SR 11-01 Dated 01/11

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 0.0% cost-of-living adjustment (COLA) for January 2011 resulting in no increase to SSA/SSI and VA Annual Review benefits. Generally, when a COLA occurs, the COLA increase is applied to SSI/SSA/VA benefits and are:

·   "passed along" in NH via a formula-based update to the adult Standards of Need for Old Age Assistance (OAA), Aid to the Permanently and Totally Disabled (APTD), and Aid to the Needy Blind (ANB); and

·   used to determine the Nursing Facility (NF) CAP which is then used to determine NF, Choices For Independence (CFI), and Home and Community-Based Care (HCBC) categorically-needy services and the income disregard for HCBC or CFI medically-needy recipients who were receiving services as of 10/1/08.

Because there will be no COLA increase for 2011, all these figures that are dependent upon this COLA increase and the subsequent SSI/SSA/VA benefit increase for any changes, will remain the same as 2010.

The resource limits and maximum monthly maintenance allowance figures for spousal impoverishment cases will also remain the same as 2010. These latter figures are based upon the Consumer Price Index Unit All Urban Consumers (CPI-U). Because the CPI-U only increased by 1.1% this past year, and this amount was not enough to offset the previous year’s decline of 1.3%, spousal impoverishment limits will not increase and will remain the same as last year.

Even though no spousal impoverishment figures were changed for January, it was decided that the following forms would be changed to reflect the January 2011 date and this SR release to reduce concerns in the field about the correct version of the electronic form to be used beginning January 2011. Although the figures on the 2010 versions of these e-forms will remain unchanged in the 2011 version, the new dates will confirm for staff that the most up-to-date version of the form is being used. The forms impacted are:

·   DFA Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses;

·   DFA Form 799, Spousal Income Protection; and

·   DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals.

The associated New HEIGHTS-generated Forms AE0020 and AE0017 are also usually updated as well when the DFA Forms 798A, 799, or 799A are changed, but because these HEIGHTS-generated forms always have the current date on them, there is no need to make any changes to them when no figures are changing.

Additionally, there are no changes to the:

·   Medicare Part D rates; and

·   the Substantial Gainful Activity (SGA) income ceiling.

However, the following figures that are also a part of the annual January updates will be experiencing changes:

·   Medicare Part B premium amounts;

·   Low-Income Premium Subsidy Amount;

·   Home equity limit used in the financial eligibility determination process for NF, HCBC, and CFI services; and

·   QMB/SLMB/SLMB135 resource limits.

The Home Equity limit used in the financial eligibility determination process for NF, HCBC, and CFI services will be updated annually by the percentage increase in the Consumer Price Index – Urban (CPI-U) as part of each January Mass Change. Changes in this limit required updates to the following electronic forms:

·   DFA Form 791E, NF/HCBC/CFI Undue Hardship Application Due to Home Equity Exceeding the Limit, and its associated instructions;

·   DFA Form 791EN, Notice of Excessive Equity Penalty, and its associated instructions; and

·   DFA Form 791HD(i), Instructions for DFA Form 791HD.

The QMB/SLMB/SLMB135 resource limits, last updated as an unrelated policy change in SR 10-22, will now be updated annually as part of the January Mass Change.

POLICY

Based upon the 0.0% cost of living increase to SSA/SSI and VA Annual Review benefits, the SSI maximum monthly benefit levels for independent living arrangements remain the same as last year at:

§   $674 for an individual;

§   $1,011 for an individual and a spouse or needy essential person; and

§   $1,349 for a couple and needy essential person.

The 2011 adult Standards of Need for OAA, ANB, and APTD individuals also did not change from the 2010 figures, and therefore will remain at:

Updates to Medicare Part B Premiums:

·   Individuals who currently have their Part B premium withheld from their SSI/SSA benefits and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not see a change in their Part B premiums for 2011;

·   New Part B beneficiaries and beneficiaries who do not currently have the Part B premium withheld from their SSI/SSA benefits will pay a Part B monthly premium of $115.40; and

·   Individuals with incomes higher than $85,000 will pay $115.40 or more.

Medicare Part B premium amounts are not a set amount this year, due to the lack of a COLA. There are three known scenarios that will impact Part B premiums for 2011:

Scenario 1: Current recipients will not see a change in their Medicare Part B premium amounts because of what is informally referred to as a "hold-harmless" provision mandated by Section 1839(f) of the Social Security Act. This provision prevents individuals who currently have their Part B premium withheld from their SSI/SSA benefit and who have income of $85,000 or less, to experience an increase in their Part B premium when the COLA does not increase. This hold-harmless provision is only applied, though, if an increase in the premium would cause the individual to receive less SSI/SSA benefits in December than they did in November. For the current recipients who meet the hold-harmless criteria, Medicare Part B premiums will remain at $96.40 to $110.50.

Scenario 2: However, the following individuals are not covered under the hold-harmless provision and will see their premiums increased to $115.40:

·   All new Part B beneficiaries;

·   Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit, which includes recipients currently eligible for State "buy-in" of their Part B premium; and

·   Higher-income beneficiaries.

Scenario 3: Additionally, there is a third group of current recipients that in 2010 saw a 10 cent change to their Medicare Part B premium, from $96.40 to $96.50. This group was initially covered by the "hold-harmless" provision described above, until the Social Security Administration completed calculations determining whether the individual would receive less SSI/SSA benefits in December than they did in November if the increase in the premium was applied. For these current recipients, an increase in the premium to $96.50 did not cause this discrepancy, so these individuals incurred a 10-cent increase in their Medicare Part B premium. These same people apparently also received a 10 cent increase in their SSI/SSA benefits, so it is assumed that no ill affects will be incurred by the individuals as far as NF patient liability or In and Out spenddown amounts.

NOTE: FSS should not make any changes to the Part B premium amounts or SSI/SSA benefits displayed in New HEIGHTS unless one of the following occurs:

·   the casehead provides verification that their Part B premium or benefit amount is a different amount than displayed; or

·   the individual’s case is placed on the discrepancy report after the mass change, at which point the individual will need to present verification of income or premium amount.

New recipients will need to verify, as always, their premium and benefit amount, so that the FSS can enter the correct amount.

The 2011 Medicare Part D Rates are as follows:

Low-Income Premium Subsidy Amount = $28.90 (from $26.96).

Maximum Co-Pays for Full Benefit Dual Eligibles:

·   Institutionalized Individuals   $0.00

·   Non-Institutionalized Beneficiaries

-   Up to or at 100% FPL

§   Generic/Preferred  $1.10

§   Other    $3.30

§   Above Out-of-Pocket Threshold $0.00

-   Over 100% FPL

§   Generic/Preferred   $2.50

§   Other    $6.30

§   Above Out-of-Pocket Threshold $0.00

The Protected Income Level (PIL) for all group sizes remains unchanged.

The Nursing Facility CAP used to determine NF, CFI and HCBC categorically-needy services remains the same as last year at $2,022.

The Income Disregard for HCBC or CFI medically-needy recipients who were receiving services as of 10/1/08 is:

·   $429 for CFI; and

·   the difference between the cost of services on 9/26/08 and the current NF categorically-needy gross income limit, which is the 2011 NF CAP, for all other HCBC categories.

Because the CPI-U only increased by 1.1% this past year, and this amount was not enough to offset the previous year’s decline (1.3%), spousal impoverishment limits will not increase and will remain the same as last year as listed below:

·   Maximum monthly maintenance allowance: $2,739;

·   Minimum resource standard: $21,912; and

·   Maximum spousal resource allowance: $109,560.

The 2011 Substantial Gainful Activity (SGA) income ceiling remains the same as for 2010 at: $1,000. The SGA is used only during initial APTD eligibility determinations; working applicants must have an adjusted earned income of less than the SGA.

The 2011 QMB/SLMB Resource Limits increased to:

·   $6,680 for an individual (from $6,600); and

·   $10,020 for a couple (from $9,910).

The Home Equity limit used in the financial eligibility determination process for NF, HCBC, and CFI = $506,000 (from $500,000).

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

No Increase to SSA/SSI

Using the individual’s Social Security Number (SSN), SSA/SSI benefits are updated during the January Mass Change by crossmatching open:

·   SSA cases against BENDEX and SVES; and

·   SSI cases against SDX.

For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed in the BENDEX/SVES/SDX files, and benefits will be recomputed. For those SSA individuals that do not match, New HEIGHTS will apply 0.0%.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases receiving an adult category of state supplement (ANB, APTD, OAA) from closing due to a COLA increase. Even though there is no increase this year, New HEIGHTS Pickle Amendment cases are processed automatically. The calculations and COLA deduction for cases that would lose cash payment are invisible to DO staff. Questions about the calculations or COLA deduction on New HEIGHTS Pickle cases should be directed to the New HEIGHTS Help Desk.

Medicare Part B Premiums

FSS should not make any changes to the amounts displayed in New HEIGHTS unless the casehead provides verification that their Part B premium or benefit amount is different than displayed, or unless the individual’s case is placed on the discrepancy report after the mass change, at which point the individual will need to present verification of income or premium amount. New recipients will need to verify, as always, their premium, so that the FSS can enter the correct amount.

QMB, QDWI, SLMB, and SLMB135 Cases

Federal law mandates that COLA increases for the year 2011 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels is effective in the spring of 2011. Normally, when there is a COLA increase, cases that would close due to the COLA are kept open automatically by New HEIGHTS until the new figures are available.

Rollbacks

New HEIGHTS will process rollbacks automatically and the correct values will be used for the pre-January amounts.

Patient Liability

Nursing facilities are automatically notified of the patient’s liability, the monthly amount the resident is expected to pay towards their care, through MMIS. Any time a new patient liability is created or a change is made to a current resident’s patient liability, New HEIGHTS will automatically generate the AE0009, Patient Liability Letter, to the nursing facility resident and/or authorized representative.

Categorically Eligible Food Stamp Households

Food stamp policy in FSM PART 231, CATEGORICALLY ELIGIBLE HOUSEHOLDS, states that certain public assistance and SSI households are categorically eligible for food stamps without regard to income or resources. To be considered categorically eligible, all members of the food stamp household must be included in an open public assistance and/or SSI case. New HEIGHTS will calculate food stamp categorical eligibility automatically.

SYSTEM CHANGES

Mass Change Schedule

Due to the unusual circumstances of this year’s January Mass Change, it will not be run in the normal manner. All cash cases will be run on January 3, 2011. All deductible and NF/HCBC/CFI cases will be run on January 4th, and all remaining cases will be run on January 6th. A final clean-up run will occur on January 19, 2011.

Although New HEIGHTS anticipates the number of cases to be similar to last year (10,600), the exact number of cases that will need to be run through the Mass Change will not be known until December 22, 2010. Because this SR will need to be released prior to that date, New HEIGHTS will notify District Offices of any changes in this plan under separate cover.

All updates, however, are effective January 1, 2011.

Mass Change NOD

Because there is no COLA this year, there will be 1 generic message that is applied to all cases as follows:

THE FEDERAL GOVERNMENT DID NOT INCREASE SOCIAL SECURITY, SSI, OR VA BENEFITS BECAUSE THERE WAS NO INCREASE IN THE COST OF LIVING. THE MEDICARE PART B PREMIUM INCREASED FOR SOME PEOPLE TO $115.40. YOUR BENEFITS, AS SHOWN IN THE OLD AND NEW BUDGETS BELOW, MAY HAVE BEEN ADJUSTED TO REFLECT THIS OR OTHER CHANGES THAT OCCURRED IN YOUR CASE.

Medicare Part B

New HEIGHTS will automatically update the Medicare Part B premium amount with the figure specified on the BENDEX report. If the Bendex or SVES file has Medicare information and New HEIGHTS does not have information in the system for this individual, the Medicare information will be automatically entered into the pertinent fields in New HEIGHTS. This year, workers may see the following in their client cases:

§   $96.40 Medicare Part B Premium; or

§   $96.50 Medicare Part B Premium; or

§   $110.50 Medicare Part B Premium; or

§   $115.40 Medicare Part B Premium.

All of these figures are or could be correct.

UNRELATED POLICY CLARIFICATIONS

Adult Assistance Manual (AAM) sections 109.01, Filing an Application, and section 121.01, Interview Sites, were revised to remove text related to a home visit as a potential option for conducting an eligibility interview for the adult categories of assistance. DFA staff no longer conduct home visits because the individual requesting assistance may assign an authorized representative to participate in the interview in the applicant’s stead or DFA conducts the personal interview over the phone. As such, the text was no longer needed and therefore removed.

The following sections in the AAM were further clarified to indicate that if an individual only applies for a Medicare Beneficiary program on the Form 800, Application for Assistance, such as the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) or SLMB135 program, and the individual applies for no other program of assistance, the individual is also not required to participate in a personal interview as a condition of eligibility. The QMB/SLMB-only applicant can request a personal interview and, if requested, a personal interview must then be granted, but a personal interview is not required in the QMB/SLMB eligibility determination process when the applicant is requesting QMB/SLMB-only on the Form 800. The AAM topics that were revised to better reflect this clarification were:

·   Section 109.01, Filing an Application;

·   Section 109.03, Processing a Filed Application; and

·   PART 121, INTERVIEWS.

POST MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change. These reports will be available in New HEIGHTS as indicated below.

NMC840RA: MC Part B Premium RPT

The Part B Premium report lists cases whose Part B premium was not updated to a new amount because their existing Part B premium amount was not $96.40, $96.50, $110.50 or $115.40 and the case was not found on the BENDEX report with their current premium amount. The clients identified on this report will need to provide their current Part B premium information at their next redetermination. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be available in New Heights on the first business day after each run of the mass change.

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number. This report will be available on the first business day after each run of the mass change.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed due to some discrepancy in data. These cases require further District Office action. It contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type. This report will be available on the first business day after each run of the mass change.

DESCRIPTION OF REVISIONS MADE TO FORMS

Even though no spousal impoverishment figures were changed for January, it was also decided that the following forms would be changed to reflect the January 2011 date and this SR release to reduce concerns in the field about the correct version of the electronic form to be used beginning January 2011. Although the figures on the 2010 versions of these e-forms will remain unchanged in the 2011 version, the new dates will confirm for staff that the most up-to-date version of the form is being used. The forms impacted are:

·   DFA Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses;

·   DFA Form 799, Spousal Income Protection; and

·   DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals.

The associated New HEIGHTS-generated Forms AE0020 and AE0017 are also usually updated as well when the DFA Forms 798A, 799, or 799A are changed, but because these HEIGHTS-generated forms always have the current date on them, there is no need to make any changes to them when no figures are changing.

The following electronic forms were changed to reflect the 2011 update to the Home Equity limit figure used in the financial eligibility determination process for NF, HCBC, and CFI. Because this figure will increase each year by the percentage of change to the Consumer Price Index – Urban (CPIU), the specific Home Equity Limit figure that would need revision every year was eliminated and replaced with more generic text. The electronic forms that were impacted by the increase to the Home Equity Limit are:

·   DFA Form 791E, NF/HCBC/CFI Undue Hardship Application Due to Home Equity Exceeding the Limit; and

·   DFA Form 791EN, Notice of Excessive Equity Penalty.

The instructions for both forms above, as well as the instructions for DFA Form 791HD, NF/HCBC/CFI Hardship Decision, were updated accordingly.

The new versions of DFA Forms 791E, 791EN, 798A, 799, and 799A will be electronically transmitted to each District Office with the electronic release of this SR. Contact Linda White, DFA State Office, at 271-4580 with any questions related to transferring the electronic versions of these forms to your PC.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 109.01  Filing an Application

Section 109.03  Processing a Filed Application

PART 121  INTERVIEWS

Section 121.01  Interview Sites

Section 167.03  COLA Adjustments Since 1977

PART 209  AID TO THE PERMANENTLY AND TOTALLY DISABLED

Section 209.03  SGA Adjustments Since 2000

Section 407.07  QMB, SLMB, and SLMB135 Resource Limits

PART 411  COMMON TYPES OF RESOURCES: REAL PROPERTY

Section 415.27  Undue Hardship

Section 415.28  Required Documentation for an Undue Hardship Waiver Application

Section 419.03  Determining the Protected Resource Amount

PART 601, TABLE A INCOME LIMITS

PART 601, TABLE B SPECIAL INCOME LIMITS FOR CFI AND HCBC INDIVIDUALS

PART 605  DEDUCTIONS

Section 627.03  Allocation to a Community Spouse

IMPLEMENTATION

Changes identified in this SR are effective January 1, 2011 for current cases, and apply to any new cases processed on or after that date.

CLIENT NOTIFICATION

Client letters to institutionalized individuals and their community spouses, attached to this SR for reference, will be sent on December 8 and 9, 2010, respectively. The letters notify individuals that there will be no changes in the spousal impoverishment figures this year.

Additionally, the New HEIGHTS-generated AE0009 will be sent to those nursing facility residents and/or their authorized representative if a new patient liability is created or a change is made to a current resident’s patient liability.

TRAINING

No training is needed or planned due to the procedural nature of this SR.

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 Adult Assistance and Forms Manuals.

DFA/KD:s