SR 10-24 Dated 01/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases policy regarding:

�   Low Income Subsidy (LIS) applications submitted at Social Security Administration (SSA) offices, and incorporates the policy and instructions released in the Director's Memo dated 4/9/10, subject line SSA LIS Applications Medicare Savings Programs (QMB/SLMB). As of the effective date of this SR, a LIS application submitted at the SSA office is also considered to be an application for the following medical assistance programs:

- Qualified Medicare Beneficiary (QMB);

- Specified Low Income Medicare Beneficiary (SLMB/SLMB135); and

- Qualified Disabled and Working Individuals (QDWI).

�   what is considered to be the application date and begin date for processing the applications when the SSA transmits this LIS application data to New HEIGHTS. The date the LIS application is filed at the SSA is considered to be the date of application for QMB, SLMB/SLMB135 or QDWI medical assistance. The date New HEIGHTS receives the transmitted LIS application data from the SSA is considered to be the begin date for processing the application.

POLICY

Individuals who file LIS applications at the SSA office can consent to have this data transmitted to the Department of Health and Human Services for determination of eligibility for QMB, SLMB/SLMB135 or QDWI. This transmitted data is now automatically treated in the same manner as if the individual submitted a paper application requesting QMB, SLMB/SLMB135 or QDWI medical assistance on Form 800, Application for Assistance, or Form 800Q, Assisted Application for Help With Medicare Costs for Medicare Beneficiaries, even if the SSA subsequently denies the LIS application.

Although the date the LIS application is filed with the SSA must be considered the date of application for QMB, SLMB/SLMB135, and QDWI medical assistance, the date New HEIGHTS actually receives the LIS application data from the SSA is considered the begin date for processing the application.

The application date establishes the effective date of eligibility for benefits. Using the date the transmitted SSA information is received at New HEIGHTS as the begin date for processing the application allows more time for processing, since the date of receipt of the transmitted LIS data could be significantly later than the date the LIS application was filed at the SSA. As of May 1, 2010, New HEIGHTS has been computing the processing due date as 45 days from when the file is received instead of 45 days from the application date.

Data transmitted from the SSA due to an LIS application at the SSA office must be acted upon in the same manner, and in accordance with the same deadlines, as if the data were an application submitted to the District Office via a Form 800 or Form 800Q. An eligibility determination must be made on each SSA transmission unless the individual withdraws the application or is deceased. Below are some examples:

�   Additional Information is Needed: If not enough information is received from the SSA transmittal of the LIS application data to make an eligibility determination, the FSS is responsible for contacting the applicant to give the applicant an opportunity to provide further information. New CR0006, LIS Verification Checklist, has been created to automatically request the additional verifications needed to continue processing the application. The applicant has 10 days from the date of the notice to provide the verifications.

�   LIS Application Denied by SSA: If the information transmitted from the SSA indicates that the SSA denied the LIS application, the FSS must still consider the transmitted information as an application for QMB, SLMB/SLMB135, or QDWI and the FSS is still responsible for making an eligibility determination, regardless of the reason the SSA denied the initial LIS application. This includes the SSA denying a LIS application for individuals who:

- are over the income standard;

- are over the resource limit;

- have failed to cooperate with the SSA; or

- are beneficiaries without Medicare Part A or Part B.

�   Self-Attestation: If the information transmitted from the SSA indicates the applicant provided self-attestation that he or she is over the resource limit for LIS, the FSS must still consider the information transmitted as an application for QMB, SLMB/SLMB135, or QDWI, and the FSS is still responsible for making an eligibility determination.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

The SSA transmits the LIS application data to New HEIGHTS daily, Monday through Friday, excluding Federal holidays. New HEIGHTS incorporated the changes released in this SR as of March 2010 and began processing daily transmissions of SSA LIS data as of that date. Various screens were modified to incorporate this new automatic QMB, SLMB/SLMB135, and QDWI application process. As of May 1, 2010, New HEIGHTS has been automatically computing the application due dates for filing and processing.

The following New HEIGHTS-generated letters were also revised or created:

�   The version of CR0004, Expired Denial Letter, sent to individuals who have applied for QMB, SLMB/SLMB135, or QDWI, was modified to remove text stating that the application was denied because the applicant missed a required scheduled interview. Individuals who applied for LIS at the SSA or QMB, SLMB/SLMB135, and QDWI applicants using Form 800Q are considered to have fulfilled their interview requirement at the time of application, so no personal interview with the Department is necessary; and

�   CR0006, LIS Verification Checklist, was created because the SSA LIS application process does not collect all the information needed to determine eligibility for the QMB, SLMB/SLMB135, or QDWI programs. The new CR0006:

- will be generated in response to every QMB, SLMB/SLMB135, QDWI application received via the daily SSA transmission of LIS application data; and

- provides the applicant with a checklist of verifications that are still needed to determine eligibility for the QMB, SLMB/SLMB135, or QDWI medical assistance programs, a list of examples of acceptable proof the applicant may provide, and a deadline for providing the verifications.

Both new letters were released by New HEIGHTS under separate cover.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 109.01  Filing an Application

Section 109.03  Processing a Filed Application

IMPLEMENTATION

All policy released in this SR is retroactively effective to January 1, 2010. However, no District Office action is needed to implement retroactively because the policy was implemented via the Director's Memo dated April 9, 2010, subject line, SSA LIS Applications Medicare Savings Programs (QMB/SLMB).

CLIENT NOTIFICATION

Individuals applying for LIS at the SSA are informed on the LIS application that unless they indicate to the contrary, the LIS data will be automatically transmitted to the Department of Health and Human Services for determination of QMB, SLMB/SLMB135, and QDWI eligibility. No other client notification is planned.

TRAINING

Detailed instructions for workers were issued via a Director's Memo dated 4/9/10, subject line SSA LIS Applications Medicare Savings Programs (QMB/SLMB), and a new HEIGHTS System Alert dated 2/25/10, SSA LIS Applications - Medicare Savings Plans (QMB/SLMB). No further training is planned.

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 www.dhhs.nh.gov/DFA/publications.htm, effective November 1, 2010. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance Manual.

DFA/KD:s