SR 11-15 Dated 03/11

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the consolidation of the application process for Nursing Facility (NF) and Home and Community-Based Care, Choices for Independence (HCBC-CFI) services. This project was a cooperative effort between the Division of Family Assistance (DFA) and the Bureau of Elderly & Adult Services (BEAS) and entails:

·   The transfer of the NF and HCBC-CFI medical eligibility determination process from OPTIONS, BEAS’ automated medical eligibility system, to New HEIGHTS, DFA’s automated eligibility system, so only one system will now track both the financial and medical eligibility determination process for NF and HCBC-CFI services; and

·   The clarification that the date the completed DFA Form 800, Application for Assistance, is filed with DFA, is considered to be:

-   The starting date for the look back period for NF and HCBC asset verification and resource assessment eligibility requirements. This reflects current policy; and

-   The applicant’s application filing date, which means the application processing time frames for both the financial and medical eligibility determination process, begins as of that date. Previously the financial eligibility processing time frames in DFA began with the application filing date of the Form 800, while the medical eligibility processing time frames in BEAS began with the filing date of BEAS’ 2-page New Hampshire Medical Eligibility Determination Application. For both BEAS and DFA, the application processing time frames now begin with the application filing date of the Form 800.

DFA Form 800, Application for Assistance, and its associated instructions, were revised to accommodate the process changes summarized above.

Additionally, this SR releases:

·   unrelated changes to Form 811R, Application: Your Rights and Responsibilities; and

·   the obsolescence of Form NHEP804T, Questionnaire for Returning Applicants, and its associated instructions.

POLICY

The financial and medical application processes for Nursing Facility (NF) and Home and Community-Based Care, Choices for Independence (HCBC-CFI) services have been consolidated. The application processing time frames for both DFA financial eligibility and the BEAS NF and HCBC-CFI medical assessment now begins as of the filing date of DFA Form 800, Application for Assistance. The look-back period and the resource assessment for these programs also begin as of this application filing date.

DFA Form 800, Application for Assistance, and its associated instructions were revised to accommodate the process changes summarized above.

DESCRIPTION OF REVISIONS MADE TO FORM 800

DFA Form 800, Application for Assistance, was revised as follows:

§   the text under the "Social Security Numbers (SSN)" header was revised to:

-   incorporate changes in 7 CFR 273.2;

-   update citations that require DFA to request SSNs;

-   identify NH Child Care Scholarship as another assistance program that does not require an SSN as a condition of eligibility; and

-   clarify how DFA will use SSNs, when provided;

§   text describing specific proof needed to verify citizenship and identity was removed from the "Citizenship & Identity" section, because changes at the federal level and implementation of the Social Security Administration cross-match in August 2010 removes the burden on most applicants to provide original paper proof of citizenship and identity as a condition of eligibility for financial and medical assistance (see SR 10-31 for more details);

§   a new check-off line was added at the beginning of the application to help determine the applicant’s current place of residence. The choices now offered are: Own Home, Nursing Facility, Adult Family Home, Assisted Living, Congregate Housing, Homeless, Hospital, Hotel/Motel, Residential Care Facility, and Other. Adding this list of resident types to the application allowed the elimination of the "are you homeless" question that was originally found later in the application;

§   The "Agency Use Only" box that was formerly located on the 2nd page of the application, was condensed and moved up to the first page of the application. Certain functionalities and layout requirements that were required by a paper case filing system are being eliminated as a result of Document Imaging and the electronic case filing system. For example, the Agency Use Only box was on the 2nd page and the 2nd page was printed upside down so that when accessed via the paper case file, both sides of the application could be viewed with ease by the FSS. Because of electronic case filing, the 2nd page will no longer be printed upside down, and now the box can be moved closer to where FSS need the information;

§   In Section C, the check box for nursing home care was expanded so it now reads "Home and Community-Based Care (HCBC)/Nursing Facility (NF) Services" and a field has been added to capture the NF Name, if pertinent. Additionally, in this same section, the checkbox for Medicare Buy-In Programs, was altered to read as follows: Medicare Savings Programs (MSP) (QMB/QWDI/SLMB/SLMB135); and

§   Text was added to Section I, Signatures, so the final sentence now reads as follows (italics added to the following text for reference purposes only): I understand a full financial and medical eligibility interview may be conducted before my eligibility can be determined. The intent of adding the text italicized above was to ensure that certain applicants, such as APTD, IDP, and NF and HCBC applicants, understand that there may be two parts to the eligibility determination process. In this same section, the final FSS signature field was altered to request the printed name, signature, and the title and agency of the staff person providing the application, as ServiceLink and Nursing Facility workers may now present this application to an applicant.

The instructions for Form 800 have been updated accordingly.

UNRELATED REVISIONS MADE TO FORM 811R

Unrelated changes were made to Form 811R, Application: Your Rights and Responsibilities, as follows:

§   under the "Nondiscrimination Notice" header, the address and phone numbers for the USDA were revised to align with updates to 7 CFR 273.2(b)(1)(viii). Additionally, the TDD access phone number was expanded to also include the option of dialing 7-1-1;

§   Under the "Administrative Appeal" header, text was added to indicate that free and reduced cost legal services are available in NH. Additionally, the TDD access phone number was expanded to also include the option of dialing 7-1-1; and

§   The "Attention" box on page 2 was expanded to more clearly delineate the computer matching programs with whom we share information, although the list is not exhaustive due to spacing constraints.

UNRELATED OBSOLETION OF FORM NHEP804T

Form NHEP804T, Questionnaire for Returning Applicants, and its associated instructions are obsolete effective with the release of this SR. This form was created in 2006 in test format, hence the "T" in the title, to track more specific information related to Financial Assistance to Needy Families (FANF) recidivism. Individuals who revealed prior receipt of cash assistance while in attendance at the NHEP Orientation would complete this form with the NHEP Counselors. This paper manual process has since been replaced with a process which includes a survey, but no longer involves the NHEP Counselors meeting with the former FANF recipient. As such, this duplicative questionnaire is no longer needed. Any Form NHEP804Ts in stock in the District Offices may be recycled upon the release of this SR; a Certificate of Destruction has been included at the end of this SR.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

To improve the NF/HCBC-CFI eligibility process, the OPTIONS medical eligibility intake process has been integrated into New HEIGHTS as of February 28, 2011. This allows NF/HCBC-CFI applications to be tracked in one system regardless of the applicant’s starting point (ServiceLink, BEAS, or DFA). The Client Registration process has also been expanded to allow BEAS and ServiceLink workers the ability to initiate a NF/HCBC-CFI application. This means that certain screens in New HEIGHTS may already be completed when the FSS initiates Application Entry for a NF or HCBC-CFI applicant.

To support the NF/HCBC-CFI application process:

·   A new "LTC App" date field was added to:

-   the "Nursing Facility Details" tab on the "Nursing Facility" screen to capture the date the individual applied for NF services; and

-   the "HCBC Details" tab on the "Home and Community-Based Care" screen to capture the date the individual applied for HCBC-CFI services.

This date generally defaults to the application date entered into Client Registration. The one exception involves current recipients who apply for NF or HCBC-CFI services after they have already been receiving DFA assistance (the process to address this situation is commonly referred to as "Add-a-Program"). In this add-a-program scenario, the "LTC App" date field will default to the current date, but can be changed if needed.

·   a new "LTC Intake" screen has been created under the "Long Term Care" function in New HEIGHTS. It is used to capture information for BEAS at the time the individual applies for LTC services and used to track the medical determination process for BEAS.

·   new activity types have been created for the NF/HCBC-CFI initial eligibility interview. An applicant or applicant representative can choose to have their initial eligibility interview at the District Office or the most convenient ServiceLink location. Upon confirming an interview appointment, a new New HEIGHTS-generated letter, CS0025: LTC Intake Initial Interview Letter, will be generated with the date, time, and location of the interview. The last page of this letter contains a specialized list of the verifications needed to make a NF/HCBC-CFI eligibility determination.

The following additional New HEIGHTS-generated letters were also created:

·   AE0111, NF Approval Letter: This Recipient Identification (RID)-based letter is generated when all NF eligibility criteria have been met. The letter is printed on BEAS letterhead and contains the individual’s name, Medical Identification Number (MID), Approved Level of Care, Facility Name, and Approval Begin, End, and Review dates;

·   AE0112, HCBC Approval Letter: This RID-based letter is generated when all HCBC-CFI eligibility criteria have been met. The letter is printed on BEAS letterhead and contains the individual’s name, date of birth (DOB), MID, and HCBC CFI effective date;

·   AE0113, NF/HCBC Denial Letter: This RID-based letter is generated from either the "Nursing Facility" or "HCBC" screen when BEAS has entered a denial decision. The letter is printed on BEAS letterhead and indicates the reason why the NF or HCBC-CFI service was denied; and

·   CS0025/CS1025, LTC Intake Initial Interview Letter. Upon ‘confirming’ an interview appointment, the CS0025 (Case) or CS1025 (RFA) (depending on whether the interview was scheduled from AE or Client Registration) is generated with the date, time and location of the interview. The last page of this letter contains a specialized list of the verifications needed to make an NF/HCBC-CFI eligibility determination.

All new New HEIGHTS-generated letters will be released by New HEIGHTS under separate cover at a later date.

IMPLEMENTATION

The new version of DFA Form 800 and DFA Form 811R will be placed on the Department’s website for immediate use upon the release of this SR. Additionally, the electronic version of the revised DFA Form 800 has been provided to BEAS for distribution to ServiceLink and Nursing Facilities so that its use can begin immediately. District Offices are to exhaust the supply of the current paper version of DFA Forms 800 and Form 811R. The new version of both forms will be sent to print once this current supply is completely exhausted. Please note that any previously released version of the Form 800 remains valid and office staff must act on all applications received according to current policy.

All Form NHEP804Ts in stock in the District Offices may be recycled upon the release of this SR.

CLIENT NOTIFICATION

No special client notification is planned or needed. BEAS notified Nursing Facility Providers, ServiceLink Resource Centers, Case Management Agencies, and CFI Providers of the upcoming changes in a General Memorandum dated 2/7/2011 and a Time Sensitive Announcement dated 2/25/2011.

TRAINING

BEAS conducted Web-based trainings for providers the last two weeks of February 2011. Similarly, the DFA Training Unit trained DFA staff of the new processes on several different dates at the end of February 2011.

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 http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective May 2, 2011. Additionally, this SR will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

DFA/JBV:s

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