Special Assistance SA-3320 REDETERMINATION OF ELIGIBILITY

B. Prior to Interview

1. Review the case record(s) to determine:

a. Other items needed to complete the redetermination;

b. The type of interview:

(1) Determine if the recipient or his/her representative can read, write, and understand written forms.

(2) Examine the recipient's or representative's previous signature, educational level, and other problems noted in the record that would help you decide which type of interview to conduct. If the educational level is documented in the record as being ninth grade or below, the recipient or representative may not be a good candidate for a mail redetermination.

(3) If appropriate type of interview is not clear, ask for input from supervisor.

c. The redetermination is done with the recipient or his/her representative. If the recipient is incapable and he/she has no authorized representative, the SA facility administrator/designee may assist the county DSS with completing the redetermination.

2. Complete the following checks prior to the redetermination:

a. On-line computer matches,

b. Print the online SOLQ to verify receipt of SSDI. Update budget if necessary.

c. Contact facility to verify recipient is still a resident of the facility.

d. Do not assume that a facility is still licensed and SA approved. Facility licensure status may change from one SA eligibility redetermination to the next. Check the EIS Facility Inquiry/Update Screen to verify the correct three-digit Facility Code and current licensure status.

e. For SA SCU a/r’s verify the facility also has a licensed Special Care Unit. If they do there will be a “Y” in the “SCU Alzheimers” field of the EIS Facility Inquiry/Update Screen.

f. Print a copy of the EIS Facility Inquiry/Update Screen and place it in the client file.

g. Property checks, and

h. Records at the Clerk of Court, if necessary.

3. Request third party verifications.

4. Send the appropriate appointment notice informing the recipient/representative of the following:

a. Date

b. Time

c. Location

d. Failure to complete the redetermination will result in termination of benefits.

e. Recipient/representative has the right to request a change in date, time, location, and type of interview

5. File a copy of the appointment letter in the record.

C. Conducting the Interview

1. General Instructions

a. Explain to the recipient/representative the redetermination process.

b. Explain to the recipient or his/her representative that he/she has the right to:

(1) Receive assistance if found eligible.

(2) Be protected against discrimination on the grounds of race, creed, or national origin by Title Vl of the Civil Rights Act of 1964. The recipient may appeal if he/she feels there has been such discrimination.

(3) Spend his/her assistance payment as he/she wishes, but it must be in his/her best interest. The intent of this requirement is that “best interest” means paying the facility for cost of care. A substitute payee may be appointed for those individuals who mismanage the payment. Refer to SA-3300, Administration of Checks and Payments.

(4) Receive his/her monthly check in advance until the payment is terminated by appropriate action.

(5) Have any information given to the agency kept in confidence.

(6) Receive a notice of action regarding recipient’s case.

(7) Appeal, if:

(a) Recipient’s assistance will be changed or terminated

(b) Recipient’s payment is incorrect based on the county's interpretation of state regulation.

(c) Recipient’s request for a change in the amount of assistance was delayed beyond 30 days or rejected.

(8) Withdraw from the assistance program at any time if recipient does not want to give the required information or for any other reason.

(9) Reapply at any time, if found ineligible.

c. Discuss other services available and make appropriate referrals.

d. Explain to the recipient or representative that he/she must cooperate in establishing eligibility and failure to cooperate is a reason for termination of SA benefits.

e. Have recipient/representative sign a release of information and explain that it will be used to make necessary contacts.

f. Discuss all eligibility requirements with the recipient or representative and document the answers in the DAAS-8190-NS, Special Assistance Workbook for Non-SSI Recipients

g. If recipient is an SAD recipient in a Carolina Access county, discuss Carolina Access and ensure that the recipient is linked to the correct provider or otherwise exempt.

h. Recipient/representative must sign the redetermination document.

i. Inform the recipient/representative of items needed to complete the redetermination and if the information is NOT received within ten workdays after the interview, his/her SA benefits will be terminated.

j. Inform the recipient that he/she will receive a notice of action regarding the results of his/her redetermination.

2. Face-to-Face Redetermination

a. The recipient or his/her representative may have other persons participate in the interview if he/she wishes. If the interview is held in an SA facility or the representative's home, remember to protect the right to privacy.

b. The county DSS must visit the SA facility in ten percent of cases due for review each month.

c. If a visit is planned, the recipient or representative must be informed prior to the visit.

d. Inform the recipient/representative, in writing, of information needed to complete the redetermination.

e. Notify recipient/representative that if information is not received within ten (10) workdays SA benefits will be terminated

3. Telephone Redetermination

a. Telephone recipient/representative on the date and at the time specified on the appointment notice, unless he/she has requested a change in the appointment.

b. Send the recipient the redetermination form and instructions, along with any other forms requiring completion of the review (i.e., consent form).

c. Enclose a self-addressed envelope to facilitate the return of the forms.

d. Notify the recipient in writing of the date that all forms above must be returned.

e. Notify recipient/representative that if information is not received within ten (10) workdays SA benefits will be terminated.

4. Mail Redetermination

a. Send the recipient/representative the redetermination form and instructions, along with any other forms, requiring completion of the review, i.e. consent form.

b. Enclose a self-addressed envelope to facilitate the return of the forms.

c. Notify the recipient in writing of the date that all forms above must be returned.

d. Notify recipient/representative that if information is not received within ten (10) workdays SA benefits will be terminated.

D. Completing Redetermination

1. Document the case record regarding the recipient’s statement and all third party verifications.

2. Evaluate ongoing eligibility.

3. Key DSS-8125, EIS Data screen and send appropriate notice,DMA-5002, Approval Notice or DSS-8110, (Adequate or Timely) Your Benefits are Changing.