SR 07-12 Dated 04/07

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revisions to Form 771A, Nursing Facility Care Renewal, and its associated instructions.

POLICY

Revisions to Form 771A, Nursing Facility Care Renewal, and its associated instructions, were precipitated by an analysis of the redetermination application process for institutionalized recipients by the Family Services Specialists specializing in Nursing Facility assistance. Additionally, text related to the treatment of annuities was incorporated into the form based on:

§   the Director’s Memo dated March 6, 2006, subject line, Implementation of Medicaid Eligibility-Related Policy Changes re: DRA 2005; and

§   the imminent release of SR 07-07, retroactively effective to February 8, 2006.

All previous versions of the Form 771A remain valid, however, and may still be used to renew nursing facility assistance.

POLICY MANUAL REVISIONS

No policy manual revisions were required as a result of changes to this form.

FORMS REVISIONS

Form 771A, Nursing Facility Care Renewal, is the mail-in redetermination form used for reviewing continued eligibility for nursing facility care. It was greatly revised to improve clarity and reduce barriers in redetermining eligibilty for nursing facility assistance by:

·   providing recipients with less complicated language in all areas of the application;

·   eliminating text from the form that was not required to determine continued eligibilty;

·   adding a question related to spousal allocation, a separate income section for spouses of institutionalized individuals, and a new statement of understanding related to spousal allowances to ease the process for institutionalized individuals wishing to voluntarily provide monetary allocations to their community spouse or change the current amount they have allocated;

·   adding a separate check box for annuities under the resource section of the renewal form and two new statements of understanding to incorporate the revised annuity policy;

·   adding a question about retention of life estate;

·   adding two new types of medical coverage, Medicare Part D and AARP, under the "Medical Insurance" section; and

·   revising the Your Rights and Responsibilities and Nondiscrimination Notice section of the form to better align with policy and text changes related to the releases of SR 06-07 dated April, 2006, and SR 02-32 dated October, 2002.

IMPLEMENTATION

The version of the Form 771A dated August 1993, SR 93-49, remains valid and any reapplication submitted on this version must be treated accordingly. As such, a certificate of destruction has not been included in the SR as the current stock is not to be destroyed or recycled. When the current stock is depleted, the new version will be printed.

CLIENT NOTIFICATION

No special notification is necessary. District Offices, providers, and clients will begin to use the new form upon receipt.

TRAINING

No special training is planned or needed.

FORMS POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the SR has been posted to the On-line manual.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective May 28, 2007.

This SR will be distributed under separate cover to all hard copy holders of the Forms Manual.

DFA/JBV:s