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Good cause for a delay in processing the application exists when we acted as promptly as possible but: The delay was the result of an emergency beyond our control; The delay was the result of needing more information or documents that could not be readily obtained; You did not give us the information within the time frame specified in subsection (1) of this section. Note: Servicescan't be backdated prior to the date of the authorization until the date that financial eligibility is established. Client relocates out of the service delivery area. $[53j(,U+/6-FBR[lvn! }k}HG4"jhznn'XwB$\HODuDX7o u'8>@)OLA@"yoTP8nd lAO Clearly indicate this is a projection and the financial application is in process. Help Stop Medi-Cal Fraud and Abuse Por favor, responda a esta breve encuesta. Explain how to request an extension if more time is needed. Denos su opinin sobre sus experiencias con las instalaciones, el personal, la comunicacin y los servicios del DSHS. 3602 Pacific Ave., Suite 200 . The determination of Fast Track is ultimately up to social services. Provide PBSstaff with the following information: Whether the client meets nursing facility level of care (NFLOC). | Health Care Services: Clients should be assisted in accessing health insurance or Marketplace plans to assist with engagement in the health care system and HIV Continuum of Care, including medication payment plans or programs. The authorization can't be backdated for HCB waiver, CFC, or MPC unless socialservices has fast-tracked services and the client is subsequently found financially eligible. | When applicable, an employee of the agency has experienced a real or perceived threat to his/her safety during a visit to a client's home, in the company of an escort or not. N _rels/.rels ( j0@QN/c[ILj]aGzsFu]U ^[x 1xpf#I)Y*Di")c$qU~31jH[{=E~ This is used for any cash, food or medical care services (MCS) request as MCS is tied to ABD cash/HEN eligibility, HCA 14-194 Medical coverage information (used to report third party insurance coverage including LTC insurance), DSHS14-539 Revocable burial fund provision for SSI-related health care, DSHS 14-540 Irrevocable burial fund provision for SSI-related health care, DSHS 14-454 Estate recovery fact sheet. Use the original eligibility review date to open institutional coverage. Did you receive verification of resources with the application? Ask about any transfers, gifts, or property sales during the 5-year look back and the circumstances of why they were made. Massachusetts Department of Public Health Bureau of Infectious Disease Office of HIV/AIDS Standards of Care for HIV/AIDS Services 2009, San Francisco EMA Home-Based Home Health Care Standards of Care February 2004, Texas Administrative Code, Title 40, Part 1, Chapter 97, Subchapter B, Rule 97.211. Need Mental Health Services? Please reference the HRSA Program Guidance above. MAGI covers NF and Hospice under the scope of care. N _rels/.rels ( j0@QN/c[ILj]aGzsFu]U ^[x 1xpf#I)Y*Di")c$qU~31jH[{=E~ Home and Community Services Division PO Box 45600, Olympia, WA 98504-5600 H 20 0 53 Information June 9 , 2020 TO: Area Agency on Aging (AAA) Directors Home and Community Services (HCS) Division Regional Administrators FROM: Bea Rector, Director, Home and Community Services Division SUBJECT: | L2 Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services. Eligible clients are referred to additional support services (outside of a medical, MCM, NMCM appointment), as applicable to the clients needs, with education provided to the client on how to access these services. Ensure AVS procedures are followed. You must apply directly with the service provider for the following programs: The breast and cervical cancer treatment program under WAC, For the confidential pregnant minor program under WAC. HCA 18-003 Rights and responsibilities (translations can be found at Health Care Authority (HCA) forms under 14-113), HCA 18-005 Washington Apple Health application for aged, blind, disabled/long-term care coverage, HCA 18-008 Washington Apple Health application for tailored supports for older adults (TSOA), DSHS14-001 Application for cash or food assistance. Percentage of clients who are no longer in need of assistance through Referral for Health Care and Support Services that have a documented case closure summary in the primary client record. What resources is the client reporting on the application or past applications? Percentage of clients accessingHome and Community-Based Health Services have follow up documentation to the referral offered in the clients primary record. The HCS case manager coordinates andconsults withthe PBS to see if Fast Track is appropriate. For apple health programs for children, pregnant people, parents and caretaker relatives, and adults age sixty-four and under without medicare, (including people who have a disability or are blind), you may apply: Online via the Washington Healthplanfinder at. Appendix 2 to Attachment 4.19-A. Referrals for health care and support services provided by outpatient/ambulatory health care professionals should be reported under Outpatient/Ambulatory Health Services (OAHS) category. Percentage of clients with documented evidence of referrals provided for HIA assistance that had follow-up documentation within 10 business days of the referral in the primary client record. Jun 2014 - Mar 201510 months. Are you enrolled in Medi-Cal? To complete an application for apple health, you must also give us all of the other information requested on the application. Percentage of clients with documented evidence of education provided on other public and/or private benefit programs in the primary client record. | We reconsider our decision to deny your apple healthcoverage without a new application from you when: We receive the information that we need to decide if you are eligible within thirty days of the date on the denial notice; You give us authorization to verify your assets as described in WAC 182-503-0055 within thirty days of the date on the denial notice; You request a hearing within ninety days of the date on the denial letter and an administrative law judge (ALJ) or HCA review judge decides our denial was wrong (per chapter. For medicaid recipients, institutional services are approved based on the first date the admission is known to DSHS as long as the client meets all other eligibility factors. Percentage of clients with documented evidence of agency refusal of services with detail on refusal in the clients primary record AND if applicable, documented evidence that a referral is provided for another home or community-based health agency. Ask about other medical coverage. f?3-]T2j),l0/%b Assessment of client's access to primary care, Need for nursing, caregiver, or rehabilitation services. DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. Please take this short survey. | Functional eligibility for DDA is determined prior to the submission of a financial application. Asset verification, if not already authorized on the application by the client and financially responsible people (if applicable), may be authorized during the interview process. Provider Fraud and Elder Abuse complaint line: State Plan Amendments. Community Health Worker, Crisis Counselor. Stick to the facts relevant to determining eligibility or benefit level. Percentage of clients with documented evidence of care plans reviewed and/or updated as necessary based on changes in the clients situation at least every sixty (60) calendar days as evidenced in the clients primary record. In-home or residential services, call 800-780-7094 or 425-977-6579, FAX 425-339-4859, Nursing home services, call 800-780-7094, FAX 206-373-6855, In-home or residential services, call 206-341-7750, FAX 206-373-6855. For information regarding prior fiscal year files, please contact the DSH unit at, Last modified date: Percentage of eligible clients with documented evidence of the follow-up and result(s) to a completed benefit application in the primary client record. !H!/tG|B^%=z+]F!lExBa0$ Funds cannot be used to duplicate referral services provided through other service categories. Aging and Disability Resources Office | Careers Progress notes will be kept in the client's primary record and must be written the day services are rendered. Percentage of clients with documented evidence of referrals provided to any support services that had follow-up documentation within 10 business days of the referral in the primary client record. Accessed on October 12, 2020. Good cause for a delay in processing the application does NOT exist when: Failing to ask you for information timely; or, Failing to act promptly on requested information when you provided it timely; or. Client transfers services to another service program. As the primary applicant or head of household, you may start an application for apple health by providing your: Physical address, and mailing addresses (if different). TK6_ PK ! Applications for LTSS may be submitted using any of the following methods: Mailing or faxing documents to Home and Community Services (HCS), Mail to: If the NF admission is on a weekend or holiday, the NF has until the first business day to report the admission. Social services will state fund Fast Track services when the client isn't financially eligible during the fast track period. How do I notify SEBB that my loved one has passed away? A good cause code must be used when finalizing any medical(AU) historically beyond 45 days. The interview can be conducted in person or by phone. d{ word/_rels/document.xml.rels ( VMo W87GJmziRokm:Kbi6P{3c33{Jp^MQKT %*|`3i4PwA'NX_D)BW<6t|XC{9qS4Yr-6M#jlHv$d@. V&ca\H>le?S9As<1CRYN]drRI/0!b Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel coronavirus (COVID-19). Services cannot be provided in the following facilities: inpatient hospital facilities, nursing homes, and other long term care facilities. L@5f)a>%X5.auU!1qV!h%SAg,U--`8F ydjz 8 'gF$v5q~~ enLr38uX*#XH)'#+Uabj8 ,]-r8| HuS.q"1,4>5H0 v!Nya" &~'iOJZG8eCvvJj(FMuT_j4f18#/SiO*i )nJE3 UXO+!h(G;:iYB0^,-x;p =8rkOS%Paa"gb-wSc%@/-|FJxD:`Au$yLt'2xi? \{#+zQh=JD ld$Y39?>}'C#_4$ The agency has attempted to complete an initial assessment and the referred client has been away from home on three occasions. Determine the client's financial eligibility for LTSSand noninstitutional medical assistance including 3 months retroactive medical coverage if financially eligible. Is the client single or married, and which resource standard is being used to make a recommendation. Explain the medical service card, automatic Medicare D enrollment if not on a creditable coverage or Medicare D Prescription Drug Plan. APPPLICANT'S NAME: LAST, FIRST, MI 2. Ensure an Asset Verification System (AVS) Authorization is on file, and if not, follow these procedures. If the applicant is eligible for an MSP based on income and resource guidelines and all information is received to determine eligibility for MSP, don't hold up processing this program while the LTSS medical is pending. adult daycare center) in accordance with a written, individualized plan of care established by a licensed physician. For calculating time limits, "day one" is the day we get an application from you that includes at least the information described in WAC. z, /|f\Z?6!Y_o]A PK ! Document in ACES remarks, in detail, all eligibility factors discussed during the interview and included on the application. Home and Community-Based Health Services Standards print version. Case Closure Summary: Clients who are no longer in need of assistance through Referral for Health Care and Support Services must have their cases closed with a case closure summary narrative documented in the client primary record. Ensure that service for clients will be provided in cooperation and in collaboration with other agency services and other community HIV service providers to avoid duplication of efforts and encouraging client access to integrated health care. Details of how eligibility factor(s) were verified. A request for service may not generate a referral. The Office of Community and Homeless Services (OCHS), the Office of Housing and Community Development (OHCD) and the Office of Weatherization and Energy Assistance (OWEA) operate within the Housing and Community Services Division (HCS) of the Snohomish County Human Services Department. Conduct prevention activities as outlined in the DSHS . The modified adjusted gross income (MAGI)-based apple healthapplication process using Washington Healthplanfinder may provide faster or real-time determination of eligibility for medicaid. (PDF) Accessed October 12, 2020. DSH Replacement State Plan Amendment 16-010. If they can't be reached, or are unavailable, send an appointment letter (DSHS 0011-01) and a request for verification letter for what is needed to determine eligibility, based only on what was declared on the application. The Aging and Disability Resources Program offers a wide range of community-based services that allow older adults and adults with disabilities to remain at home as long as possible. Name Unit Division Phone *Medicaid Helpline: Medicaid: HCS: 1-800-562-3022: Abbott, Amy: Director's Office, RCS: RCS: 360.725.2401: Acoba, Curtis: OT - IT Security Social Service Intake and Referral form (DSHS Form #10-570) The form is available here on the intranet: https://www.dshs.wa.gov/fsa/forms The form is available here on the internet for the public. The LTSSstartdate is the date the client is both financially and functionally eligible. SSI recipients who need institutional services, or HCB waiver, must complete and sign an application, or the. catholic community services hen program. Health care services: Clients should be provided assistance in accessing health insurance or Marketplace health insurance plans to assist with engagement in the health care system and HIV Continuum of Care, including medication payment plans or programs. IHSS Service Desk for Providers & Recipients, (866) 376-7066, Suspect Fraud? Explain what changes of circumstances need to be reported. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). HRSA/HAB Division of Metropolitan HIV/AIDS Programs Program Monitoring Standards Part A April 2013, p. 14-16. The following Standards and Measures are guides to improving health outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program. Olympia WA 98504-5826; or If you reside in one of the following counties: Adams, Asotin, Chelan, Colombia, Douglas, Ferry, Franklin, Garfield, Grant, Kittitas, Klickitat, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens, Walla Walla, Whitman, or Yakima509-568-3767 or 866-323-9409,FAX 509-568-3772. | Percentage of clients with documented evidence of referrals provided to any core services that had follow-up documentation within 10 business days of the referral in the primary client record. Por favor, responda a esta breve encuesta. Medicaid eligibility begins, the first day of the month the client is eligible for LTSS. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility. APPLICANT'S HOME ADDRESSCITYSTATEZIP CODE 6. Posted wage ranges represent the entire range from minimum to maximum. IHSS Timesheet Issues/Questions: Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services. The LTSS authorization date, which is described in WAC, If there is a transfer penalty as described in WAC. Training and social services development, delivery and evaluations; budget setting; and relationship cultivation. Welcome to CareWarePlease select your portal type. Summarize what verification is needed to complete the application and send a request for information letter. Day one is the date the application was received. Always include the client's full name and the DSHS client id (if known) on any document mailed or faxed to DSHS. Type of client interaction (phone, in-person, etc.). | If the 13-746 is not received timely, count back 5 businessdays from the date of receipt to determine the authorization date. If you are experiencing a mental health crisis and need immediate assistance, please call "911" and explain the nature of your problem to the operator. BIRTH DATE 4. 6. TK6_ PK ! Dont open a case in ACES until you have everything needed to establish financial eligibility. For HCS clients, both functional and financial eligibility are determined concurrently. | Please report broken links or content problems. Demonstrate the reasonableness of decisions. The PBS should reviewthe original application to ensure there are no changes and proceed to determine eligibility. f?3-]T2j),l0/%b Whether there is a housing maintenance allowance and the start date, if appropriate. Repaying the state for medical and long-term services and supports, DSHS 14-501 Community resource declaration (used to evaluate resources (assets) for an applicant and their spouse based on date of institutionalization. The Home and Community-based Services program provides individualized services and supports to persons with intellectual disabilities who are living with their family, in their own home or in other community settings, such as small group homes.