Special Assistance SA-3310 CHANGES IN SITUATION

II. CHANGES DURING APPLICATION PROCESS

A. Change of Address/Living Arrangement

1. From SA facility to SA facility

a. Verify and document change.

b. Verify new facility code in EIS.

c. Complete DSS-8125, EIS Data Sheet. (No notice is required from County DSS.)

2. From SA facility to Private Living

a. Verify and document change.

b. Evaluate for open/shut SA payments, refer to SA-3220, Budgeting.

c. Send theDMA-5002, Approval Notice, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn, to disposition the application.

d. For SSI applicants complete and send the DMA-5049, Referral to Local Social Security Office, to SSA.

e. For non-SSI applicants, always evaluate for potential Medicaid eligibility and other programs of assistance.

B. Change in Level of Care

1. SA facility Basic (ambulation code B) applicant moves to a Special Care Unit (SCU) for Alzheimer’s (or related disorders).

a. Document the date applicant moved to the SCU.

b. Visit the facility to verify applicant is in a licensed SCU.

c. Verify the diagnosis on the current FL-2 is for Alzheimer’s or a related disorder.

d. Budget using the SCU rate beginning with the date of the move to the SCU. See SA-3200, Resources.

e. When approving the application specify the effective date for the SA SCU payment on the DSS-8108, separately from the SA facility Basic payment effective date.

2. An SA facility SCU applicant moves to an SA facility Basic (ambulation code B) area of the facility.

a. Document the date recipient moved to the SA facility basic section of the facility.

b. Re-budget using the SA facility Basic rate effective the date the a/r moved to a room outside of the SCU. See SA-3220, Budgeting Principles.

c. Send a DSS-8110, Your Benefits Are Changing (Timely) to reduce the SA payment

3. SA facility to Long-Term Care (Not expected to return within 30 days)

a. Document date agency received FL-2/MR-2, Level of Care Recommendation/Mental Retardation Services, in the record;

b. If a bed is available, evaluate for open/shut SA payments, refer to SA-3220, Budgeting. Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn, to disposition application. The SSI applicant must still be evaluated for long-term care Medicaid by appropriate IMC. If the applicant is Non-SSI, he/she must be evaluated for Private Living Medicaid and Long-Term Care Medicaid.

NOTE: If the applicant or representative chooses not to accept the bed, applicant

is no longer eligible for SA.

c. If there is no bed available at the appropriate level of care you may approve SA at the current rate until a bed is located. Review and document placement progress with the appropriate services staff each month until the applicant is placed. (Refer to DSS-8194, Income Maintenance Transmittal Form, for a suggested documentation format on these cases.)

4. SA facility to Hospital Acute Care

a. If the applicant returns to the SA facility within 30 days, continue to process the application.

b. If the applicant is hospitalized for more than 30 days:

(1) Evaluate for open/shut SA payments.

(2) Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn, to disposition application.

(3) For SSI applicants, complete and send DMA-5049, Referral to Local Social Security Office, to SSA.

(4) For Non-SSI applicants, always evaluate for potential Medicaid eligibility and other program assistance, including long-term care Medicaid.

5. SA facility to a Public Institution

When a SA applicant moves from an SA facility to a public institution, take the following steps:

a. If the applicant is admitted to a public institution other than jail or prison and is expected to return to the SA facility within 30 days, continue to process the application.

b. Verify and document change.

c. If the applicant is admitted to a public institution and is not expected to return within 30 days, or if the applicant is incarcerated:

(1) Evaluate for open/shut SA payments, refer to SA-3220, Budgeting.

(2) Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn to disposition application.

(3) For SSI applicants complete and send DMA-5049, Referral to Local Social Security Office, to SSA.

(4) For non-SSI applicants, always evaluate for potential Medicaid eligibility and other programs of assistance.

NOTE: SAD applicants under age 21 (or under age 22, who had their 21^st birthday while in the state mental hospital), and all SAA applicants must be evaluated for Long-Term Care Medicaid.

C. Change in Resources

1. For applicants receiving SSI, complete and send a DMA-5049, Referral to Local Social Security Office to SSA. Refer to SA-3110, Application Processing for instructions for pending an application while awaiting information from SSA.

2. For applicants not receiving SSI, verify and document change in resources according to

instructions in SA-3200, Resources.

a. Record all verifications, including those items that are excluded from resource determination, on forms DAAS-8190-NS, Special Assistance Workbook for Non-SSI Recipients and DAAS-8190-S, Special Assistance Workbook for Non-SSI Recipients, and DMA-5030, Reserve History Sheet.

b. Process all changes in resources and determine if the value of resources affects eligibility (i.e., real property, personal property and liquid assets) in accordance with SA-3200, Resources.

c. If eligibility is not affected by the value of the resource, continue to process the application.

d. If the value of the resources exceeds the resource allowance, send a DMA-5097, Request for Information, along with a statement of countable resources. If resources are reduced to allowable limits within the processing time standards, continue to process the application.

Authorize SA payment effective the month after the month the resource was reduced to the allowable limit and all other eligibility requirements are met. Refer to SA-3110, Application Process, for application processing time standards.

D. Change of Income

A change in income is defined as an acquired source of income, a change in rate or pay that will continue (not fluctuating income), or a termination of an existing source of income. Do not react to change until income is received.

1. For applicants receiving SSI, complete and send a DMA-5049, Referral to Local Social Security Office, to SSA. Refer to SA-3110, Application Process for instructions for

pending an application while awaiting information from Social Security.

2. For applicants not receiving SSI, verify and document change in income according to

instructions in SA-3210, Income.

a. Calculate the amount of the new SA payment. Refer to SA-3210, Income for information on determining base period for changing income during the application process.

b. Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn to disposition application.

c. If applicant is denied for SA payments, always evaluate for potential Medicaid eligibility.

E. Other Changes

1. Unable to Locate

If an applicant moves, but leaves no forwarding address, and you are unable to contact the representative, deny the application. Refer to SA-3110, Application Process.

2. Change in State Residency

a. Evaluate for open/shut SA eligibility. Refer to SA-3220, Budgeting.

b. Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn, to disposition application.

c. For SSI applicants complete and send DMA-5049, Referral to Local Social Security Office, to SSA.

3. Death

a. Verify and document date of death.

b. Evaluate for open/shut SA payments. Refer to SA-3220, Budgeting.

c. Send DSS-8108, Notice of Benefits, or DSS-8109, Your Application for Benefits Is Being Denied or Withdrawn, to disposition application.

d. For SSI applicants, complete and send DMA-5049, Referral to Local Social Security Office, to SSA.

e. For any payments issued after death of applicant refer to SA-3300, Administration of Checks and Payments.