsible for the existing SAB caseload of sixty-nine. All county DSSs will be responsible for new applications for individuals who would have previously applied through the DSB.
This administrative letter provides instructions to county DSSs for transitioning current SAB recipients into the SA program. One notable change is the eligibility of children under age 18 who are legally blind and reside in Specialized Community Residential Centers (i.e., those that are not ICF/MR Medicaid facilities). These facilities are licensed under
N.C.G.S. 122 C and are defined in 10A NCAC 27G. 2101. Recipients under age 18 reside in Holy Angels in Belmont or in Hilltop Home in Raleigh. Minor recipients, like all SA recipients, have various counties of residence for SA purposes, which may differ from the county in which the facility where they reside is located.
The thirty-one county DSSs will soon begin receiving paper case files for the existing SAB caseload of 69 individuals (adults and children). Case records will be sent to counties securely via FedEx to the attention of the SA Supervisor. Attachment 1 provides a list of counties and the number of adult and minor cases you will receive. All case files should be received in the county DSSs by September 1, 2010.
The week of August 9, 2010 each recipient and each facility, where an SAB recipient resides, will receive a letter explaining the transition and providing contact information for the county DSS where the case will be maintained. These letters are provided for your information as Attachments 2 and 3 to this Administrative Letter.
Each SAB recipient currently receives Medicaid and is in EIS under the MAD, MSB, or MAB program category and not under SAA or SAD. Because the SAB cases are not currently in EIS as SAA or SAD, changes have been made to EIS to allow these cases to be entered. Because of this change in program category in EIS, a new Medicaid card will be issued.
A. Beginning September 1, 2010, county DSSs will complete an “Administrative” SA reapplication in EIS (DSS-8124) using the current Medicaid case ID for each SAB recipient and will approve the case for SAA or SAD. The EIS disposition date cannot be later than September 27, 2010.
B. Each county will use the information from the previous DSB paper case file received from DAAS to complete the DAAS-8190S/NS application workbook for each SAB recipient and will authorize assistance under SA.
DAAS is not requiring the recipient/authorized representative to sign the 8190S/NS for the transition to the SA program. Instead the IMC will write “SAB transition case” in the applicant/representative signature space. Date the DAAS-8190S/NS the date it is completed by the IMC.
Below is a list of forms that are found in the DSB paper SAB case file that caseworkers will use to complete the transition of the case to SAA or SAD.
1. DSB-7204 – Determination of Eligibility for Special Assistance for the Blind: This is the application booklet and includes general demographic information and information regarding income and resources. This form also includes the rights and responsibilities and consent to release Social Security information.
2. DSB-7207 – Verification of Eligibility – Budget: This form shows countable income, the verified Medical Care Special (MCS) monthly expense amount if any, and the SA payment calculation. (See III. below for information on MCS.)
3. DSB-7209 – SAB Authorization: This form shows the approval for payment. It lists the substitute payee, if any. It shows if the action taken was a change, termination, etc.
4. The files also contain copies of the following forms, where applicable to the individual case: FL-2; POA; completed substitute payee forms; verification of MCS expenses; bank statements; and other verification documents. The files also contain correspondence, such as approval letters and other notices.
5. DAAS staff will pull and print the EIS Facility Inquiry/Update Screen for each recipient’s facility and place a copy in the paper DSB case file. The correct facility mailing address for the SA payment will be highlighted in yellow.
However, if the recipient has a substitute payee, that will also be noted and the substitute payee name and address will be provided on a separate spreadsheet page, and labeled as such.
6. If a form is missing or is not current, the IMC must still approve the SAB transition case in EIS based on the current SAB payment amount shown on the most current DSB-7209. The county is not required to complete a redetermination at this time.
C. Once the information from the SAB file has been transferred to the DAAS-8190S/NS, the SA case file has been set up, and the DSS-8124 has been entered in EIS, each SAB case must then be approved on the DSS-8125 as SAA for recipients age 65 and older or as SAD for recipients age 64 and under. SAB transition cases must be keyed in EIS no later than September 27, 2010.
D. Close the existing Medicaid case on the DSS-8125 at the time of the SA approval.
E. The SA payment effective date must be October 1, 2010. Make certain the substitute payee, if any, is identified and keyed in the EIS substitute payee field.
F. The SA payment review period must be October 1, 2010 through September 30, 2011. Redeterminations for these cases will be due in August 2011.
Forty-seven SAB recipients receive an additional SA amount to cover MCS expenses. MCS are over the counter (OTC) expenses prescribed by the recipient’s health care professional that are not covered by Medicare or Medicaid. These recipients will have a variable maintenance amount in EIS that is greater than the SA Basic maintenance amount of $1,228.00.
A. In order to allow this additional payment amount to be included in the SA payment, a new ambulation capacity code “M” is available in EIS effective September 1, 2010.
B. SAB transition cases approved by DSB prior to September 1, 2010 for an additional SAB amount to cover MCS are the only cases that can be approved as SA with an “M” ambulation capacity code in EIS.
No new SA applications taken by county DSS staff on or after September 1, 2010 can be approved as “M” in EIS. No “M” SAB transition cases can be keyed in EIS after September 30, 2010.
C. Complete instructions for MSC cases and budgeting at the time of redetermination will be included in Change Notice 04-10 and will be posted prior to September 1, 2010.
D. To accommodate this difference in budgeting for “M” recipients, a new worksheet, the DAAS-8190S/8190NS, Attachment A, (Attachment 4 below) has been created and is required when completing the SA budget for all “M” recipients.
Example: Existing case with MCS and facility charges the established SA facility Basic rate for room and board.
Maximum SA facility Basic Rate |
$1,182.00 |
Personal Needs Allowance |
46.00 |
Basic Maintenance Amount without MCS |
$1,228.00 |
MCS Costs |
+ 125.00 |
Variable Maintenance Amount |
$1,353.00 |
Total Countable Monthly Income (TCMI) after applicable deductions and exclusions, including the $20 general income exclusion |
- 704.47 |
Difference (round to the nearest dollar) |
$ 648.53 |
SA Payment |
$ 649.00 |
Note: The variable maintenance amount for “M” cases in EIS must equal the total of the TCMI + the SA payment amount rounded to the nearest dollar.
In the example above, this can be checked for accuracy before keying in EIS using the calculations below.
Total Countable Monthly Income (TCMI) after applicable deductions and exclusions, including the $20 general income exclusion |
$ 704.47 |
SA Payment |
+ 649.00 |
Variable Maintenance Amount (round to nearest dollar) |
$ 1353.47 |
Variable Maintenance Amount |
$ 1353.00 |
E. Enter the SA payment amount in the EIS DSS-8125 screen in the payment field.
F. Enter the SA/ACH ‘M’ variable maintenance amount in the maintenance amount field.
A. Because there will be no changes in benefits for any of the SAB transition cases, approve the case using a manual notice. The reason code for approval is A6 “other.”
B. Override the automated notice by entering a ‘Y’ in the notice override field.
C. Complete a manual DSS - 8108 approval notice. The “other “reason for approval should be “SAB Transition to SA.” Please also note on the approval notice that the recipient will receive a new Medicaid card that is effective October 1, 2010 through
September 30, 2011. The policy reference is DAAS Administrative Letter 10 -15.
D. The last day in September for mailing a manual notice is September 27, 2010, and the last day to key the DSS-8125 is September 27, 2010, regular run deadline for September.
Beginning September 1, 2010, county DSSs will determine initial eligibility for new applicants who are requesting SA due to blindness. Changes in the SA Program to accommodate SAB recipients and new applications include the changes in A – E below. These policy changes will be incorporated into the SA Program Manual, along with detailed procedural instructions that will follow in Manual Change Notice 04-10 prior to September 1, 2010.
A. SA payments will be made for qualifying individuals of any age who are legally blind and need assistance to meet their financial needs.
B. Legal blindness must be confirmed by SSI status or through an evaluation by the DSB’s Medical Director.
C. All adult SA recipients will continue to need an FL-2 stating that they require “assisted living or domiciliary” level of care. Specialized community residential centers, where minor SA recipients reside, do not require an FL-2. DAAS is working to determine the type of documentation for level of care that will be required for minors for the SA Program.
D. Individuals under age 18 must be determined legally blind and must reside in a specialized community residential center.
E. Ambulation capacity code “M” is not valid for new applications.
Profiles will be created for each SAB transition case approved in EIS. These cases will appear on reports in which current SAA/SAD recipients are displayed.
If you have any questions regarding this information, please contact your Adult Programs Representative or Brenda Porter at 919-733-3818.
Sincerely,
Dennis W. Streets, Director
DWS/SPM:bp
Attachments:
Attachment 1: SAB case numbers by county
Attachment 2: Letter to facilities with active SAB cases
Attachment 3: Letter to SAB active recipients
Attachment 4: DAAS 8190S/NS Attachment A
Attachment 1 |
|||
County DSS Number of SAB Transition Cases | |||
|
|
|
|
County |
Adult |
Children |
Total |
Alamance |
3 |
|
3 |
Alexander |
1 |
|
1 |
Buncombe |
5 |
|
5 |
Burke |
1 |
1 |
2 |
Cabarrus |
|
1 |
1 |
Catawba |
1 |
1 |
2 |
Cleveland |
|
1 |
1 |
Craven |
1 |
|
1 |
Cumberland |
1 |
3 |
4 |
Durham |
1 |
3 |
4 |
Franklin |
2 |
1 |
3 |
Gaston |
2 |
4 |
6 |
Guilford |
2 |
|
2 |
Halifax |
1 |
|
1 |
Harnett |
|
2 |
2 |
Haywood |
2 |
|
2 |
Lee |
|
1 |
1 |
Lincoln |
1 |
1 |
2 |
Martin |
1 |
|
1 |
Mecklenburg |
|
1 |
1 |
Moore |
1 |
1 |
2 |
Orange |
1 |
|
1 |
Pasquotank |
1 |
|
1 |
Pender |
2 |
|
2 |
Person |
|
1 |
1 |
Robeson |
|
1 |
1 |
Vance |
1 |
|
1 |
Wake |
5 |
7 |
12 |
Watauga |
1 |
|
1 |
Wayne |
|
1 |
1 |
Wilkes |
|
1 |
1 |
August 10, 2010
TO: FACILITIES RECEIVING PAYMENTS FROM RESIDENTS WITH SPECIAL
ASSISTANCE
FROM: Division of Aging and Adult Services
Dennis W. Streets, Director
Division of Services for the Blind
Eddie Weaver, Director
SUBJECT: Consolidation of Special Assistance for the Blind Program with the State/County Special Assistance for Adults Program
Special Assistance for the Blind (SAB) is being consolidated with the State/County Special Assistance for Adults (SA) Program. The SAB Program, currently administered by the Division of Services for the Blind, will now be administered by the Division of Aging and Adult Services, Adult Services Section, which oversees the SA Program. This change was enacted by the North Carolina General Assembly in Session Law 2010-31 (Senate Bill 897), which was ratified on
June 30, 2010. The goal for the consolidation of the two programs is to eliminate duplication and streamline access to services for applicants and recipients of the programs.
The consolidation of the two programs is effective September 1, 2010. All case record information will be at the county department of social services (DSS) where the recipient lived in a private residence prior to entering a facility (their county of residence). SAB recipients have been sent correspondence instructing them to contact the DSS in their county of residence to report any changes in their situation. A copy of the letter to recipients is included as an attachment to this letter. The county DSS income maintenance worker will contact the recipient when it is time for a case eligibility review and redetermination. All new applicants must make an application with the DSS in their county of residence. DSSs in all counties will take courtesy
applications with the permission of the county of residence, if it is more convenient for the applicant.
SAB recipients receiving Medical Care Special payments will continue to receive these payments based on receipts submitted to the DSS case worker at their annual eligibility review and redetermination. No additional Medical Care Special payment cases will be approved under the consolidation of the two programs.
We anticipate a smooth transition. Current SAB recipients should receive a payment from the SA Program in the same amount they received from the SAB Program. Effective
October 1, 2010, recipients will receive the first check from the SA Program, and will no longer receive a check from the SAB Program. Recipients will receive a new Medicaid card with their October SA check. The Medicaid identification number will not change nor will the Medicaid coverage. The new Medicaid cards should be used instead of the old ones beginning
October 1, 2010. Old Medicaid cards should be shredded and discarded.
Any changes in the SA recipient’s situation should be reported to the county DSS which is assigned to handle the case (the DSS in the county of residence). Enclosed with this letter you will find a list of residents in your facility receiving SAB, their county of residence, and the contact information for the county DSS. The DSS listed is the DSS which will now handle the SA case.
If you should have questions concerning this change, please contact either:
Division of Services for the Blind
Cynthia Joos or Debbie Tutor
(919) 733-9744 or 1-866-222-1546
or
Division of Aging and Adult Services
Chris Urso or Brenda Porter
(919)733-3818
or toll-free through the NC CARE-LINE 1-800-662-7030.
Attachments
EW:cj/ddt
DWS:cu
cc: Mary Flanagan Social Services Supervisors
Cynthia Joos Social Workers for the Blind
Suzanne Merrill Debbie Tutor
Chris Urso Brenda Porter
DAAS Adult Programs Representatives Melodee Stokes
DSS Special Assistance Supervisors
August 10, 2010
Dear Special Assistance for the Blind Consumer:
Subject: Consolidation of the Division of Services for the Blind
Special Assistance for the Blind (SAB) Program with the Division
of Aging and Adult Services State/County Special Assistance (SA) Program
The Division of Services for the Blind’s Special Assistance for the Blind (SAB) Program is being combined with the Division of Aging and Adult Services’ State/County Special Assistance (SA) Program. This change is a result of the North Carolina General Assembly passing Senate Bill 897 on June 30, 2010 to eliminate duplication of programs and improve access to services.
The SA Program operates much the same as the SAB Program does. If you reside in a licensed adult care home or specialized community residential center, you will receive a payment from the SA Program in the same amount you received
(Attachment 3, continued)
from the SAB Program. Effective October 1, 2010, will receive your first check from the SA Program, and you will no longer receive a check from the SAB Program. You will receive a new Medicaid card with your October SA check. Your Medicaid identification number will not change nor will your Medicaid coverage. Your new Medicaid card will have new dates. Use the new Medicaid card beginning October, 1, 2010. You should shred and discard the old Medicaid card.
Any changes in your situation should be reported to the county department of social services (DSS) which handles your case. The DSS which handles your case is the last county in which you lived in a private residence. Attached to this letter is an SA contact list, including the addresses for county department of social services. You will hear from your new SA income maintenance case worker when it is time for an eligibility review/redetermination.
The Division of Services for the Blind has enjoyed serving you, and we anticipate a smooth transition with combining these two programs. If you should have questions concerning this change, please contact either:
Division of Services for the Blind
Cynthia Joos or Debbie Tutor
(919) 733-9744 or 1-866-222-1546
or
Division of Aging and Adult Services
Chris Urso or Brenda Porter
(919)733-3818
or toll-free through the NC CARE-LINE 1-800-662-7030.
(Attachment 3, continued)
Sincerely,
Eddie Weaver, Director
Division of Services for the Blind
Dennis W. Streets, Director
Division of Aging and Adult Services
Attachment
EW:cj/ddt
DWS:cu
cc: Mary Flanagan
Cynthia Joos
Debbie Tutor
Suzanne Merrill
Chris Urso
Brenda Porter
Social Services Supervisors
Social Workers for the Blind
DAAS Adult Programs Representatives
DSS Special Assistance Supervisors
Attachment 4
DEPARTMENT OF HEALTH AND HUMAN SERVICES
REVISION IN PAYMENT: Redetermination [ ] Desk Revision [ ]
COUNTY________________________ Date____________ EIS Case ID _ _________
CLIENT Last Name______________________ First Name _____________ ________
Additional Explanation/Comments: ___________________________________________
DAAS-8190S/DAAS8190NS – Attachment A
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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