Transitions to community living
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Transitions to Community Living. Special Assistance In-Home. Angie B. Phillips Division of Aging and Adult Services, Adult Services Section Special Assistance Program Representative. Joyce Massey-Smith and Joann Windley

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Transitions to community living

Transitions to Community Living

Special Assistance In-Home


Transitions to community living

Angie B. PhillipsDivision of Aging and Adult Services, Adult Services SectionSpecial Assistance Program Representative

Joyce Massey-Smith and Joann Windley

Division of Aging and Adult Services, Adult Services Section Adult Programs Representatives


Webinar objectives

Webinar Objectives

  • Provide information on Special Assistance In-Home (SA/IH) Program, including obtaining initial approval for SA/IH and ongoing eligibility

  • Clarify roles and responsibilities of LME/MCO Transition Coordinators/In-Reach Specialists, ACTT Staff, and Tenancy Support Workers regarding SA/IH benefits

  • Provide guidance on the communication process between LME/MCO Transition Coordinators/In-Reach Specialists, ACTT staff, Tenancy Support Workers and DSSs

Division of Aging and Adult Services Feb 2014


Webinar objectives1

Webinar Objectives

  • Overview of Communication between the LME/MCO and DSS to insure timely SA/IH benefits are issued.

  • Discuss economic assessment process and continued need for SA/IH

  • Review budgeting and uses of the SA/IH payment

  • What to do when the consumer is no longer eligible for SA/IH

  • Review SA/IH Quarterly Payment Tracking Tool

Division of Aging and Adult Services Feb 2014


Transitions to community living

What is Special Assistance In-Home?

  • SA/IH provides a cash supplement to help low-income adults who are at risk of placement to remain at home safely in the community.

  • The payments are intended to help maintain the individual’s health and safety while remaining in the community.

Division of Aging and Adult Services Feb 2014


Basic eligibility criteria for sa ih

Basic Eligibility Criteria for SA/IH

  • The individual has to meet categorically needy income and resource limits for Medicaid. Income limit is 100% of the FPL as of 4/1/14: $973.00) and countable resources for an individual $2,000 or less.

  • Valid FL-2 indicating a need for licensed residential level of care completed by a physician, physician’s assistant or nurse practitioner.

  • The individual has a documented financial need related to health and safety

  • The individual can live safely in a private living arrangement with services and the SA/IH payment.

Division of Aging and Adult Services Feb 2014


Transitions to community living

Initiating Access to SA In-Home Slots: Notification to County DSSs

  • Division of Aging and Adult Services (DAAS) staff notify the DSS Adult Services Supervisor that a TCL slot has been approved for a specific individual.

  • DAAS will contact the DSS in

    • the county of SA/Medicaid eligibility and

    • the county(ies) which the LME/MCO has indicated the consumer is interested in moving to

  • The DSS staff is responsible for assuring an available SA/IH slot is assigned

    • When seeking approval from DHHS for a TCL housing slot, the LME/MCO must indicate both the county of Medicaid origin and ALL counties where the consumer is interested in moving

Division of Aging and Adult Services Feb 2014


In reach process and responsibilities of the lme mco

In-Reach Process and Responsibilities of the LME/MCO

  • Obtain a signed release of information

  • Appendix E Supplement 2 is used for communication.

  • Contact the DSS in the county of Medicaid origin. Check “Request SA/IH Eligibility Box”.

  • A current, valid FL-2 is required. The FL-2 should not expire within next 30 days.

Division of Aging and Adult Services Feb 2014


In reach process and responsibilities of the lme mco and dss of medicaid origin

In-Reach Process and Responsibilities of the LME/MCO and DSS of Medicaid Origin

  • Within 5 business days – DSS will notify the LME/MCO (via Appendix E Supp 1) of the presumptive SA/IH eligibility and potential maximum SA/IH payment.

  • LME/MCO conducts Economic Assessment based on presumptive eligibility.

Division of Aging and Adult Services Feb 2014


In reach process and responsibilities of the dss of medicaid origin and lme mco

In-Reach Process and Responsibilities of the DSS of Medicaid Origin and LME/MCO

  • LME/MCO notifies DSS of the SA/IH authorized payment based on needs, new address & any changes (via Appendix E Supp 2)

  • DSS of Medicaid origin will change case from SA (adult care home) to SA/IH once the consumer has moved into supported housing.

  • The DSS processes the Medicaid and SA/IH eligibility and communicates with the beneficiary and authorized representatives.

  • DSS where consumer lives provides ongoing responsibility for case changes and ongoing eligibility

Division of Aging and Adult Services Feb 2014


Diversion process and responsibilities of the lme mco and dss of medicaid origin

Diversion Process and Responsibilities of the LME/MCO and DSS of Medicaid Origin

  • Obtain a signed release of information

  • Appendix E Supplement 2 is used for communication between the LME/MCO and DSS

  • Contact the DSS in the county of Medicaid origin. Check “Request SA/IH Eligibility Box”.

Division of Aging and Adult Services Feb 2014


Diversion process and responsibilities of the lme mco and dss of medicaid origin1

Diversion Process and Responsibilities of the LME/MCO and DSS of Medicaid Origin

  • An application for SA/IH must be made at the Medicaid county of origin, or last private living county.

  • If LME/MCO applies on behalf of consumer, need statement from the consumer authorizing this along with a release of information.

  • A current, valid FL-2 is required. The FL-2 must be dated within 90 calendar days prior to the date of the SA/IH application.

Division of Aging and Adult Services Feb 2014


Diversion and responsibilities of the dss and medicaid origin

Diversion and Responsibilities of the DSS and Medicaid Origin

  • DSS determines SA/IH financial eligibility and Medicaid eligibility (if not already Medicaid eligible)

  • Once eligibility for Medicaid is established, DSS determines maximum potential SA/IH payment.

  • Communicates with the LME/MCO (Appendix E Supplement 1) of the presumptive SA/IH eligibility and potential maximum SA/IH payment.

  • LME/MCO conducts Economic Assessment based on presumptive eligibility.

Division of Aging and Adult Services Feb 2014


Diversion and responsibilities of the dss and medicaid origin1

Diversion and Responsibilities of the DSS and Medicaid Origin

  • LME/MCO notifies DSS of the SA/IH authorized payment based on needs, new address & any changes (via Appendix E Supp 2)

  • DSS provides final eligibility determination once consumer moves into housing and final payment recommendation received from LME/MCO.

  • Approves case if eligible and notifies county DSS Supervisor if consumer has moved to another county.

  • Provides ongoing responsibility for case changes and continued eligibility.

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet

Completing the Economic Assessment Worksheet

  • Identifies sources of income

  • Indicates how income is being used

  • Reveals a surplus or deficit

  • Identifies unmet health & safety needs

  • Provides documentation of SA/IH payment amount and its uses

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet basic principles

Completing the Economic Assessment Worksheet - Basic Principles

  • The SA/IH payment benefit is to be used for those health, safety, and basic needs that will allow an individual to remain safely in his/her home as opposed to residing in a residential care facility.

  • Prior to allocating the SA/IH funds for a particular service or need all other available resources should be accessed to meet the consumer’s health and safety needs. This includes the $2,000 transition funds available to each consumer. The SA/IH is a last resort source of payment.

Division of Aging and Adult Services Feb 2014


Priority of sa ih payment

Priority of SA/IH Payment

  • The first priority for the SA/IH payment is to address those needs that will ensure that the consumer’s health and safety needs are met.

  • Efforts should be made to link the consumer to community resources that the adult is eligible to receive but may not be knowledgeable about

  • The SA/IH payment should not be used to replace or duplicate services and resources already available to the consumer.

Division of Aging and Adult Services Feb 2014


Uses of the sa ih payment

Uses of the SA/IH Payment

  • The SA/IH Payment should be used to help the consumer remain in the community by using SA/IH funds on the following:

    • Health/Medical

    • Safety

    • Basic Needs

Division of Aging and Adult Services Feb 2014


Uses of the sa ih payment medical health

Uses of the SA/IH Payment (Medical/Health)

  • Medications, including OTC recommended by the physician

  • Co-payments for prescriptions and physician visits

  • Nutritional Supplements

  • Incontinence supplies

  • Durable medical equipment

  • In Home Aide Services

Division of Aging and Adult Services Feb 2014


Uses of the sa ih payment basic needs

Uses of the SA/IH Payment (Basic Needs)

  • Rent

  • Utilities

  • Food - ensure that consumer has applied for Food and Nutrition Services (FNS)

  • Essential clothing – gained/lost weight, weather appropriate etc.

  • Cleaning supplies

  • Personal care items

  • Pre-need burial

  • Other basic needs that may come up after the $2,000 transition funds have been expended.

Division of Aging and Adult Services Feb 2014


Uses of the saih payment basic needs

Uses of the SAIH Payment (Basic Needs)

  • Personal care items

  • Pre-Need burial

Division of Aging and Adult Services Feb 2014


Prohibited uses of the sa ih payment

Prohibited Uses of the SA/IH Payment

  • Automobiles

  • Cigarettes/Alcohol

  • Entertainment (cable, movies, etc.)

  • Purchases for others/gifts

  • “Spending Money”

Division of Aging and Adult Services Feb 2014


Uses of the sa ih payment1

Uses of the SA/IH Payment

All items/services purchased with SA/IH funds must be clearly related to maintaining health, safety and basic needs and should be documented in the consumer’s record. Questions about the appropriate use of the SA/IH payment should be directed to Chris Urso, SA Program Manager at NC DAAS or Suzanne Merrill, Adult Services Section Chief, at NC DAAS (contact information provided at the end of the webinar).

Division of Aging and Adult Services Feb 2014


Uses of the sa ih payment2

Uses of the SA/IH Payment

  • If it is discovered that SA/IH payments have been authorized for prohibited items or services, the LME/MCO has 30 days to notify the consumer and make adjustments to the SA/IH payment and notify the DSS SA caseworker.

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet basic principles1

Completing the Economic Assessment Worksheet - Basic Principles

  • Explore regular monthly expenses and expenditures. Determine expenses that are essential to health, safety and basic needs.

  • Do not arbitrarily divide monthly household bills by the number of adults living in the household.

  • Explore unusual expenses reported by the consumer. Verify if necessary.

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet1

Completing the Economic Assessment Worksheet

Income

Social Security, SSI, VA, Dividend/Interest payments, Pensions, Railroad Retirement, Wages, Rental Income, Business Income, Child Support, General Assistance (DSS), On-going Cash from Others

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet2

Completing the Economic Assessment Worksheet

Other Benefits

  • Rental Assistance (including TBRA)

  • Food and Nutrition Services

  • Energy Assistance (Seasonal)

  • In-Kind Support

Division of Aging and Adult Services Feb 2014


Completing the economic assessment worksheet3

Completing the Economic Assessment Worksheet

Resources

Assess the availability of any resources that can be converted to cash that might be available to meet the consumer’s needs

Division of Aging and Adult Services Feb 2014


The economic assessment worksheet

The Economic Assessment Worksheet

Essential Expenses

  • Rent

  • Basic Utilities (heating, cooling, electric)

  • Food (consider if consumer has Food and Nutrition Services)

  • Clothing

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet

Economic Assessment Worksheet

Essential Expenses

  • Laundry

  • Medical bills/prescriptions and co-pays

  • Essential insurance premiums (pro-rate)

  • Transportation costs related to health, safety, and basic needs

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet1

Economic Assessment Worksheet

Non-Essential Expenses

Document other expenses reported by the consumer. These expenses will not be used to determine total expenses when calculating the SA/IH payment need. Review of these items is necessary to help the consumer determine where his/her income is used and to help him/her make choices about his/her primary health and safety needs.

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet2

Economic Assessment Worksheet

Unmet Financial Need

May include unmet needs or expenses that are not accounted for in the monthly expenses. This would include one-time purchases or a new service that the consumer has not had access to, but is an essential need. An example of this might be a cooking class if consumer has never lived independently and has not learned to cook.

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet3

Economic Assessment Worksheet

Personal Needs Allowance (PNA)

NEW PROVISION

The consumer is allowed a $66.00 per month Personal Needs Allowance (PNA). This amount is disregarded when calculating the consumer’s income and can be used by the consumer for those items not considered essential expenses. The $66.00 is based on the current Special Assistance PNA for individuals residing in a licensed residential care facility.

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet4

Economic Assessment Worksheet

Medical Coverage

Document all Medical Insurance coverage and any costs to consumer. Include in essential expenses as appropriate.

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet5

Economic Assessment Worksheet

  • Review consumer’s ability to mange finances

  • Explore problems/irregularities

  • Other resources available to consumer

  • Unmet Needs

    Document on Items D-I on Pages 3 and 4 of the Economic Assessment Worksheet

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Transitions to community living

Division of Aging and Adult Services Feb 2014


Computation of the sa ih payment

Computation of the SA/IH Payment

  • Total Monthly Available Income including other Resources or Benefits

    2. Total Monthly Essential Expenses (include personal needs expenses that should be covered with the personal needs allowance)

    3. Total Monthly Deficit or Surplus

    4. SA/IH Maximum Payment Amount (determined by DSS income maintenance caseworker)

Division of Aging and Adult Services Feb 2014


Computation of the sa ih payment1

Computation of the SA/IH Payment

5. Compare total in #3 to Maximum Payment Amount in #4. If #3 is deficit, can recommended deficit amount be covered in maximum payment amount? Y N

6. If there are alowable unmet financial needs that must be included in the monthly payment amount, enter amount.

7. Recommended SA/IH Payment Amount

Division of Aging and Adult Services Feb 2014


Economic assessment worksheet6

Economic Assessment Worksheet

Special Assistance In-Home Spending Plan (p. 5)

NEW REQUIREMENT

  • Document Maximum Payment Amount

  • Document Authorized Payment Amount

  • List all items/amounts for use of the SA/IH payment

  • Consumer signs to indicate agreement with spending plan and acknowledgement that failure to do so could result in reduction or termination of payment

  • Document any change to payment

Division of Aging and Adult Services Feb 2014


Communication of the sa ih payment amount

Communication of the SA/IH Payment Amount

  • Once the Economic Assessment Worksheet is completed LME/MCO In-Reach/Transition will communicate to the DSS SA worker the amount of the SA/IH payment. This communication should take place on Appendix E, Supplement 2.

Division of Aging and Adult Services Feb 2014


On going support oversight

On-going Support & Oversight

  • The SA/IH payment is paid directly to the consumer unless the consumer is unable to handle his/her own finances or already has a substitute payee.

  • In instances where there is a need for a substitute payee at the time the consumer transitions to his/her new housing, LME/MCO In-Reach/Transition is responsible for requesting the payee arrangement prior to the consumer’s move.

  • No receipts are required to be kept by the consumer unless misuse of SA/IH funds is suspected by the Tenancy Support Worker

Division of Aging and Adult Services Feb 2014


On going support oversight1

On-going Support & Oversight

  • Regularly review (at least monthly) the SA/IH payment plan with the consumer

  • Communicate to the consumer how the SA/IH payment is to be used

  • Monitor to assure that the SA/IH payment is being used appropriately

  • For large projects or items estimates should be obtained

  • Link consumer to available services in the community

Division of Aging and Adult Services Feb 2014


On going support oversight2

On-Going Support & Oversight

  • Regularly discuss with the consumer progress in meeting goals

  • Continue to assess and document how the SA/IH program is helping the consumer remain safely in the community

  • Ask for receipts when necessary if there is concern regarding how the SA/IH payment is being spent

Division of Aging and Adult Services Feb 2014


Annual reassessment sa ih eligibility redetermination

Annual Reassessment & SA/IH Eligibility Redetermination

Tenancy Support Worker will assist the consumer to obtain necessary information for the SA/IH payment eligibility redetermination

The Tenancy Support Worker conducts an annual reassessment of the consumer using the DHHS Economic Worksheet and documents the consumer’s continued need for the SA/IH payment and his/her ability to remain safely in the community

Division of Aging and Adult Services Feb 2014


Annual reassessment sa ih eligibility redetermination1

Annual Reassessment & SA/IH Eligibility Redetermination

  • Tenancy Support Worker should add, change, or delete supports according to the consumer’s current condition and situation

  • Tenancy Support Worker can request an increase or decrease in the SA/IH payment, not to exceed the maximum allowable amount established by the DSS SA worker and based upon the consumer’s needs

  • The change request must be submitted to the DSS SA worker

  • Tenancy Support Worker will continue monitoring payments and supports

Division of Aging and Adult Services Feb 2014


Changes in consumer s needs

Changes in Consumer’s Needs

Tenancy Support Worker must report changes in circumstances to the DSS SA worker immediately or at least within 5 days

After a hospital or Nursing Home stay the consumer’s needs may have changed. - Make sure that the FL-2 is still appropriate for SA/IH. If not, SA/IH must be terminated; If still appropriate, make any changes to the SA/IH payment as needed

SA/IH payment must be terminated when an absence is over 30 days

SA/IH payments may increase or decrease based on the needs of the consumer

Division of Aging and Adult Services Feb 2014


Changes in consumer s needs1

Changes in Consumer’s Needs

  • The Tenancy Support Worker must notify the DSS SA worker if the consumer is incarcerated

  • If it is determined that the consumer has been incarcerated, the termination process for SA/IH should begin

Division of Aging and Adult Services Feb 2014


Denials and terminations

Denials and Terminations

Financially ineligible/not eligible for Medicaid

No Need for SA/IH payment

Failure to meet programmatic qualifications:

Death

Absence from the homeof over 30 days

Move out of state

Consumer voluntarily withdraws

Consumer’s safety, health and well-being cannot be maintained in the community

Incarceration

Division of Aging and Adult Services Feb 2014


Required sa ih reporting

Required SA/IH Reporting

  • SA/IH Quarterly Expenditure Reporting Tool (Payment Tracking Form) should be used to record the SA/IH payment amounts and the services or items purchased with the SA/IH funds.

  • This SA/IH Quarterly Expenditure Reporting Tool (Payment Tracking Form) is to be completed for each consumer participating in SA/IH on a quarterly basis and Email to DAAS staff who is [email protected]

Division of Aging and Adult Services Feb 2014


Sa ih payment tracking excel workbook

SA/IH Payment Tracking Excel Workbook

  • Due to DAAS every quarter by the last workday of the month following the reporting quarter

  • Example: 2nd quarter for 2014 ends June 29th. The Payment Tracking Report is due to be emailed to DAAS by July 31st

Division of Aging and Adult Services Feb 2014


Resources

Resources

  • Resources for the SA/IH Program can be found at: http://www.ncdhhs.gov/mhddsas/providers/dojsettlement/index.htm

Division of Aging and Adult Services Feb 2014


Contacts

Contacts

  • Resolving concerns when working with the DSS:

    • Contact the DSS SA Supervisor or Program Manager

    • If unable to resolve contact the DSS Director

    • If all efforts to resolve locally are exhausted, contact DAAS as follows:

    • Suzanne Merrill, Adult Services Section Chief,

      919-855-3460, [email protected] or Chris Urso, SA Program Manager, 919-855-3461 at [email protected]

Division of Aging and Adult Services Feb 2014


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