SR 09-20 Dated 07/09

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

DFA SIGNATURE DATE:	June 15, 2009
FROM:	OFFICE OF THE DIRECTOR, DFA Joyce St Onge for Terry R Smith
AT (OFFICE):	Division of Family Assistance
TO:	DFA Supervisors NHEP Teams
SUBJECT:	DFA State Office Will Now Verify Medical Exemptions Related to NHEP and the FANF 60-Month Lifetime Limit; Revised Forms 752(State Office), Physician/Clinician Statement of Capabilities, Form 752a, Authorization for Release of Protected Health Information, and Form 752HH(State Office), Physician/Clinician Statement of Necessary Patient Care for a Household Member, and Their Associated Instructions
EFFECTIVE DATE:	July 1, 2009

SUMMARY

This SR:

§ releases changes in the Division of Adult Learning and Rehabilitation (DALR) referral process as released in SR 04-26, dated October 2004, for individuals applying for or receiving:

- an exemption from New Hampshire Employment Program (NHEP) work requirements due to their own or a household member’s medical issue; or

- an extension to the 60-month lifetime limit on receipt of Financial Assistance to Needy Families (FANF), due to their own or a household member’s medical issue; and

§ incorporates the policy released in the Director’s Memo dated April 15, 2009, subject line Division of Adult Learning and Rehabilitation (DALR) Changes & New Medical Exemption Procedures (Form 752 Process), and subsequent amendments to that Director’s Memo.

As of July 1, 2009, DALR will no longer verify medical exemptions related to NHEP work requirements or the 60-month hardship application process. DFA State Office staff began absorbing the core duties currently provided by the DALR Work Capacity Specialists (WCS), on May 1, 2009.

The following forms, and their associated instructions, were updated as a result of the policy changes:

§ Form 752(State Office), Physician/Clinician Statement of Capabilities;

§ Form 752a, Authorization for Release of Protected Health Information; and

§ Form 752HH(State Office), Physician/Clinician Statement of Necessary Patient Care for a Household Member.

FORMER POLICY

NEW POLICY

FANF applicants or recipients who claimed an exemption from NHEP work requirements or requested an extension to the FANF 60-month lifetime limit due to their own or a family member’s medical issue:

§ had to complete Form 752a, Authorization For Release of Protected Health Information;

§ had to have a physician or clinician complete Form 752 or Form 752HH indicating the individual’s ability to fully, partially, or totally participate in NHEP; and

§ was potentially contacted by a DALR WCS who provided case management services and, when appropriate, helped the recipient explore and apply for other programs that might better assist the family.

FANF applicants or recipients who claim an exemption from NHEP work requirements or request an extension to the FANF 60-month lifetime limit due to their own or a family member’s medical issue will still need to complete Form 752a and have a physician or clinician complete Form 752 or Form 752HH, but instead of a DALR WCS reviewing the forms, DFA State Office staff will be receiving and processing the medical exemption or hardship extension claims.

POLICY

As of July 1, 2009, the Division of Adult Learning and Rehabilitation (DALR) will no longer review medical exemptions related to NHEP work requirements or extensions to the 60-month hardship application process. DFA State Office staff has absorbed the core duties currently provided by the DALR Work Capacity Specialists (WCS). As a result of this change, DFA and NHEP offices are no longer divided into the four WCS "catchment" areas of Laconia, Manchester, Nashua, and Portsmouth; all medical exemption packages can now be sent to, and will be processed by, DFA State Office in Concord.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Text in New HEIGHTS-generated client letters AE0070, Medical Review Process Notice, and AE0071, Notice of Medical Review Decision, has been changed to direct client questions to State Office. The AE0070 contained the new text as of May 1, 2009 and the AE0071 contained the text as of May 15, 2009. Both letters have been released under separate cover by New HEIGHTS.

DESCRIPTION OF REVISIONS MADE TO FORMS

Form 752(State Office), Physician/Clinician Statement of Capabilities, Form 752a, Authorization for Release of Protected Health Information, and Form 752HH(State Office), Physician/Clinician Statement of Necessary Patient Care for a Household Member, were all revised to remove references to the DALR WCS or one of the catchment areas of Laconia, Manchester, Nashua, or Portsmouth, and the associated catchment area address. The DALR WCS text was replaced with "TANF Program Analyst," which is the title of the State Office position that will now be managing the medical exemption process, and all addresses were replaced with the State Office address of 129 Pleasant St in Concord, as well as the new contact phone number information.

Additionally, text was added to each form to collect the FANF individual’s name, case number, and District Office. Field staff indicated that when the forms came back with only signatures, it was often difficult to determine identifying case information, as some clients have the same name. As such, case numbers and District Office location information are now required fields on the form. District or NHEP staff must complete these fields before providing the forms to the client. The associated instructions for all the forms have been updated accordingly.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 134.03 Specified Hardship Criteria

Section 203.09 Interim Disabled Parent (IDP)

Section 808.05 Exemptions from Participation in NHEP

Section 808.07 Verification of Exemptions

Section 808.45 Referrals to the TANF Program Analyst

IMPLEMENTATION

Transition to State Office

The transition to State Office administration of the medical review process began May 1, at which point all completed Forms 752a that were returned to the District or NHEP Offices had to be forwarded to State Office. As of June 5, 2009, DALR Work Capacity Specialists were no longer assisting recipients with the medical review process in the District or NHEP offices of Nashua, Keene, Claremont/Lebanon, Concord, Laconia, Littleton, Conway and Berlin. All correspondence received by these District or NHEP offices after that date were immediately forwarded to State Office for review. Similarly, any calls related to DALR or the medical review process were directed to 271-4240 or toll free (800) 852-3345 x 4240 as of that date. The remaining offices were transitioned to State Office administration as of June 15, 2009, with completion of the transition effective July 1.

New Forms Implementation

All District and NHEP offices were sent a supply of the new Form 752 packets at the end of April for a May usage date. This monthly distribution was repeated for each month after the begin date. The packets will not contain the new version of Form 752a, however, until the current supply is exhausted.

CLIENT NOTIFICATION

No special client notification is planned. When clients receive the various forms, they will be notified of the new contact information.

TRAINING

No special training is planned or needed.

FORMS MANUAL POSTING INSTRUCTIONS

Remove and Destroy

Insert

Forms Manual

Form 752(State Office), Physician/Clinician Statement of Capabilities,

SR 09-xx/April, 2009

2 sheets

Form 752(State Office), Physician/Clinician Statement of Capabilities,

SR 09-20/July, 2009

2 sheets

Form 752(Laconia), Physician/Clinician Statement of Capabilities,

SR 06-12/October, 2006

2 sheets

None

Form 752(Manchester), Physician/Clinician Statement of Capabilities,

SR 06-12/October, 2006

2 sheets

None

Form 752(Nashua), Physician/Clinician Statement of Capabilities,

SR 06-12/October, 2006

2 sheets

None

Form 752(Portsmouth), Physician/Clinician Statement of Capabilities,

SR 06-12/October, 2006

2 sheets

None

Form 752(i), Instructions for Form 752,

SR 06-12/October, 2006

1 sheet

Form 752(i), Instructions for Form 752(State Office), SR 09-20/July, 2009

1 sheet

Form 752a, Authorization for Release of Protected Health Information for the Use and Disclosure of Individually Identifiable Health Information, SR 08-04/April, 2008

2 sheet, 4-Part NCR

Form 752a, Authorization for Release of Protected Health Information for the Use and Disclosure of Individually Identifiable Health Information, SR 09-20/July, 2009

2 sheet, 4-Part NCR

Form 752a(i), Instructions for Form 752a,

SR 08-04/April, 2008

1 sheet

Form 752a(i), Instructions for Form 752a,

SR 09-20/July, 2009

1 sheet

Form 752HH(State Office), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 09-xx/April, 2009

2 sheets

Form 752HH(State Office), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 09-20/July, 2009

2 sheets

Form 752HH(Laconia), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 06-12/October, 2006

2 sheets

None

Form 752HH(Manchester), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 06-12/October, 2006

2 sheets

None

Form 752HH(Nashua), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 06-12/October, 2006

2 sheets

None

Form 752HH(Portsmouth), Physician/Clinician Statement of Necessary Patient Care for a Household Member, SR 06-12/October, 2006

2 sheets

None

Form 752HH(i), Instructions for Form 752HH,

SR 06-12/October, 2006

1 sheet

Form 752HH(i), Instructions for Form 752HH(State Office), SR 09-20/July, 2009

1 sheet

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

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 August 3, 2009. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Family Assistance and Forms Manuals.

DFA/JBV:s