SR 14-13 Dated 10/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases changes to DFA Form 37, Verification of Legal Liability for Applicants/Recipients of Public Assistance, and its associated instructions, as the result of:

·      amendments to RSA 167:18-a that, effective July 1, 2008, removed the county’s liability for proportionate payments for applicants and recipients of Old Age Assistance (OAA) and Aid to the Permanently and Totally Disabled (APTD) cash assistance, as previously released in DFA SR 14-07; and

·      general updating to reflect current policy, terminology, and procedures.

BACKGROUND

In June 2008 in response to changes to RSA 167:18-a, New Heights correctly stopped generating AE0030, Verification of Legal Liability for Applicants/Recipients of Public Assistance, as documentation of a county’s liability for paying a proportionate share for applicants and recipients of OAA and APTD cash assistance. However, DFA Form 37, the paper back-up to the New HEIGHTS-generated AE0030, was not updated at that time. With the release of this SR, the corresponding changes that were needed on DFA Form 37 are complete.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 37, Verification of Legal Liability for Applicants/Recipients of Public Assistance, is an electronic, single-sided, 1-page form used by DHHS staff to formally notify counties of their financial responsibility to the state, pursuant to RSA 166:10. It is used with applicants or recipients of OAA or APTD medical assistance, Nursing Facility (NF) care or any category of Home and Community-Based Care (HCBC-CFI/DD/ABD/IHS) services, when New HEIGHTS is unable to generate Form AE0030, Verification of Legal Liability for Applicants/Recipients of Public Assistance.

DFA Form 37 was primarily revised to align with changes to RSA 167:18-a (see SR 14-07 for more details). Because Field Operations requested that the OAA and APTD cash assistance designations be left on the form for tracking purposes, this was accomplished by adding text to indicate that there is no county liability for paying a proportionate share of the individual’s OAA cash assistance or APTD cash assistance.

Because this form can now be scanned into the e-case file, or copied as needed, the multi-page aspect of the form, needed when it was a no-carbon-required (NCR) form, was eliminated, reducing the final form to one page. Additionally, due to its infrequent usage, DFA Form 37 will no longer be printed and stored in the DHHS Warehouse. Instead it is now available electronically on the Family Services database.

Other changes were made to replicate current titles and terminology and accurately reflect its present usage and by adding RSA authorities for determining the legally liable county.

The instructions for DFA Form 37 were revised accordingly.

The new version of DFA Form 37 is available electronically, for Department staff only, on the Lotus Notes Family Services Database, to be used as a paper back-up when New HEIGHTS is inoperable or cannot generate the AEOO30. The form is also available online at http://www.dhhs.nh.gov/dfa/presumptive/forms.htm.

The old version of the paper form, if any are left in any location, must be recycled and the new version used immediately. A Certificate of Destruction has been included with this SR.

New Hampshire Hospital (NHH) staff will continue to print and use DFA Form 37 as part of a NHH patient’s application packet whenever a NHH patient uses DFA Form 800, Application for Assistance, to apply for OAA, APTD, NF care or HCBC-CFI/DD/ABD/IHS services.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Since New HEIGHTS stopped generating AE0030, Verification of Legal Liability for Applicants/Recipients of Public Assistance, for applicants and recipients of OAA and APTD cash assistance as of June 30, 2008, no changes to New HEIGHTS’ procedures or implementation are necessary.

IMPLEMENTATION

The policy regarding the changes to and use of DFA Form 37 released in this SR are effective upon receipt or October 31, 2014, whichever is earlier.

CLIENT NOTIFICATION

No special client notification is necessary.

TRAINING

No special training is planned or 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 November 24, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Forms Manual.

DFA/KD:s