SR 10-40 Dated 12/10

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the program area responsibilities for the Medical Exemption Unit (MEU), which is located at the Brown Building, Hugh Gallen State Office Complex, Concord. The MEU is responsible for verifying:

·   medical exemptions from the New Hampshire Employment Program (NHEP) work requirements; and

·   medical conditions used by applicants and recipients in the request for a hardship extension to the 60-month lifetime limit on receipt of Financial Assistance to Needy Families (FANF).

The release of the MEU necessitated revisions to the following DFA Forms that are included in what is informally called the "Medical Exemption Packet":

·   DFA Form 752, Physician/Clinician Statement of Capabilities;

·   DFA Form 752A, Authorization for Release of Protected Health Information for the Use and Disclosure of Individually Identifiable Health Information, and its associated instructions; and

·   DFA Form 752HH, Physician/Clinician Statement of Necessary Patient Care for a Household Member.

Additionally this SR incorporates into policy 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).

POLICY

With the release of this SR, the Medical Exemption Unit (MEU) is responsible for verifying:

·   medical exemptions from the New Hampshire Employment Program (NHEP) work requirements; and

·   medical conditions used by applicants and recipients in the request for a hardship extension to the 60-month lifetime limit on receipt of Financial Assistance to Needy Families (FANF).

The following forms included in the "Medical Exemption Packet" were updated to incorporate the release of the MEU:

·   DFA Form 752, Physician/Clinician Statement of Capabilities;

·   DFA Form 752A, Authorization for Release of Protected Health Information for the Use and Disclosure of Individually Identifiable Health Information, and its associated instructions; and

·   DFA Form 752HH, Physician/Clinician Statement of Necessary Patient Care for a Household Member.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Changes to client letters, notices of decisions, and report structures to incorporate the MEU have been completed as of the release of this SR.

Special MEU District Office Procedures

All Medical Exemption Packets and/or completed forms associated with these packets that the District Office (DO) receives from clients or medical personnel are to be returned to the MEU for processing. Clients receive a DFA State Office Business Reply Envelope (BRE) with the Medical Exemption Packets which helps to direct these forms to the MEU. However, as some clients lose these BREs or drop off the paperwork at their local DO rather than mail the information back, it is imperative that DO workers forward any completed forms associated with the Medical Exemption Packets to the MEU on a daily basis for processing by MEU staff. Any action taken on the case by staff in the MEU will be noted in the client’s case notes and, if applicable, Recipient Identification (RID) notes. Once the MEU determination is complete, the completed packet will be sent to the Centralized Scanning Unit (CSU) to be scanned into the client’s electronic file.

DESCRIPTION OF REVISIONS MADE TO FORMS

"Medical Exemption Unit" has been substituted as the contact unit in State Office on the following forms:

·   DFA Form 752, Physician/Clinician Statement of Capabilities;

·   DFA Form 752A, Authorization for Release of Protected Health Information for the Use and Disclosure of Individually Identifiable Health Information, and its associated instructions; and

·   DFA Form 752HH, Physician/Clinician Statement of Necessary Patient Care for a Household Member.

Additionally, the MEU’s contact information was updated, as needed, to incorporate a change in the 4-digit MEU phone extension, so that the MEU contact phone number reads as follows: 271-7272 or (800) 852-3345 ext. 7272, and the fax number for the MEU was also added. The new version of these forms will be printed at the next print reorder. Continue using the current version until the supply is exhausted.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 134.03  Specified FANF Hardship Extension Criteria

Section 808.05  Exemption from Participation in NHEP

Section 808.07  Verification of Exemptions

Section 808.45  Referrals to the Medical Exemption Unit (MEU)

IMPLEMENTATION

The piloting of the new MEU began on July 1, 2009. The finalization of all policy related to this unit, as presented in this SR, is effective as of the release of this SR.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

No special training was needed.

FORMS MANUAL POSTING INSTRUCTIONS

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 January 31, 2011. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Forms and Family Assistance Manuals.

DFA/JBV:s