 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||||
| |||||||||||||
Administrative Letter No. 12-12 - Change in the State/County Special Assistance In-Home (SA/IH) Payment Rate
N.C. Division of Aging and Adult Services, Adult Services Section
Date: August 6, 2012
Subject: Change in the State/County Special Assistance In-Home (SA/IH) Payment Rate
Distribution: County Directors
Special Assistance Supervisors
Adult Services Supervisors
Effective Date: July 1, 2012
I. Background and Content of Change
Session Law 2012-142, effective July 1, 2012, increases the SA/IH maximum payment to 100% of the SA Basic payment an individual would be eligible for if he/she were living in an SA facility.
The certified budget for SFY 2012-13 for the SA Program and the county allocations remain the same as SFY 2011-12. The purpose of this letter is to advise how this change affects SA/IH cases.
On August 1, 2012 an edit was added to the Eligibility Information System (EIS) DSS-8125 screen that enables county income maintenance case workers (IMCs) to key an SA/IH payment amount up to 100% of the SA Basic maintenance amount for SA/IH applicant/recipients. This administrative letter outlines the procedures for the IMC and Adult Services case manager to follow to implement this change.
II. Active SA/IH Cases (Ambulation Capacity Code “H”), Maximum SA/IH Payment Effective July 1, 2012
SA/IH recipients may benefit from a reassessment or reevaluation by the Adult Services case manager to determine if an increased payment should be issued due to this change.
A. Steps to determine the need for an increase in the SA/IH payment for SA/IH ongoing recipients effective July 1, 2012.
1. The SA IMC will verify the SA/IH applicant/recipient’s total countable monthly income.
2. The SA IMC will calculate the maximum allowable payment effective July 1, 2012 based on 100% of the SA Basic maintenance amount.
3. The SA IMC will communicate the maximum allowable payment amount to the Adult Services case manager in writing, using the SA/IH Case Management Manual Appendix E, SA/IH Program Interagency Transmittal Form.
The Adult Services case manager will use this information to assess the SA/IH applicant/recipient’s financial needs.
4. The Adult Services case manager, after completing the needs assessment with the applicant/recipient, will notify the SA IMC of the amount of the SA/IH payment/s needed, when approving the SA/IH application or at redetermination using the SA/IH Case Management Manual Appendix E, SA/IH Program Interagency Transmittal Form.
Note: The Adult Services case manager may approve SA/IH payments which are less than the maximum allowable payments, but he/she can never approve SA/IH payments for more than the maximum allowable amount as calculated by the SA IMC.
B. If it is determined by the Adult Services case manager that the SA/IH recipient should receive an increased payment beginning July 1, 2012:
1. For July and August 2012, request supplemental checks on the DMA-5022.
2. Effective September 2012 and ongoing; key the increased payment in the DSS-8125 screen.
3. Send a DSS-8110/DSS-8110s Adequate Notice, Change in Benefits, notifying the recipient of the increased payment amount.
III. Pending SA/IH Applications with a Date of Application Prior to July 1, 2012
A. If eligible, the IMC will determine the maximum allowable SA/IH payment for all months/days prior to July 1, 2012 using the rate of 75% of the SA Basic maintenance amount of $1,228.
B. If eligible, the IMC will determine the maximum allowable SA/IH payment effective July 1, 2012 and ongoing using 100% of the SA Basic payment based on the maintenance amount of $1,228.
C. The IMC will communicate to the Adult Services case manager in writing the maximum allowable payment amount for the partial month and ongoing full months as applicable and based on the 75% rate prior to July 1, 2012 and 100% for July 1 and ongoing using SA IH Case Management Manual Appendix E, SA/IH Program Interagency Transmittal Form .
The Adult Services case manager will use this information to assess the SA/IH applicant’s financial needs.
D. The Adult Services case manager, after completing the needs assessment with the applicant/recipient, will determine the payment amount for both time frames (prior to and on or after July 1, 2012.) The Adult Services case manager will notify the SA IMC of the amount of the SA/IH payment/s needed when approving the SA/IH application using the SA/IH Case Management Manual Appendix E, SA/IH Program Interagency Transmittal Form.
E. The IMC will key the SA/IH payment on the DSS-8125 screen or on the DMA-5022 as appropriate.
F. The IMC will send a manual DMA-5002/DMA-5002s to notify the applicant of the authorized SA/IH payment amount.
IV. Pending SA/IH Applications with a Date of Application July 1, 2012 or Later
A. If eligible, the IMC will determine the maximum allowable SA/IH payment effective July 1, 2012 and ongoing using 100% of the SA Basic payment based on the maintenance amount of $1,228.
B. The IMC will determine maximum partial payments for SA/IH applicants eligible after the first day of the month as follows:
1. Determine the number of days of eligibility by subtracting the date the person became eligible from the number of days in the month and adding one (1).
2. Divide the SA Basic rate, $1,182, by the number of days in the month, and round to the nearest cent. This is the per diem amount.
3. Multiply the per diem amount times the number of days the applicant is eligible.
4. Add the amount in #3 to the personal needs allowance of $46.00. Round to the nearest dollar for the maximum allowable partial payment.
C. The IMC will communicate to the Adult Services case manager in writing the maximum allowable payment amount for the partial month and ongoing full months as applicable based on the 100% of the maintenance amount for July 1, 2012 and ongoing using the SA/IH Case Management Manual Appendix E, SA/IH Program Interagency Transmittal Form .
The Adult Services case manager will use this information to assess the SA/IH applicant’s financial needs.
D. The Adult Services case manager, after completing the needs assessment with the applicant/recipient, will determine eligibility for SA/IH and if eligible, the payment amount. The Adult Services case manager will notify the SA IMC of the amount of the SA/IH payment/s needed using the Appendix E, SA/IH Program Interagency Transmittal Form.
E. The IMC will key the SA/IH payments on the DSS-8125 screen or on the DMA-5022 as appropriate.
F. The IMC will send a manual DMA-5002/DMA-5002s to notify the applicant of the authorized SA/IH payment amount.
V. Redeterminations and Changes in Situation July 1, 2012 or Later
For regular redeterminations and changes in situation, if eligible, determine the maximum allowable SA/IH payment based on 100% of the SA Basic maintenance amount of $1,228 effective July 1, 2012.
1. See II. above for instructions.
2. If the Adult Services case manager approves the SA/IH payment for more than 75% of the SA Basic payment:
a. Request supplemental checks for July and August 2012, on the DMA-5022.
b. Key ongoing September 2012 SA/IH payment on the DSS-8125 screen.
3. Send a manual DSS-8110/DSS-8110s Adequate Notice, Change in Benefits, notifying the recipient of the increased payment amount.
If you have any questions regarding this information, please contact the Special Assistance listserv at specialassistance@dhhs.nc.gov.
Sincerely,
Dennis W. Streets, Director
DWS/SPM/bp
|
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
| |||||||||||||